Doctors and Guns Redux

[LogicMan]

There is no such thing as being too conspiratorial when it comes to the issue of gun rights. Constant vigilance is required.

Originally Posted by Loosedhorse

also the doctor's constitutional right to discuss this topic (and others) with patients. At least for now, according to the 11th Circuit: http://media.ca11.uscourts.gov/opini...14009.enbc.pdf

The argument that the patients' 2nd Amendment rights must blot out the doctors' First Amendment rights seems for now unpersuasive.

What right of free speech is involved in a doctor asking a patient about guns? That is a very private issue.

[Loosedhorse]

Originally Posted by LogicMan

What right of free speech is involved...

Discussed at length in the opinion I linked.

It is an odd question that you ask, LogicMan. The Florida Firearms Owners’ Privacy Act had three provisions limiting physicians' speech, and those provisions were all struck down on First Amendment grounds. Would one ask after the DC Circuit panel struck down DC's handgun ban on 2nd Amendment grounds in Parker v. DC, "What right of keeping and bearing arms is involved in a person buying a handgun?"

That is a very private issue.

Perhaps the "very private" nature of conversations between doctor and patient is one of the best reasons to keep government restrictions on speech out of that space. I don't think it can be argued that the First Amendment is designed to protect only public speech, and so allow the gov't to restrict "very private" speech.

[Aguila Blanca]

I don't think the 1st Amendment was intended to -- or should -- restrict a doctor's freedom to discuss any topic with a patient. That said, I remain of the opinion that a doctor who has not received extensive training in firearms safety is committing a boundary violation by presuming to enter into a field about which he or she is not knowledgeable.

There are many dangers around the home: poisons, toxic chemicals, throw rugs, bathtubs, loose or missing handrails, hand tools and electric tools, knives ... yet the AMA wants doctors to zero in on firearms. That's my clue that the concern isn't patient safety, the concern is an anti-gun political ideology.

When I was discharged to home after a heart operation, someone sent around an occupational therapist to review my living situation to be sure I wasn't in danger from things around the house while I was in a weakened condition. She went over the full list -- bathtubs, stairs, grab rails, stair handrails, loose rugs -- all the things that were likely to pose a risk of injury to someone who was weak and not fully mobile. Firearms weren't even mentioned.

Once you remove murder from the statistics, firearms are barely a blip on the radar. Here's an article listing the five most prevalent causes of accidental death in the U.S.:

http://listosaur.com/miscellaneous/t...united-states/

1. Motor vehicles -- 42,000
2. Poisoning -- 39,000
3. Falls -- 25,000
4. Fires -- 2,700
5. Choking -- 2,500

6. Drowning -- 2,000

By contrast, accidental deaths due to firearms came in at 600.

Draw your own conclusions.

[ShootistPRS]

The fourth and fifth amendments both restrict what anyone can ask you to divulge about personal matters and expect a response. I will gladly share my medical history with my doctor but they don't need a financial statement or my recreational activities to provide health care. If necessary they can ask me to restrict my activities to aid in recovery of injury but they don't get to know whether I shoot guns or fire my howitzer in my recreational hours.

[Frank Ettin]

Originally Posted by ShootistPRS

The fourth and fifth amendments both restrict what anyone can ask you to divulge about personal matters and expect a response. I will gladly share my medical history with my doctor but they don't need a financial statement or my recreational activities to provide health care.....

No, they most definitely do not.

First, the Constitution in general regulates only the conduct of the federal government, although certain rights protected by the Bill of Rights have been found (through application of the Due Process clause of the Fourteenth Amendment) by the courts in the last hundred or so years to also be protected against some regulation by states.

Second, both the Fourth and the Fifth Amendments are very specific as to the personal interests protected against governmental intrusion. The Fourth Amendment protects one against unreasonable searches and seizures of one's person or property under federal or state governmental authority. The Fifth Amendment protects one against being compelled to testify against himself in a criminal case (as well as protecting certain other rights, such as requiring a grand jury indictment to be prosecuted by the federal, but not a state, government).

It's important to understand what the Constitution does, as well as what it does not do.

[Loosedhorse]

Originally Posted by Aguila Blanca

I don't think the 1st Amendment was intended to -- or should -- restrict a doctor's freedom to discuss any topic with a patient.

Difficult statement to parse. No one has claimed that the 1st Amendment was intended to do that; just the opposite, the 11th Circuit has held it protects that freedom.

Originally Posted by Aguila Blanca

...is committing a boundary violation by presuming to enter into a field about which he or she is not knowledgeable.

That is not the definition of a "boundary violation." Please see post #73.

Originally Posted by Aguila Blanca

By contrast, accidental deaths due to firearms came in at 600.

And accidental injuries by firearm use number at 16,000 or more; and suicides and homicides by firearm use are well over 35,000. And...so what?

Again, please read the 11th Circuit's opinion. The court states that firearms safety discussions are well within the purview of medical care-givers. As it happens, the doctors have the same opinion. Your opinion that the court and the docs are wrong about that is, well, your opinion.

Originally Posted by ShootistPRS

The fourth and fifth amendments both restrict what anyone can ask you to divulge about personal matters and expect a response.

No.

They do limit the government's powers of inquiry: what its agents can ask you, under what circumstances they can ask you, and whether it can impose penalties on you for refusal to respond as a means of compelling your reply.

They do not limit what your doctor can ask you, just as they don't limit what you can ask him or her.

Originally Posted by ShootistPRS

they don't get to know whether I shoot guns or fire my howitzer in my recreational hours.

They do if they ask, as they are allowed to, and if you answer, as you are allowed to. Otherwise, correct: they don't get to know.
:-)

[ShootistPRS]

Our rights whether enumerated in the bill of rights or not are personal rights that are outside the control of the government. We retain those rights without governmental enumeration and they can only be restricted when they might conflict with the rights of others. You are not free to practice your religion in another's religious house (church) without the permission of the owner. You cannot carry a gun into the house of another without permission. You cannot freely travel across the land belonging to another without permission. You can't yell "FIRE" in a way or at a time that will needlessly endanger others. You can't use your free speech to incite illegal action in others.

As long as my rights are not infringed you are free to exercise yours. We had the rights before we had the government and we will have them long after the government is gone. The constitution does not provide our rights it tells government that they have to protect them.

[Frank Ettin]

Originally Posted by ShootistPRS

Our rights whether enumerated in the bill of rights or not are personal rights that are outside the control of the government .....

We're discussing what the law actually is and how things actually work in the real world. Your personal, philosophical views are irrelevant. Our focus revolves around how courts see things, and at the core of this discussion are a specific, recent actions by the Massachusetts Attorney General and a recent decision of the Eleventh Circuit.

Please stick to an evidenced based discussion of the topic at hand.

[Aguila Blanca]

Originally Posted by Loosedhorse

That is not the definition of a "boundary violation." Please see post #73.

I saw your post #73, and I looked at the link. That's only one definition, from one specific institution, but IMHO it still fits.

Boundary Violation
When one does not distinguish between his or her own personal and emotional needs from those presented by the patient. It refers to over-stepping boundaries that jeopardize and compromise the therapeutic relationship.

For example: If I go to my doctor (as I recently did) to follow up on a surgical procedure performed last year (gallbladder removal), I have no personal or emotional need to discuss firearms in my home. I'm there to see if I'm recovered from the operation. But the doctor's standard intake form included a number of questions unrelated to the purpose of my visit, including a couple about firearms.

Despite the fact that I wasn't there to talk about anything other than my gallbladder (or lack thereof), the doctor nonetheless asked a number of questions relating to other things that might or might not be going on in my life. Things that don't affect my health, except perhaps in some extremely tenuous and undemonstrable way.

By the definition YOU provided, that's a boundary violation.

[Loosedhorse]

Originally Posted by Aguila Blanca

That's only one definition, from one specific institution

It is a representative definition. I invite you to look at others from other medical ethics sources.

Originally Posted by Aguila Blanca

but IMHO it still fits.

Really?

At first, your definition of a boundary violation was shown here:

Originally Posted by Aguila Blanca

...committing a boundary violation by presuming to enter into a field about which he or she is not knowledgeable.

A boundary violation thus, according to you (without reference to any source), was when a doctor discusses with a patient "a field about which he or she is not knowledgeable."

Now, you are claiming that a doctor discussing gun safety is not part of the doctor-patient relationship, even though doctors and the 11th Circuit say it is; but instead that discussion is the doctor using the patient for "his or her own personal and emotional needs."

Seems we're still missing your evidence that your definition of "boundary violation" has any validity beyond your unsupported opinion; and that a doctor discussing gun safety--or just having a gun question on a standard form--is using the patient for "his or her own personal and emotional needs."

[Chris_B]

I just want to mention that the subject of extracurricular activities is a natural one in many cases not related to firearms.

If you injure your knee, the MD may well ask if you play sports. During my hospital stay this month, they discovered a hole in my heart. Sports came up. Yes, I want to play roller hockey again, stroke be damned. I can already run half speed and juggle. Anyway, it's an example of recreational activities that are surely applicable to medicine.

[Aguila Blanca]

Originally Posted by Loosedhorse

Seems we're still missing your evidence that your definition of "boundary violation" has any validity beyond your unsupported opinion; and that a doctor discussing gun safety--or just having a gun question on a standard form--is using the patient for "his or her own personal and emotional needs."

I never claimed that my definition of a boundary violation was anything other than mine, or that my opinion that [most] doctors talking to patients about guns is a boundary violation was anything other than my opinion. That said, I am far from the only person who does think it's a boundary violation.

You are, of course, at liberty to disagree.

And you are taking liberties with the very definition you referred me to. There's more to it than just the doctor's personal needs and emotions. I quoted the definition to which you referred us above, but here it is again -- ALL of it:

Boundary Violation
When one does not distinguish between his or her own personal and emotional needs from those presented by the patient. It refers to over-stepping boundaries that jeopardize and compromise the therapeutic relationship.

"Those", in the context and grammatical structure of that sentence, refers to the personal and emotional needs of the patient, Do you disagree that if a doctor asking about the patient's ownership of guns makes the patient uncomfortable, or (as we have seen in previous discussions here) causes the patient to dissemble rather than provide straightforward, candid responses to questions. it "jeopardizes and compromises the therapeutic relationship"?

Since you're new around these parts, some suggested reading:

https://thefiringline.com/forums/sho...dary+violation

https://thefiringline.com/forums/sho...dary+violation

https://thefiringline.com/forums/sho...dary+violation

https://thefiringline.com/forums/sho...dary+violation

https://thefiringline.com/forums/sho...dary+violation

[jdc1244]

What right of free speech is involved in a doctor asking a patient about guns? That is a very private issue.

Government has the authority to place limits and restrictions on speech.

First Amendment case law places limits and restrictions on how government seeks to regulate speech, where some limits and restrictions comport with that case law – and are valid and Constitutional – and some do not, such as government seeking to regulate the speech of doctors discussing guns in the home with their patients.

In addition of being in violation of the First Amendment, the Florida measure is also invalid because it is predicated on the fallacy that doctors discussing guns in the home with their patients might have a ‘chilling effect’ on gun ownership, and the fallacy that doctors addressing the issue of guns in the home might ‘foment’ further ‘gun control,’ when in fact nothing could be further from the truth.

There is no such thing as being too conspiratorial when it comes to the issue of gun rights. Constant vigilance is required.

Nonsense.

Second Amendment ‘advocates’ engaging in hyperbolic conspiracy theories, unfounded demagoguery, and propagating ridiculous lies serve only to undermine the rights enshrined in the Second Amendment.

[44 AMP]

Government has the authority to place limits and restrictions on speech.

In public.

There is no such thing as being too conspiratorial when it comes to the issue of gun rights. Constant vigilance is required.

Nonsense.

Second Amendment ‘advocates’ engaging in hyperbolic conspiracy theories, unfounded demagoguery, and propagating ridiculous lies serve only to undermine the rights enshrined in the Second Amendment.

While I agree that running about yelling that "the sky is falling" when it isn't does not do our side any good, being vigilant against threats to the RKBA is not nonsense.

Perhaps you don't remember "if I could have gotten 51 votes, Mr & Mrs America, turn them ALL in!"

The threat IS real. It's virulence ebbs and flows, but it doesn't end, or ever go completely away.

[Loosedhorse]

Originally Posted by Aguila Blanca

Do you disagree that...

I disagree with the premise of your question.

You claim that the doctor, by asking a gun question, "causes the patient to dissemble". No. The patient is not a child, and the doctor does not control the patient's action.

If the patient CHOOSES to lie ("dissemble"), that's on him: he is his own agent and must take responsibility for his own decisions and actions. So, if there is any harm to the doctor-patient relationship, that has come from the lying patient--from HIS decision.

The patient has options. Tell the truth. Refuse to answer. Object to the question (very strongly, if he wants). Find another doctor.

Oh, and in case you're wondering: the patient choosing to lie is not a "boundary violation"; neither is the doctor's question.

Originally Posted by Aguila Blanca

Since you're new around these parts...

But not new to this topic. I am aware of Dr. Wheeler's opinion on "boundary violations"; he is wrong, as any medical ethicist or medical educator (or even the 11th Circuit) can tell you.

I like his other writing, however. For example, his chronicling of the malfeasance and bias at the CDC and at some medical journals (like the NEJM) is great; it well documents why the CDC should (my opinion) never be trusted with funding "gun violence studies" again.