Tag Archives: doctor-patient relationships

Time to Shoot Down the NRA

The NRA reveres the Second Amendment (well, their version, at least). The First, not so much.

In the wake of daily reports of gun violence–the most recent of which include the massacres in Orlando and Dallas, and the murder of two bailiffs in a Michigan courtroom and none of which were prevented by a “good guy with a gun”–it may be appropriate to look at the extent to which the organization has stymied even reasonable legislative efforts to understand the dimensions of the problem.

Thanks to the NRA, Congress has steadfastly refused to fund research that might help us understand how we might tackle gun injuries and improve public safety. But the NRA isn’t active only at the federal level, and it isn’t just worried about research.

As I learned from Mort Tavel’s blog,

As a physician, I had always prided myself on being free to advise patients about all health issues, including risks that could endanger their personal well-being and that of their families and loved ones. This meant that I could inquire not only about immediate risks such as smoking and diet, but, among others, about whether a patient was using his/her seat belt when driving, or exposing family members to the toxic effects of secondary cigarette smoke in the home. I was also free to inquire whether a given patient had a firearm at home, because of the potential dangers involved. In that regard, evidence shows that the presence of a gun in a home increases by threefold the risk of death for all household members, especially by suicide, when compared with homes free of guns. Even worse, this risk rises to fivefold greater for children residing in homes possessing firearms. Thus these dangers are so great that it is incumbent on physicians to counsel patients about risks of home firearms and to recommend countermeasures, which include use of safety devices and meticulous storage of weapons, or better yet, total removal of guns from the household. This is so important that all major physicians’ organizations, including the AMA, have recommended that physicians discuss firearm safety with their patients.

So can such responsibilities be forbidden? Outrageously, Florida’s Firearm Owners’ Privacy Act was enacted in 2011 in response to concerns raised by some patients whose physicians asked them about gun ownership. The law prohibits physicians from intentionally entering information into a patient’s record about firearm ownership that “is not relevant to the patient’s medical care or safety, or the safety of others.” Thus physicians may not ask about firearm ownership unless they believe “in good faith” that “such information is relevant to the patient’s medical care or safety, or the safety of others.” Physicians who violate this law may be “disciplined” (whatever that means).

A physicians’ group sued Florida, on the very reasonable grounds that the law violates doctors’ First Amendment free speech rights. However, a 3-judge panel of the Florida Court of Appeals upheld the Act, on the dubious grounds “that physician counseling may be so persuasive as to deter patients from exercising their Second Amendment right to own guns.”

To say that such a decision is bizarre and totally inconsistent with First Amendment jurisprudence is an understatement.

Worse, last year, the Eleventh Circuit Court of Appeals upheld the decision.

This, the court acknowledges, is a restriction on doctors’ speech. But, the court concludes, when a professional (lawyer, doctor, financial planner, and the like) is directly advising a client — as opposed to, say, opining on law or medicine on a blog — that professional-client speech is more restrictable.

The Volokh Conspiracy is a legal blog maintained by Eugene Volokh, a conservative law professor who is a strong defender of both the First and Second Amendments. Volokh has serious concerns about the Eleventh Circuit’s reasoning.

This selective targeting of questions about guns — when other, likely quite common, questions about private matters aren’t restricted — suggests that this law isn’t really about protecting privacy as such. Rather, it’s about preventing doctors from spreading what many gun rights supporters see as unsound anti-gun propaganda.

The First Amendment forbids government suppression of speech based upon its content. This is a very troubling deviation from settled constitutional principles.

Missouri and Montana have laws similar to Florida’s; all supported by the NRA.

For far too long, elected officials at all levels–and evidently, a number of judges– have been in thrall to the NRA, an organization devoted to the bottom-line health of gun manufacturers, not fidelity to the Second Amendment or–quite clearly– any other part of the Constitution.

It needs to stop.