Should physicians routinely inquire about guns? No: this inquiry is an invasion of privacy.

Abstract

This sort of inquiry, on a routine basis, is not part of science or medicine but the overt promotion of a political agenda on the part of physicians who wittingly or unwittingly are functioning as agents of the state rather than as advocates for their patients.1 Physicians participating in this political campaign will be breaching medical ethics and committing boundary violations by using their authority to violate their patients' privacy and advance a political agenda. As Timothy Wheeler explained,2 A patient who seeks medical or psychiatric treatment is often in a uniquely dependent, anxious, vulnerable, and exploitable state. In seeking help, patients assume positions of relative powerlessness in which they expose their dignity, and reveal intimacies of body or mind, or both. Thus compromised, the patient relies heavily on the physician to act only in the patient's interest and not the physician's. From time immemorial, patient privacy has been an ethical concept that, up until now, was fundamental to the patient-doctor relationship. With the problems we have seen in terms of preserving the confidentiality of medical records in the electronic age, asking about guns will be received by patients with great concern and trepidation. Patients may ultimately become reluctant to seek medical care and to talk candidly with their physicians; this reluctance, in turn, may be detrimental to their physical and mental health. The other side, I'm sure, will respond by reciting a litany of gun-violence statistics, including accidental, tragic shootings of children; yet, supporters of gun control refuse to acknowledge effective gun-safety programs such as the National Rifle Association's Eddie Eagle, which simply instructs children, “If you see a gun: Stop! Don't touch. Leave the area. Tell an adult.” As a result of such programs, since 1930, the annual number of fatal firearm accidents has declined by more than half, even though there are twice as many people and 4 times as many firearms today.3 The number of gun crimes has also fallen, despite an increase in gun ownership. Gun availability does not cause crime—criminal minds do! And what about risk management? Are physicians going to also inquire about the storage of household cleaning agents, or matches, and about swimming pools? If not, why not? More youngsters die annually of poisoning, fires, and drowning than of firearm injuries. According to the ethics of Hippocrates, ethics that have served the medical profession well for 2,500 years, physicians must place the interest of their individual patients above that of the collective, whether it is the state, “the greater good of society,” or any political campaign hatched by their professional organizations. This campaign is gun control politics at work, promulgated by organized medicine to score public relation points at the expense of their patients' privacy. It is a low point for the medical profession in general and medical ethics in particular.4 Physicians should have learned the lessons from medical history. In Medical Science Under Dictatorship, Leo Alexander, the chief US medical consultant at the Nuremberg War Crimes Trials, examined “the process by which the German medical profession became a willing and unquestioning collaborator with the Nazis.” Medicine, more than any other profession, was heavily represented in the Nazi Party, which German physicians joined in droves. The first step taken by German doctors was to collect data on their patients and then release it to the state. “Corrosion,” Alexander wrote, “begins in microscopic proportions.” From small beginnings, the values of an entire society may be subverted, leading to the horrors of a police state.5 Have organized medicine and rank-and-file physicians learned the lessons of history? To our peril, apparently not!