Physicians should counsel patients about firearms in their homes, according to medical and professional ethics, but they should be aware of state laws pertaining to firearm counseling, temporary transfer, and safe storage. However, patient counseling is particularly essential when there is potential harm involved.

In an article published in the AMA Journal of Ethics, Alexander D. McCourt, JD, MPH, and Jon S. Vernick, JD, MPH, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, argue that physicians should be prepared to offer appropriate guidance to patients, particularly when encountering a firearm owner at risk for self-harm or at risk of harming others.

There are, however, caveats that must be considered. Some states prohibit temporary firearm transfer, and others require physicians to report to authorities if an individual is at risk for self-harm or is a potential harm to others. Under New York’s SAFE Act, such reporting would allow the removal of the patient’s firearms. 

Although federal and state laws require background checks prior to certain firearm transfers, these laws pertain only to firearms purchased from licensed dealers. Many states allow private transfers without a background check. Conversely, 19 states and Washington, DC have universal background check laws that mandate a background check whenever a firearm is transferred.

With patients at risk for suicide, timely intervention is key. Performing background checks prior to a temporary transfer might increase the risk for suicide, which is often impulsive. In some states with universal background check laws, there are mechanisms to facilitate temporary transfers to family members for a limited time without a background check.

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Other states, however, do not have such mechanisms. In those cases, physicians might discuss safe firearm storage laws with a patient. Eighteen US states have child access prevention laws that require firearms to be stored so that children or adolescents cannot easily gain access to them. These laws have been associated with lower accidental deaths of children and adolescent suicides.

Some states have considered implementing laws that prohibit physicians from asking patients about firearms or gun ownership. However, only Florida has passed such a law, the Firearm Owners’ Privacy Act, which took effect in June 2011. The Eleventh Circuit Court of Appeals found that the restrictions of the act violated the First Amendment, and physicians can now feel confident that they will not be prosecuted for asking a patient about guns in the house.

Reference

McCourt AD, Vernick JS. Health Law. Law, ethics, and conversations between physicians and patients about firearms in the home.  AMA J Ethics. 2018;20:69-76.