Should doctors counsel patients about guns in the home?

Robert K. Musil, Ph.D., M.P.H. Executive Director and CEO, Physicians for Social Responsibility     YES   Physicians have the obligation to warn a patient that a gun in the home will increase the risk of firearm-related injury or death-unintentional or otherwise, homicide or suicide-to a member of his or her family.   Suicide by nature is impetuous and often a cry for help. Unfortunately, firearms are so lethal that when a gun is used in a suicide attempt, death or severe injury is the end result and that cry is never heard. Self-inflicted firearm deaths now account for more than 17,000 deaths annually and represent the majority of gun-related fatalities in the U.S.   Most homicides stem from an argument between people who know each other and are often related. Of all firearm homicides in 1998, only 30% of victims were killed by strangers.   Access to a firearm also increases the risk of unintentional gun-related death and injury to children. Parents may have unrealistic perceptions about their child’s ability to find and fire a gun, to distinguish between a real gun and a toy, and to consistently follow rules about gun safety. Nearly all childhood unintentional shooting deaths occur in or around the home.   These statistics alone should be a solid argument for health professionals to engage in clinical counseling about the risks of keeping a gun in the home. Our duty to protect public health requires that we tell parents to keep their children in car seats, to store medicine out of reach, and to enforce a dozen other safety requirements.   Due to the power and lethality of firearms, physicians have a specific role in gun-violence prevention. This role includes speaking one-on-one with patients about the dangers of firearms.

John R. Lott Jr., Ph.D. Senior Research Scholar, Yale University Law School; Author, More Guns, Less Crime (University of Chicago Press, 2000)   NO   Asking patients about guns not only strains doctor-patient relations, it exaggerates the dangers and risks lives.   Accidental gun deaths do claim some children’s lives, but the number is much smaller than most people think. While rarely reported, people use guns defensively about two million times a year, five times the rate guns are used to commit crime.   In the U.S. during 1998 the CDC identified only 53 accidental gun deaths involving a child under age 10 and six involved handguns. By comparison, bathtub drownings account for 80 deaths annually among kids under age 5.   Yet, with over 85 million adults owning at least one gun, the overwhelming majority of gun owners must be extremely careful or such gun accidents would be much more frequent.   Most people incorrectly think that accidental gun-related deaths involve kids shooting other kids. In fact, shooters are overwhelmingly adult males with alcoholism and violent criminal histories.   Trigger locks will not stop adults from accidentally firing their own guns, and the risk of accidental shootings in law-abiding households is essentially zero. Studies have overwhelmingly found that safe storage and gun-lock laws do not reduce accidental deaths or suicides.   Locked unloaded guns are not readily accessible for defensive use. States requiring people to lock their guns have a higher rate of experienced criminals attacking people in their homes. The Department of Justice’s National Crime Victimization Survey shows that possessing a gun is the safest course of action when confronted by a criminal. For example, women who behave passively are 2.5 times more likely to be seriously injured than women who have a gun.