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09/12/2014

It’s not primarily about the guns

A recent article in Dignitas and a recent post to this blog discuss gun violence as a public health issue. I don’t know if the broad category of gun violence properly falls under the heading of public health, but one aspect of it certainly does: accidental firearm injuries in the pediatric population. It is difficult to obtain reliable statistics to say how prevalent this problem is, since Congress has blocked the CDC from firearms-related research since the early 1990s; I have read estimates that put it anywhere between the ninth- and sixth-leading cause of accidental deaths among children aged 1-14.

As a family doctor, I see pediatric patients for well-child exams. At these exams I provide “preventive guidance.” I ask patients and their parents about various age-apropriate things that have been shown to affect the health and life of children, and provide guidance where indicated. I recommend things like smoke detectors, infant/booster seats or seat belts, bicycle helmets, and fences around swimming pools. I recommend against smoking, drug use, and keeping bleach and aspirin where young children can reach them. I make sure parents have the phone number for the poison control center. And if there are guns in the household, I recommend they store them in a way that their young children cannot accidentally access them.

In 2011 Florida passed the Firearms Owners’ Privacy Act. This act provides that a doctor “should refrain from” asking a patient about firearms, unless he believes “in good faith” that the “information is relevant to the patient’s medical care or safety, or the safety of others.” Penalties for the criminals who don’t “refrain from” asking about firearms include fines and the loss of one’s medical license. The district court wisely blocked the law in 2012. However, the state of Florida appealed, and this past July the 11th Circuit Court of Appeals reversed the lower court’s decision.

This situation falls into the arena of bioethics, not because it has anything to do with guns; not because it has anything to do with pitting one Constitutional right against another; but because it is an unreasonable and unwarranted intrusion into the physician-patient relationship. As the appeals court wrote in its opinion, the government does regulate the practice of medicine. But the government proscribing what a physician can talk about with her patients? This is a far different thing than the government proscribing, say, the sharing of private patient information or participating in kickback schemes.

At the heart of the profession of medicine is the patient-physician relationship. This relationship is built on the foundation of one person acting altruistically in the interests of another person. The relationship is perverted when it is forced to serve the political agenda of an outside interest group. The precedent set by this law is corrosive to the fiduciary nature of the relationship, and should be overturned — and if not overturned, then ignored by all physicians who value the profession.

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