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Proposed Restriction of Doctors' Speech Related to Guns:

The Virginian-Pilot reports:

A pediatrician who asks a child's parent about firearms in their home could lose his or her license or be disciplined under legislation being considered by a [Virginia state] Senate committee today.

The bill would prohibit health care professionals from asking a patient about gun possession, ownership or storage unless the patient is being treated for an injury related to guns or asks for safety counseling about them....

The legislation is opposed by The Virginia Chapter of the American Academy of Pediatrics because it blocks a common practice by medical professionals to inquire about gun ownership and safety when they go over a safety checklist with parents during a child's regular checkups from birth to puberty....

As I've noted before, the constitutional status of professional-client speech is unsettled. It seems pretty clear that the government has some extra power to regulate such speech, but I doubt that this power is or should be unlimited.

And this restriction (which I regret to say is supported by the NRA) seems to me to be well outside the proper limits of the government's power here. The restriction isn't limited to speech that is misleading or dangerous to patients; perfectly accurate and reasonable advice about preventing gun injury is covered alongside exaggeration and hysteria. Nor is this a requirement that doctors say extra things that the government thinks patients ought to know (such speech compulsions are generally forbidden, but may be constitutional when imposed on professional-client speech); this limits the information that doctors can give patients, rather than adding to such information.

The NRA argues that doctors' advice about guns in "intrusive" and "unnecessary," but it seems to me that the government needs much more than such beliefs to suppress speech. Speech can't be banned just because the legislature believes it "unnecessary," and absent unusual circumstances the sensible response by patients outraged by "intrusive" statements is to switch to a doctor they like better (or perhaps to warn their new doctor that they don't want gun safety advice). Timothy Wheeler, at the Claremont's Institute "Local Liberty" blog, defends the law as aimed at preventing "boundary violations": "With very few exceptions, a doctor's probing of a patient about guns in the home is a politically motivated question. That makes it an ethical boundary violation, which is unprofessional conduct. Doctors are forbidden to misuse the trust of their patients to advance a political agenda such as gun control." There's no doubt that many medical organizations have taken political stands on gun control; the American Academy of Pediatrics, for instance, urges that handguns be banned. And it's certainly quite possible that some doctors' political prejudices lead them to give unsound advice, for instance exaggerating the risks to health of keeping firearms in the home, or ignoring the possible benefits (including to the owners' health) of keeping firearms in the home.

But "liberty," "local" or otherwise, includes the liberty to communicate views that are influenced by one's ideology, without the government's banning such speech on the theory that it is "unprofessional." And it likewise includes doctors' liberty to convey their professional views on the health threats that various behaviors — bicycling, playing sports, engaging in unsafe sex, storing guns in certain ways — pose.

I should note that the government has much more authority to control what its employees or contractors say (see, e.g., Rust v. Sullivan); but this law would apply to all doctors, not just those hired or funded by the government.

The bill passed in the Virginia House by 88-11, though it was apparently blocked in the Senate committee by a 6-9 vote. Thanks to Glenn Wright Bowen for the pointer.

Defending the Indefensible:
How would this affect the right of physicians to recommend medical marijuana in states like California?
2.25.2006 4:28pm
Fishbane (mail):
How would this affect the right of physicians to recommend medical marijuana in states like California?

As this is a Va. state law, not at all, unless you're asking the result if it is appealed to the SCOTUS and upheld. If that happened, well, state legislatures could script rather a lot of your future medical advice; an outcome, I'll note, which is unfortunately popular on both poles of the US political spectrum.
2.25.2006 4:36pm
Dave Hardy (mail) (www):
It does sound like a First Amendment infraction (or potential one, since it wasn't enacted).

My doctor ALWAYS asks about my guns. He owns an Uzi and wants to keep up. If a doc gave me antigun lectures, I'd find some other doc who minds his own business. *If* I were open to balancing away the First Amendment, I'd like to see a weightier interest than "I'd rather not change doctors, I want you to order this guy to speak or not speak as I prefer."

Might be an interesting comparison with bills to forbid pharmacists to refuse to fill "morning after" abortion pills, a prohibition endorsed by ACLU and others. I figure -- they're not government employees, nor do they have a monopoly. The simple solution is to go to a different pharmacist.
2.25.2006 4:54pm
Glenn W Bowen (mail):
to throw on some more fuel, does the American Academy of Pediatrics recommend questioning parents about-
1) plastic five gallon buckets. more children under five drown in them than are shot.

2) bicycles. more children under 14 are killed on bicycles than are shot, by a wide margin.

3) swimming pools. more children under ten drown in them than are shot, by a wide margin.

?
2.25.2006 5:08pm
Eugene Volokh (www):
Well, according to the quoted article, "Medical professionals are encouraged to use the routine safety survey to counsel parents about everything from car safety seats and child-proofing a house and backyard pool to bicycle helmets and fire safety once the child reaches the appropriate age." Doesn't say anything about five-gallon buckets, though.
2.25.2006 5:22pm
Steve:
Doctors are forbidden to misuse the trust of their patients to advance a political agenda such as gun control.

Even if a doctor flat-out advises all his patients that they shouldn't own a gun, there's a rather large difference between voluntarily choosing not to own a gun and "gun control."
2.25.2006 5:23pm
JohnAnnArbor:
My pediatrician always talked about basic safety. I don't recall off-hand whether guns were in the mix or not, but putting them there is only common sense, along the lines of don't play with fire and power cords and in parking lots. The idea that it's interference is ludicrous.

Of course, perhaps there are pediatricians that disapprove of guns, just as I'm sure there are pediatricians that disapprove of parents driving their kids around in Corvettes. Trying to micromanage discussions of such issues, though, is idiotic. Adults can handle their own discussions!
2.25.2006 5:56pm
reader_iam (mail) (www):
It strikes me as inappropriate to pass legislation like this, especially if it's focusing on one particular type of question having to do with potential threats to kids. Can't adults just deal with this privately, without more government intervention or opening up freedom of speech issues?

That said, as the mother of a kindergartner, I have found some of the questions addressed to my child even when he was 2-3 younger, by medical professionals, to be a bit disconcerting. This is particularly true because sometimes the list of questions have included some things, such as guns, but not others, such as common daily hazards you can't "lock up" (another commenter mentioned some of these, so I won't be redundant).

The other oddity is that the list of questions sometimes vary from nurse to nurse, for example, and the emphasis on and length of safety suggestions seem to vary based not on anything to do with our personal situation but rather on the other individual.

On one particular occasion, one nurse asked about guns, we said (truthfully) that we don't own any, and yet she preceded to go into gun safety at some length. But during the very same conversation, when we shared that our son precociously had gone to a two-wheeler (without training wheels) and was capable of miles-long bike rides regularly, she asked no detailed questions nor offered similarly detailed advice. That was fine, because we had it covered, but this was a decidedly odd encounter.
2.25.2006 6:01pm
anonymous coward:
Spreading lies about processed food is another insidious tactic of leftist doctors. My doctor told me to eat fresh fruit and vegetables, but who is she to tell me I need to eat hippie food like Alice Waters? Liberals can't stand the thought that big corporations make the tastiest food, like Oreos, and torture themselves with nasty stuff like sushi and arugula.

Or suppose I believe that being moderately overweight--like (allegedly) owning a gun--isn't actually a health risk. I could pass a law preventing doctors from promoting their ridiculous sizeist agenda. Well, why not?

The right not to be offended may be the dread spawn of identity politics but is increasingly effective in the hands of College Republicans, creationists, and gun nuts. I love it.
2.25.2006 6:04pm
margate (mail):
Eugene -

What's the constitutional hook for this law?

The state's general police power based on its control of licensing?

I don't believe the 2nd Amendment has been incorporated by the 14th. But I seem to recall reading somewhere that the 14th A's privileges &immunities clause was, based on the discussions in Congress before its adoption, broad enough to encompass 2nd A rights.

Where might the SCt's reasoning in United States v. Vuitch, 402 U.S. 62 (1971), fit in here. [Justice Black wrote the opinion.]

There, in affirming the constitutionality of a District of Columbia statute criminalizing abortion, unless necessary to are necessary to preserve the mother's "life or health," the majority remarked:
"Generally, doctors are encouraged by society's expectations, by the strictures of malpractice law and by their own professional standards to give their patients such treatment as is necessary to preserve their health."


Id. at 71.

As an aside, Vuitch rejected a vagueness challenge and allowed the prosecution to proceed on the premise that the word "health" was broad enought to "include[ ] psychological as well as physical well-being." Id. at 72.

That's where the basis for Roe really took root.
2.25.2006 6:07pm
Mikeyes (mail):
Does this mean that if I ask my suicidal patient if he owns a firearm that I am a criminal in VA? Or does it exempt me from being sued if he goes home and shoots himself?

Sometimes I wonder if too close a connection to the Bush administration has addled the NRA brains (and I say this as a Life Member) and they come up with this kind of foolishness. This legislation puts peoples lives in danger, it is as simple as that.

Also, I don't think it is very professional to impose your political views on your patients since physicians hold a special place in society and patients are usually very vulnerable when they come to see you. In fact, such speech (advocating a strong political position that is not related to patient care issues) is probably unethical. Physicians often hold strong positions on various issues (gun control is a good example) and whenever these issues become part of a professional organizations issues, the result is either chaos or an acrimonious split. On the other hand, there are very strong reasons to ask a family with young children if there are firearms in the house involving safety. You'd think that the NRA of all organizations would be aware if this, but the attitude of "never give in" blinds them even to their own laudable efforts at teaching gun safety.

Maybe the attitude of honoring all the amendments should apply to the NRA (and the VA legislature) too since they bring this up all the time in their literature.
2.25.2006 6:15pm
kiswanson:
As a medical student, I can say that we are trained to ask a whole long list of potential dangers to kids, including gun safety, helmet and seatbelt use, drowning and poisoning prevention, etc. A doctor shouldn't tell a parent to get rid of a gun, but they should ask if the parent has taken measures to prevent accidents, for example storing the gun in a locked cabinet and storing ammo separate from the gun. These type of questions are perfectly reasonable and I think necessary. Legislating against a doctor's ability to ask questions seems very irresponsible. A doctor can recommend but not force parental actions, and a parent can always seek another doctor if they find such recommendations are intrusive. Such a gag rule is completely unnecessary.
2.25.2006 6:20pm
John R. Mayne (mail):
I think Professor Volokh is just right on this; I also think the slippery slope downhill from here is pretty easy to see. Doctors can't ask about guns, must ask about methamphetamine, can't ask about kids watching Oprah, but must ask about kids watching South Park - this is a bad step on this slope.

(Hey, someone should do a law review article on the slippery slope.)

--JRM, who is aware that dry throwaway lines sometimes are viewed as serious.
2.25.2006 6:46pm
eng:
Doctors are not merely professionals. They are licensed by the state and granted a monopoly on the practice of medicine.
2.25.2006 6:54pm
Ivan (mail) (www):
I find it interesting to juxtapose this law with laws requiring doctors to discuss quite a bit of personal information (e.g., here is everything else you can do instead, here's how old your fetus would be, here's what it might look like, you can make the father pay money for it) with women before they get abortions. It doesn't quite seem consistent to require doctors to worry so much about children in the womb, then forbid them to ascertain safety from guns in the house once out. But then again, I'm not a Virginia legislator.
2.25.2006 7:17pm
Mikeyes (mail):
eng,

Technically you are correct, doctors are licensed by the state to practice the full scope of medicine, but I doubt you'd want me to do a heart transplant on you. But in many states, nurses, physician assistants, psychologists, podiatrists, and optometrists have full prescribing privileges and are considered independent practitioners of medicine. I suppose in VA that the physician can refer the family to a podiatrist who will be allowed to ask about gun safety.
2.25.2006 7:39pm
Mikeyes (mail):
Whoops, I guess not, the bill states that "health care professionals" are prohibited.
2.25.2006 7:40pm
nk (mail) (www):
The doctor-patient relationship is entirely consensual (as is the attorney-client relationship). I advise Virginia's doctors to simply refuse to accept as patients any legislator who votes for this bill. Something along these lines, "Hey,politico. You wanna practice medicine? Practice it on yourself, too."
2.25.2006 7:44pm
Jack Diederich (mail) (www):
The AMA is very gun-unfriendly. A quick google for AMA gun ownership brings up as top links quoting and criticizing the AMA for a strong anti-gun stance.

I can't comment on the law but for real life.. The AMA is a national association and is gun-unfriendly while the state of Virginia is gun-friendly. The AMA is trying to use it's national status to further a political goal. Virginia is taking their only state recourse.

I think both are acting politically and not in keeping with their core missions. Much easier to pick another doctor if you don't like the one you have.
2.25.2006 8:04pm
Barry Dauphin (mail) (www):
The bill would prohibit health care professionals from asking a patient about gun possession, ownership or storage unless the patient is being treated for an injury related to guns or asks for safety counseling about them....

Suppose you are a psychologist (a health care professional in every state) who is evaluating an adolescent that has been referred for several behavior problems, including drawing a picture depicting said adolescent shooting a school official and that picture was found by school officials...you mean the psychologist can't ask the parents if there are any guns in the house and whether the family stores the guns and ammunition in a safe manner? Even a psychologist who is a hunter and supporter of the 2nd Ammendment is going to want to know this information in undertaking such an evaluation.

Even if the AMA has an anti-gun agenda, do we really want the state "protecting" us from such speech? Are our lawmakers truly so wise, everyone of them a vertiable Socrates in Armani, that we should trust them to regulate every aspect of a private encounter? Does the NRA now support the Nanny State, as long as the Nanny prohibits speech they deem offensive?
2.25.2006 8:42pm
Brooks Lyman (mail):
The concern is, I think two-fold.

First, that the doctor may be making notes in one's medical records to the effect that one owns firearms and how one uses and stores them, which is really none of his business, and is certainly none of anyone else's business. Unfortunately, as I understand it, current medical record "privacy" law is rather broad as to the people who can legally access your records, even without your knowledge. In our present nanny-state climate, I would not be at all surprised if people who told their doctor that they owned guns - particularly if they have children - might start attracting the attention of their state's Departments of Mental Health or Child Welfare. I'm sure you can imagine where such things can lead. This may be an extreme view, but these sort of bureaucrats often have too much power which, when combined with certain agendas and beliefs, can result in a lot of unnecessary grief for people.

Second, as we have seen, the various medical - particular pediatric - associations tend in the main to be anti-gun. That's their privilege insofar as it goes, but the anti-gun people are not noted for accuracy in their statistics and statements (the NRA does a lot better in this regard), and while doctors may be well-educated people, they are also often specialists, not generalists, in their knowledge, and so may be prone to swallowing the anti-gun arguments and spreading them among their patients - incorrect statistics about the danger of having guns in the home, the usefulness of guns in self defense, the actual danger to children of guns in the home, etc. Let's face it, there are 70 or 80 million gun owners and only 4 million NRA members; the vast majority may not be aware of the truth of these issues. We do no favors to people when we disarm them, whether voluntarily or by government fiat, as the statistics from
Australia, Britain and Canada are showing us.

All of that having been said, I am afraid that this issue falls into the category of "there oughta be a law," which is no guarantee that such a law is either wise or Constitutional. In this case, I am afraid that it is neither, which leaves us with the problem that the bill was intended to address....
2.25.2006 8:43pm
Duncan Frissell (mail):
What I want to know is what does safety agitprop have to do with medicine? Medicine treats disease and injuries and has absolutely nothing to do with physical safety.

Wouldn't a parent be worried that a "wrong" answer to such questions would cause legal problems since the parent is not a patient of the pediatrician (and a third party - the child - may be present). Even if there is a priviledge, it doesn't cover ongoing criminal activity or future crimes. (failure to use a car seat is a crime, though gun storage violations usually are not.)

Don't get me started on the car seat garbage. I actually heard a threat by a health care professional to commit the crime of false imprisonment if any mother with newborn attempted to leave the hospital without a car seat in her possession. That's when a gun would come in handy. Sheer nonsense of course but they repeat these fantasies all the time.

My guns have never been locked up (at home) and never will be.

"Doc, I'd love to lock my guns up but how will Tad shoot a piece of human debris breaking and entering the dwelling house of another in the nighttime with intent to commit a felony therein when I'm not home, if the Mossberg is in a safe in the basement?"
2.25.2006 9:04pm
Porkchop (mail):
I always take the easy way out with my kids' pediatrician:

"It's none of your business. I don't care what you think about firearms, and I don't need safety lectures. Let's talk about my kid's health, that's what I pay you for."

It seems to work all right.
2.25.2006 9:07pm
Cornellian (mail):
There's nothing inherently anti-gun or pro-gun control in recommending safe handling of firearms. Heck even in the NRA is happy to preach gun safety to anyone who wants to listen.

And the fact that only licensed physicians can practice medicine constitutes a monopoly only if you believe that all doctors are employees of the same corporation.
2.25.2006 9:07pm
nk (mail) (www):
[DELETED by EV. Nasty personal insults like this one will be deleted; people who keep posting them will be banned.]
2.25.2006 9:23pm
Anderson (mail) (www):
The AMA is very gun-unfriendly. A quick google for AMA gun ownership brings up as top links quoting and criticizing the AMA for a strong anti-gun stance.

Treating a few gunshot victims could do that to a person. For that matter, police organizations support gun control, for similar reasons perhaps.

I just don't understand the gun owners who are such sissies, they have to run crying to the legislature because their doctor ASKED THEM A QUESTION.
2.25.2006 9:24pm
juris imprudent (mail):

Does the NRA now support the Nanny State, as long as the Nanny prohibits speech they deem offensive?

This is one of my big beefs with the NRA - they are much too willing to support big, intrusive govt. They did it with Project Exile (federalizing crime) and here with this. They've also been very supportive of the War on Drugs. Give me the GOA over the NRA any day.

Treating a few gunshot victims could do that to a person. For that matter, police organizations support gun control, for similar reasons perhaps.

Funny how I just was discussing with someone the 'filters' people develop. Treating a few gunshot victims does not give a person an accurate picture of guns in this country. Same with cops, and I will add, that rank-and-file cops typically do NOT support gun control while chiefs (i.e. politicians) do.
2.25.2006 9:36pm
Mikeyes (mail):
I agree that it is intrusive on the part of a physician to ask about gun ownership if he or she is trying to indoctrinate or change your mind, but there are instances in which this knowledge is vital. For example, if a patient tells you that they are going to harm someone or themselves, you have to ascertain if they are capable of doing so. One of the red flags is the ownership of firearms. If a patient is suicidal (and that is often hard to determine without a lot of talking to the patient) then those guns have to be taken out of the possession of the patient. I usually ask family members (with the permission of the patient) to remove any guns until that person is no longer suicidal.

In addition, federal law does not allow a committed patient to own firearms (I am not convinced this is fair or effective, but it is the law) so a reminder to the patient is often in order (I don't call the police on this issue.) Also, Tarasoff warnings are mandated in many states and are common sense to avoid liability and tragedy. If a patient threatens another person and is armed, then I have to take appropriate measures to protect that person (not to mention protect me from a lawsuit.)

Children who are in danger of physical harm or sexual abuse have to be reported in every state, the presence of guns in these cases is also a tremendous worry.

So I don't think that the statement that gun ownership is none of the physician's business is strictly correct.

Again, I am a strong advocate of gun ownership, but that ownership has to be responsible and safe both for society's sake and for personal safety. When a patient has an illness that might trigger unsafe use of a firearm (such as severe depression, mania, psychosis, etc.) then it becomes the business of a physician. A number of state and federal laws apply, even in Virginia, in these cases, not to mention the always present liability issue.

Maybe you just have to be there to understand.
2.25.2006 10:01pm
Enoch:
I just don't understand the gun owners who are such sissies, they have to run crying to the legislature because their doctor ASKED THEM A QUESTION.

It's this little thing called "privacy".
2.25.2006 10:41pm
Eugene Volokh (www):
Here are two traditional ways of dealing with people who you think are asking privacy-intruding questions:

(1) Refuse to answer.

(2) Stop doing business with them.

Why exactly are these two items not enough? Why is a government-imposed restriction on the questioners' speech somehow needed instead?
2.25.2006 10:58pm
JunkYardLawDog (mail):
The biggest worry I would have is how long before the doctors start voluntarily or under requirement of law start reporting patients to the state department of child welfare for endangering their children and not acting in the best interests of their children if the parents don't give the *correct* answers to the gun questions.

Every state has laws on the books right now that require doctors to turn in patients for child abuse. How long before anti-gun doctor ideology makes the equation "parent owns gun and refuses safety instruction = child abuse and child endangerment for which I the doctor am required to report to child welfare for investigation"?

I would like it a lot better if the doctors would worry more about stopping killing 100,000 patients per year through their negligence, than to they worry about the less than 1000 accidental gun shootings of children per year.

There are TWO slippery slopes here in play. One for free speech, but also one with regard to the right to parent your children without undue observation by doctors acting as agents for big government.

Says the "Dog"
2.25.2006 11:04pm
yclipse (mail):
Might I suggest an editorial point? The original story quoted in the post simply describes "the bill", "the legislation", and a "Senate committee", without telling us whether this was the state legislature or the U.S. Congress. Since only three paragraphs are quoted, it may be that the entire article clarifies this issue, but I suggest that a blogger citing something like this clarify the issue for his readers.

I know that the context suggests that this is a state legislative initiative, but it would be pretty simple to include this information explicitly, especially for non-lawyer readers.
2.25.2006 11:18pm
Lev:
I have a vague recollection that various groups have either proposed legislation, or tried to get legislation passed, that would require "health care professionals" and others to ask children if guns are in their homes, and then would require them to report affirmative answers to children's protective services or similar as potential child endangerment.

Anyone else recall something like that?

Is that what the NRA legislation is reacting to?
2.25.2006 11:54pm
therut:
I personally as a physician can not stand any of the professional medical associations some more than others. I refuse to join or give them money. They have been politized regarding social issues and they should know better. Medical Students are taught all kinds of social propaganda now. The APA is very anti-gun. They have in their major textbooks (Randolphs) the Kellerman study and they recommend no firearms at all in the homes where children are. This is tantamount to saying no free speech in homes with children. I refuse to ask the blanket questions put out by these nanny organizations. Fie on them. They are pumping out the idea that gun violence is a disease and guns are the pathogen. Ridiculous. I hope one of these dopy physicians gives someone their professional opinion and that person removes all their firearms then when the family needed them for self-defense and was harmed becuse they did not have them the family sues that professional. IF the nannies really wanted to do some good they would want to fund gun safety courses in schools. I do not mean anti-gun classes I mean real safety coarses on how to handle a firearm responsibily. And for the liberals who would scream about this I would repeat back to them their own advice regarding sex education------They are going to be exposed to firearms and knowledge is what they need not just to be told NO. Did you know that in the state of Arkansas if you are a Foster Family you lose your 2nd amendment rights. No fireams allowed in your home. Where is the ACLU?????????? I even had the wonderful experience to be taught by Joycelyn Elders the author of "Lets teach our children to masterbate" claim of fame. She was very anti-gun. I would also add that the recommended well child exams are excessive and nothing more than a revenue generating scam.
2.25.2006 11:55pm
Tom Anger (mail) (www):
As a medical student, I can say that we are trained to ask a whole long list of potential dangers to kids, including gun safety, helmet and seatbelt use, drowning and poisoning prevention, etc. A doctor shouldn't tell a parent to get rid of a gun, but they should ask if the parent has taken measures to prevent accidents, for example storing the gun in a locked cabinet and storing ammo separate from the gun. These type of questions are perfectly reasonable and I think necessary.

Who put doctors in charge of counseling people about such stuff? Quit wasting your time and your patients' time and stick to actual health issues. No wonder I've never had that feeling that any of my doctors has really given much thought to my health issues. They've been too busy practicing Psych 101 and Political Correctness 102, when they've not been boning up on the sales literature from pharaceutical companies. And I say that as a big fan of pharmaceutical companies.

Statements like the one I quoted remind me why I think medical licensing laws are a bad thing.
2.26.2006 12:51am
Kendall:
Tom Anger - Since when is gun safety being politically correct? I'd think that its common sense, you keep your guns safe and you keep your kids safe. But somehow that's part of a vast liberal agenda for some people. Unbelievable.
2.26.2006 3:07am
kiswanson:
Tom Anger.
It is not political correctness to ask about child safety issues. The fact is that numerous children are injured and killed needlessly because simple preventative measures are not taken. I say this as a gun owner, a libertarian on gun issues, and a medical student. Are you suggesting that the mere mention of gun safety is politically correct? Are other suggestions of preventative measures also unacceptably PC, such as proper storage of chemicals, use of helmets, vaccinations? All are designed to prevent common causes of injury and death, not to treat present illness.

The NRA heavily supports the use of gun education and other safety measures to protect kids. From their website:

Education decreases accidents. Voluntary firearms safety training, not government intrusion, has decreased firearms accidents. NRA firearm safety programs are conducted by 62,000 NRA Certified Instructors and Coaches nationwide. Youngsters learn firearm safety in NRA programs offered through civic groups such as the Boy Scouts, Jaycees, the American Legion, and schools.6 NRA's Eddie Eagle GunSafe(r) program teaches children pre-K through 6th grade that if they see a firearm without supervision, they should "STOP! Don't Touch. Leave The Area. Tell An Adult."

A perfect time to raise the issue and possibly suggest such a program is during an annual well child checkup. The ones trying to legislate a politically correct society are those wishing to gag doctors. Well, that's enough fun, time to hit the books and review our medical school code of politically correct ideology.
2.26.2006 5:53am
logicnazi (mail) (www):
The proposed law has been roundly critisized for all the The fear that an extreme 'nanny state' is going to show up in the next decade or two and pass a law mandating physician reporting of guns over what would undoubtedly be the strong opposition of doctors, health professionals and the NRA is just not plausible.

Despite doctors inclination to more liberal views they aren't stupid and would surely realize the harm to the doctor patient relationship such a requirement would entail. Nor would it go unobserved that such a measure would guarantee every gun owner lies, and perhaps even starts hiding his guns instead of keeping them safely locked up ultimately increasing the gun danger.

Hell, the NRA by itself should be enough to keep pressure off the backs of known gun owning parents and with even a significant chunk of docs worried about these side effects such a law just isn't going to pass.
2.26.2006 6:08am
logicnazi (mail) (www):
Oops sorry about that first line in last post..was supposed to go here.

The proposed law has been roundly critisized for all the right reasons but there seems to be a bit of an argument whether it is right for doctors to ask about guns in the home. The obvious trivial answer is that, "it depends on how and when they do it." Some ways to ask/provide gun safety information (for instance if the doc brings it up in the context of how he keeps his guns away from his kids) are going to be palatable to even the most pro-gun family. The very real worry though is that many doctors are not only asking in the interest of providing disinterested advice about safety but instead to influence the gun-owner to get rid of their guns.

The people who defend these doctors rightly point out that a doctor should be concerned with all aspects of health/well-being. However, they then fail to take this premise seriously by narrowing the doctor's concerns to physical injury when clearly mental health and quality of life are even more important than physical injury. Obviously physical health is only a means to the end of a satisfying life (if one had a choice between having your brain transfered to a vat but could keep working, interfacing with the world, and commenting on Volokh or being stuck in a blank white room but guaranteed perfect bodily health which would you choose). Yet these considerations seem to be absent when considering the gun issue.

Whether you like guns or not there are many people who do like guns and derive great satisfaction from hunting, target practice, or even just peace of mind from apparent safety (whether real or not). Even if it is true that guns in the home increase the rate of death/injury to kids it doesn't follow that therefore it would be better to remove the guns. This would also make the parents less happy, and indirectly the kids. Quite frequently a more enjoyable life is worth extra physical risk (eat junk food anyone) and it seems like many doctors forget about this with guns.

However, it would be a mistake to think this is just an issue with guns. In my experience it is a more general problem with doctors, particularly psychiatrists. My best guess is that the incentive system is set up backwards. The psychiatrist who has 2 patients kill themselves but the rest of his patients are way happy is going to feel worse about it than the psychiatrist who plays it safe and has no suicides but most of his patients are still somewhat unhappy. This effect is exacerbated by general societal attitudes which view suicide/death as way worse than chronic unhappiness and a slightly puritanical attitude. Additionally doctors are given the power to dispense narcotics and other euphoria inducing drugs. While these drugs can have some pretty bad side effects (addiction leading to street use) severely depressed patients on whom less risky treatments failed would be better off drugged up on opiates then they would be enduring the misery of their life. Yet, for various social reasons stemming from the drug war doctors are expected to 'protect' people from that sort of 'abuse' even when it is a last ditch measure to make life bearable.

Stepping back to the narrow question of guns on top of not giving sufficent weight to be enjoyment someone gets from guns there is also sense in which the great concern about guns seems hypocritical. As I understand it car accidents are a much larger killer of children. Are physicians making sure you are driving a safe car? Do they ask about your driving speed?

In short it seems right to me for doctors to try and improve patients lives by involving themselves in less traditional areas (provided they learn their shit first). However, I am unconvinced the choice of guns to focus on rather than cars or something else was the result of appropriate cost-benefit analysis and bothered by the failure of doctors to take into account personal enjoyment.
2.26.2006 6:37am
Mikeyes (mail):
It always annoys me when people with strong opinions and absolutely no knowledge of a subject blather on and make remarks such as "The psychiatrist who has 2 patients kill themselves but the rest of his patients are way happy is going to feel worse about it than the psychiatrist who plays it safe and has no suicides but most of his patients are still somewhat unhappy."

Psychiatrists deal with mental illnesses which, for the most part, are biologically and genetically determined and usually quite severe. Suicidal patients brought to the attention of a psychiatrist are driven to kill themselves in many cases. These are not the worried well. Studies show that untreated Major Depressive Disorder has a 15% mortality (that means death) rate, so any effort to change that statistic is in the pervue of the physician. To imply that suicide is always a rational option in these cases is evidence of ignorance of the facts.

As for narcotics, for the most part they are not treatments for mental illness, any more than alcohol is even though many people self-medicate with both substances.

I know of no physicians who are willing to abet the government by turning in names of gun owners to government entities just because they own guns. I wouldn't even know who to turn the names into and I certainly would not do it, not just because of my 2nd Amendment stance (pro-gun) but because it would be a good way to lose patients. No doctor likes reporting anything except those things mandated by law (child and elder abuse) and the paperwork alone is daunting not to mention the time it takes to deal with the authorities.

Also, my son just graduated from medical school, and he did not run into any anti-gun diatribes. He was never taught that he had to get guns out of the hands of the people to make a utopia on earth. He was taught (as I was) to "First, do no harm"

Granted, there are professional organizations who have taken up this line but all most doctors are a) conservative politically and b) capable of making independent decisions in spite of some of the rhetoric noted above. The leaders of professional organizations tend to be academics who have more time on their hands than the usual practicing physician. I don't belong to any professional organizations for that reason alone, but mostly because I don't think they do anything worth the dues they ask.

If you think that all doctors are minions of the state aching to take your guns away, the answer is simple: try an alternative, there are plenty of them out there. But the next time you see your doctor at the skeet range, the odds are he is not a spy for the anti-gun crowd.
2.26.2006 8:10am
David Chesler (mail) (www):
+ Some medical organizations believe nobody should own guns, and want their members to so advise their patients

+ Patients expect expert advice from their doctors. Patients expect that the advice they get from their doctors is scientifically sound.

+ The family doctor is increasingly rare. Even the family doctor has little time to chat in the clinical setting.

+ Doctors see the failures more than the successes or the neutral cases, and the failures get more press. Dramatic failures expose them to more liability.

+ Doctors ought to limit talk that is likely construed as medical advice to topics where they have medical expertise. This certainly should include safety, including anecdotal, as acceptable ("I've been seeing a lot of kids with injuries from [new toy] so be careful with it." I'm lucky that I found a pediatrician who has seen it all in 50 years of practice and advises parents not to worry, even when a toddler has just swallowed a tiny ornamental light bulb.) But it should not include propaganda such as "Guns are bad, mmkay?" or "Don't vote for Candidate X".

+ Many patients are at a power disadvantage. The state having taken over so much of medicine, they don't have free choice of doctors. (Many of us have spoken against socialized medicine, or more palatably named schemes like single payor, on the basis that "Who pays the piper calls the tunes.")

+ Doctors don't always limit themselves to areas of medical expertise, and in fact some of their professional organizations advise them to go outside their area of expertise as regards guns, much more so than any other area.

+ A few doctors have gotten published for gun studies using inapplicable epidemiological methods.

+ Doctors get extraordinary legal powers, from free parking with MD plates to confidentiality; and as mandated reporters they are already acting as agents of the state.

Conclusion Maybe the state has more interest in doctor-patient speech than it does in barber-client speech. And maybe this is a problem that does need to be looked into somehow.

Parallel problem The other AMA (the American Motorcyclist Association) attempted to deal with a problem, gated communities in California banning motorcycles from their private roads, by making it illegal for the CC&Rs freely agreed to by the residents from containing such provisions. More relevant to this blog are moves excluding US flags, as a matter of public policy, from bans on hanging things from the windows and doors of condos. Most libertarians find these to be unpalatable solutions.

Attempted better solution Some states, like Texas, that have made their gun carry licenses "shall issue" (essentially a statutory right to carry) have allowed businesses to retain the right to prohibit guns from their premises. Gun owners have bristled. Some have called for taking away this right of the owners of the premises. I wonder what the ACLU would say? Neal Knox Associates said in their latest Hard Corps Report that this goes to far, but that imposing strict liability on the premise owners for any harm that befalls a visitor who disarmed himself for a visit to the premises, while at, heading towards, or returning from, that visit. (I wasn't clear how big a nexus there had to be between the harm and the voluntary disarming.) Sheesh. This is just a smaller stick. This is just replacing the jackboots with something softer. The principal is still the same.
2.26.2006 8:14am
David Chesler (mail) (www):
Dr. Mikeyes writes No doctor likes reporting anything except those things mandated by law (child and elder abuse)

If gun ownership were added to the list (as an independent item, or as part of child protection) would this then fall under the exception of things doctors don't mind reporting?

Would the doctors who didn't speak up when they came for the child abusers[*] speak up now?

[*]In my state, a healthy child coming to school with a facial bruise (received at the hand of a sibling) triggers a mandatory report of suspected child abuse or neglect. The report triggers an involuntary home visit and inspection. The home visit includes questions about the parents' religion, ethnicity, political affiliation, and (HIPAA notwithstanding) medical history.
2.26.2006 8:23am
Frank Drackmann (mail):
A large percentage of the legal owners of machine guns in the U.S. are physicians. This is partly because of the high cost of registered automatic weaponsm as production of new ones for private citizens was stopped in 1986(signed by President Reagan!)In 1985 a citizen who qualified for ownership( i.e, no criminal history, and able to get approval from his local sheriff or police chief) could buy a brand new Colt M-16 for around $600 plus the $200 federal tax. The same weapon today runs for about $16,000 if you can find one.
2.26.2006 8:27am
Ryan Waxx (mail):
People 'debunking' the 'state monopoly' argument are being purposefully decietful: We aren't talking about letting anyone who feels like it practice medicine, and it's a lie for you to pretend we are. We are talking about a left-liberal organization using it's government-guaranteed access to doctors to promote harassment of gun owners.

And the last I heard, it was NOT an acceptable argument to tell victims of harassment to go elsewhere if they don't want to hear it.

I guess harassment by left wingers is special that way.
2.26.2006 8:50am
Mikeyes (mail):
David Chesler,

There are aprox. 6 million physicians (my guess) in the US so a certain percentage of them will be idiots politically. To simply state that "doctors are ..." is ignoring this statistic and is doing a lot of physicians and their patients a diservice. And I agree with a lot of what you said about the medicine as a profession, there is too little time, too many demands on physicians from outside entities such as government and insurance, and we have not figured out how to cure all disease. But a lot of these issues are not controlled by physicians (believe me they have tried, but monopoly laws, among others have thwarted these efforts) and most doctors are not even interested in politicizing their practices.

I think that the original question is whether the state has a right to interfere with the patient-doctor relationship and whether the state has the right to impose certain restrictions or policies on health care workers. Clearly when the safety of children or incompetents (elders or mentally retarded or persons under guardianship) is at stake the state has some say (and I believe this has been vetted by the courts) but in a situation described by the proposed law, I doubt it. In fact, it would be good if the law passed and the Virginia Medical Society challenged it just to see if it is constitutional. I abhor the government telling me how to practice medicine if there are no safety or criminal issues involved and I believe that that is the classical conservative position. I have enough problems with the insurance companies (in the form of some clerk reading off of a list) telling me how to practice medicine and not taking any of the responsibility in the process ("This agreement is not an authorization to treat ..." Well, then what is it?)

Physicians, just like other people, have a variety of political, religious, and philisophical beliefs. For the most part they tend to be conservative and apolitical unless it is their ox who is being gored. A large number of physicians are gun owners and most tend to be independent, which is one of the reasons they got into medicine in the first place even though the days of the single practice are over.

By the way, do lawyers always limit themselves to their areas of expertise?
2.26.2006 8:56am
Moneyrunner43 (www):
When I visit my doctor or bring my child into a doctor I expect that person to get a medical history and ask me what the problem is. I am there for his professional expertise in the area of curing illnesses or injuries. I am not there for his opinions on gun safety, bicycle safety or car safety since his opinions on these issues are not areas in which he has been trained.

However, since we live in a litigious society, it would be interesting to see if dispensing advice on non-medical issues like gun safety carries with it legal liabilities. If the medical community accepts responsibility for advising parents on bicycle helmets, can a doctor who fails to do so be sued for negligence if little Johnny cracks his skull?

Conversely, can a doctor who tells a parent to sell his guns be sued if that unarmed parent is subsequently injured by an intruder?

The voluntary, even aggressive, intrusion by physicians into previously uncharted areas of advice have the potential for providing the legal profession new ways of making money and insurance companies richer.
2.26.2006 9:39am
David Chesler (mail) (www):
By the way, do lawyers always limit themselves to their areas of expertise?

Since the lawyer's work product is more clearly reliable advice[*] than is the case for doctors, I understand that lawyers are generally more acutely aware of when their advice could be construed as "legal" advice, and at least some won't touch legal areas outside of their area of specialization lest it be malpractice.

[*]Lawyers don't treat, manipulate, cut, or administer drugs to their clients.
2.26.2006 9:43am
SDN (mail):
If your medical records contain the answer you have a gun registration list. I guarantee you the govt can get access to those records and search them. My last doctor also had the charming policy of marking a nunuvyerbizness answer as a yes.

There's also the charming practice some doctors have of maintaining lists of patients who complain, file lawsuits, etc. and refusing to accept them as patients.
2.26.2006 10:01am
Eugene Volokh (www):
Ryan Waxx: I don't exactly know whom you're referring to in your post; but in any event, please avoid calling fellow commenters "deceitful" or labeling their arguments "lies." Even if they're wrong, there's plenty of honest error to go around; simply sticking to "that argument is mistaken because ..." is generally both fairer and more conducive to helpful debate.
2.26.2006 10:32am
davod (mail):
Frank:

The private owbership of machine guns was banned in the 1920s and never reinstated. You must be thinking of a different weapon.
2.26.2006 11:04am
Eugene Volokh (www):
Davod: You're a dirty liar. Stop deceiving the good citizens of Volokh-land! It turns out that this isn't so. The federal government has heavily taxed and regulated machineguns since the 1930s, but only banned them in the 1980s -- and even then grandfathered in previously lawfully owned weapons. There are an estimated legally registered 100,000 machineguns in civilian hands (see Kleck, Targeting Guns).
2.26.2006 11:12am
Mikeyes (mail):
By the way, do lawyers always limit themselves to their areas of expertise?

This was meant to be an attempt at ironic levity and should have read:"By the way, do lawyers always limit themselves to their areas of expertise? "

One of the things I like about this list, and I suspect most of us like, is the reaonalbe discourse that usually occurs outside of the occasional ad hominem argument that always seems to creep in. So next time, I will be a little less subtle. I am perfectly aware that lawyers have no opinions outside of their areas of expertise.
2.26.2006 11:29am
Mikeyes (mail):
I just realized that my emoticon, which is bracket G bracket does not show up on this list.

My quote should read:"By the way, do lawyers always limit themselves to their areas of expertise? (G)" and the last line should have an emoticon after it too.
2.26.2006 11:31am
David Chesler (mail) (www):
Many a truth is spoken in (G)
2.26.2006 12:13pm
Ken Arromdee (mail):
Imagine that there was an organized campaign to get doctors to tell their patients to vote Democrat, on the grounds that the Republican Party's policies could lead to war or some other consequence that increases the chance a child may die. Would it be okay forbidding doctors to ask parents their political affiliation? After all, through this chain of reasoning the doctors believe it affects the child's health.
2.26.2006 1:12pm
Mikeyes (mail):
If there was an organized campaign to tell doctors to do anything Democratic it would be met with a collective yawn. Individual physicians would possibly buy into that rather stretched logic, but only because they believe it in the first place. Most physicians are far more worried about the possibility of avian flu breaking out. That makes us sweat.

Now if the Democrats promised to get rid af all the paperwork...
2.26.2006 1:16pm
Richard Nieporent (mail):
Let me start off by saying that I don't believe that the government should restrict what a physician can say to a patient. However, I thought the job of a physician was to administer to your health needs, not your lifestyle. For example if you are a rock climbing or skydiver you are taking part in activities that are inherently dangerous. If we believe that it is the job of a physician to council you against all dangerous activities then shouldn't they tell you to avoid these activities. Clearly the most dangerous thing most of us do is driving. Shouldn't they in the same vein question you not only about the use of seat belts but how you drive? For example do you speed, cut in and out of lanes, tailgate etc. All of these can be justified on the basis that if you avoid doing dangerous things then you will live longer. What I see here is the Nanny state been extended from government to professional groups. It is not the job of your physician to tell you how to live your life.
2.26.2006 1:18pm
subpatre (mail):
Several viewpoints on one particular aspect have been addressed. There are other considerations though:

  • The American Academy of Pediatrics advocates gun bans. Bans, as in "total prohibition", not instruction in the safe use and handling of firearms. The AAP's nexus of safety to firearms is (paraphrased) 'guns are unhealthy, all guns gone is best'.

    In the few circumstances it's risen, they disagree with firearms instruction for minors on the grounds of acclimatization or desensitization. AAP doesn't offer advice on firearms handling, nor do they recommend existing programs. [Anticipating counter-claims, "properly securing" is not a safety program]

    Claims that AAP questioning is a safety matter are false.

  • It's the American Academy of Pediatrics that promotes bans and advocates asking children about firearms at home. I'm not sure where 'child' ends, but pediatricians treat people from 6 months to 16 years of age.

    In the absence of probable cause, it's totally inappropriate to interrogate children about articles in their parents' homes. [Or about their parents' lifestyle, recreation habits, political comments, etc.]

  • Insurance-mandated HMO/PPO service providers --themselves operating under state rules— alter the balance of free market or choice for patients.

  • Finally there's HIPPA, mandatory distribution of patient records, and defacto registration databases.


  • As a Virginian I welcome the legislature's attention to this. The law is overbroad and needs to be tuned, but it's an appropriate response to an outrageous violation of ethics.
    2.26.2006 1:38pm
    frankcross (mail):
    For a long time, free speech was seen as the province of liberals but more recently it's claimed as that of conservatives. This thread makes clear that suppression of free speech is no monopoly of the left.

    Conservatives are just as eager to suppress speech that they find objectionable. IMHO, the biggest problem with this thread is the people claiming that it's somehow ok to limit the speech of doctors because the doctors are biased or wrong in what they say, which seems totally irrelevant to the question. That's what free speech is all about -- the ability to be biased and wrong. Take that away and there's no free speech.
    2.26.2006 1:49pm
    subpatre (mail):
    It's unfortunate Professor Volokh quoted a newspaper but didn't link to the actual bill, in italics below.
    A. The Board may refuse to admit a candidate to any examination; refuse to issue a certificate or license to any applicant; reprimand any person; place any person on probation for such time as it may designate; suspend any license for a stated period of time or indefinitely; or revoke any license for any of the following acts of unprofessional conduct:...
    22. Oral or written inquiry to a patient concerning the possession, ownership, or storage of firearms, where such inquiry has no relationship to the practice of the healing arts or the medical condition of the patient, and is for the purpose of gathering statistics or to justify patient counseling, unless such inquiry is the subject of a request, or related to a medical complaint, made by the patient.
    It seems many of the comments here are irrelevant to the actual proposal.
    2.26.2006 2:08pm
    JunkYardLawDog (mail):
    EV makes an interesting point about the regulation of machine guns. The NFA (National Firearms Act) was passed in the 30's as a result of lots of violent crimes and mob killings using machine guns. In the 1930's Congress didn't believe it had constitutional authority to outright ban the ownership of machine guns. Therefore, they tried to accomplish the same thing by creating a discretionary licensing scheme that only the Rich or Politically connected could get around, and the $1,000 license fee in the 1930's was so prohibitive cost wise that only the very wealthy could afford to pay it. Skip to the 1980's with no intervening change in the constitution suddenly congress has all the authority it needs to make an outright ban on the ownership of machine guns. Such an outright ban would have been illegal in the 1930s and is illegal and unconstitutional today, irrespective of opinion or any court rulings to the contrary.

    Says the "Dog"
    2.26.2006 2:45pm
    Malvolio:
    A hypothetical: a pediatrician advises her patient's parents to "secure" their firearms, put the guns in a safe, store the ammunition separately. The parents follow the pediatrician's advice exactly. That night, a madman breaks in and, because the weapons are locked up, the parents are unable to defend themselves and the mother is killed. For the sake of argument, assume that the previous means of gun storage (say, in the nightstand) would have virtually guaranteed a better outcome.

    The question: is the pediatrician liable for malpractice?

    (Perhaps America's famed out-of-control tort system could solve this problem for us...)
    2.26.2006 2:53pm
    Eugene Volokh (www):
    Subpatre: I did read the bill text before posting, though hadn't seen the link to the free online version -- thanks for passing along that. The story seems to summarize the bill text pretty accurately; the proposal does seem aimed at barring asking people about gun possession when the purpose of such questioning is "to justify patient counseling" (as opposed to treatment of a current "medical condition" or other forms of "healing"). How do you think the law as proposed is different from the law as reported?
    2.26.2006 3:00pm
    GONZO (mail):
    I think outright prohibition gets into First Amendment problems, but I also think that regulation of professional licenses can properly impose restrictiosn.

    Fact is, that Physicians are in a "power" position with the capability of exercising undue coersion. That is why they, like other professionals (including lawyers) are not allowed to engage in what are clearly otherwise constitutionally protected actions (such as sexual relationships with patients).

    If the physicians groups are furthering a political agenda disguised as a public health interest, that in my view can be regulated under professional licensing doctrines such as those related to "boundaries" and whatnot.

    The fact that the invasive questioning on gun ownership comes from a polically motivated perspective is well documented. I dare say that if the AMA started encouraging physicians to track patients' status as legal/illegal residents; or their sexual history (including, for example, by pushing a politically motivated "public health" set of bullet points about the increased risks of a homosexual lifestyle, there would be hell to pay and new laws JUST LIKE THIS passed reflexively by many legislatures. Again, its a question of what doctors should be trying to do. By their own admission, they're not just tracking information (which is bad enough), they're engaging in the equivilent of push polling and that's what's got the NRA up in arms.

    Amusingly, patients on some prominant gun enthusiast message boards have taken to confronting their busybody doctors with a "release form" like the following. Very funny, indeed:

    ========snip=========
    FIREARMS SAFETY COUNSELING REPRESENTATION:
    PHYSICIAN QUALIFICATIONS AND LIABILITY
    Part One: Qualifications

    I affirm that I am certified to offer (Name of Patient: ), herineafter referred to as "the Patient", qualified advice about firearms safety in the home, having received:

    Specify Course(s) of Study:
    from:
    Specify Institution(s)
    on:
    Specify Course Completion Date(s):
    resulting in:
    Specify Accreditation(s), Certification(s), License(s) etc.:

    Check one, as appropriate:
    ___ I represent that I have reviewed applicable scientific literature pertaining to defensive gun use and beneficial results of private firearms ownership. I further represent that I have reviewed all other relevant home safety issues with the Patient, including those relating to electricity, drains, disposals, compactors, garage doors, driveway safety, pool safety, pool fence codes and special locks for pool gates, auto safety, gas, broken glass, stored cleaning chemicals, buckets, toilets, sharp objects, garden tools, home tools, power tools, lawnmowers, lawn chemicals, scissors, needles, forks, knives, etc. I also acknowledge, by receiving this document, I have been made aware that, in his inaugural address before the American Medical Association on June 20, 2001, new president Richard Corlin, MD, admitted "What we don't know about violence and guns is literally killing us...researchers do not have the data to tell how kids get guns, if trigger locks work, what the warning signs of violence in schools and at the workplace are and other critical questions due to lack of research funding." (UPI). In spite of this admission, I represent that I have sufficient data and expertise to provide expert and clinically sound advice to patients regarding firearms in the home.

    OR

    ___ I am knowingly engaging in Home/Firearms Safety Counseling without certification, license or formal training in Risk Management, and; I have not reviewed applicable scientific literature pertaining to defensive gun use and beneficial results of private firearms ownership.

    Part Two: Liability

    I have determined, from a review of my medical malpractice insurance, that if I engage in an activity for which I am not certified, such as Firearms Safety Counseling, the carrier (check one, as appropriate):

    ___ will

    ___ will not

    cover lawsuits resulting from neglect, lack of qualification, etc.

    Insurance Carrier name, address and policy number insuring me for firearms safety expertise:

    I further warrant that, should the Patient follow my firearm safety counseling and remove from the home and/or disable firearms with trigger locks or other mechanisms, and if the patient or a family member, friend or visitor is subsequently injured or killed as a result of said removal or disabling, that my malpractice insurance and/or personal assets will cover all actual and punitive damages resulting from a lawsuit initiated by the patient, the patient's legal reprerentative, or the patient's survivors.

    Signature of attesting physician and date:

    Name of attesting physician (please print):

    Signature of patient and date:
    Name of patient (please print):
    Note to patient: Indicate if physician "REFUSED TO SIGN." Ask physician to place copy in chart/medical record.
    =========================
    2.26.2006 3:11pm
    Anderson (mail) (www):
    Malvolio: The question: is the pediatrician liable for malpractice?

    The answer: no.
    2.26.2006 3:12pm
    Kevin P. (mail) (www):
    The simplest solution: Print out two copies of the following form. Hand them to the offending physician, ask him to sign both copies, one for you and one for his file:
    http://www.keepandbeararms.com/downloads/gundocform.pdf
    2.26.2006 3:25pm
    J. Peden (mail):
    My somewhat peripheral advice concerning this interesting issue is to avoid any ground level medical provider who smells of political correctness or who you think is getting intrusive in ways you instinctively know are not really related to your treatment or to what you thought your real health concerns were.

    I know it's vague, but in my opinion any provider getting into these unrelated realms is quite possibly going to deal with you medically in a remote way also and is probably not capable of dealing with your exact case, or with you as an individual, instead applying algorithmic treatment derived from stereotypical groups or dogmatic rules, apart from your actual case.

    Perhaps I'm unduly influenced by my last experience with this scenario, where a close friend of mine who is 71 and able to ascend 9000 ft. mountains like a goat while giving continuous dissertations on poisonous snakes, was adjudged by a "brilliant" cardiologist to have "heart failure" because of one test, and put on a blood pressure lowering drug, also thought to be a "magic pill", which caused him to pass out once while driving[!] and continuously threatened him with stroke and myocardial infarction. [He often felt faint, and would become "rummy" on hikes. His blood pressure was already low and only got lower.]

    The cardiologist's "brilliance" was somehow connected to her having had an article published about the oppression of women in medicine. I kept asking my friend, "Didn't she take a history?" and finally convinced him after several months to stop the the offending medication. Literally the next day he said, "I feel normal again". She'd almost killed him. [He has no heart disease.I had told him to ask her if he instead "needed a heart transplant", could I have his?]

    Really, this p.c. thing is bad for your health, apart from its social consequences. Run from it if you can.
    2.26.2006 3:29pm
    Moneyrunner43 (www):
    It seems to me that the focus of the bill is to address and define one type of unprofessional conduct. Is it the position of Professor Volokh that the legislature of Virginia is prohibited from defining unprofessional conduct by doctors if they persist in the gratuitous inquiry into gun ownership, which is a constitutional right. Incidentally, the medical profession is already a regulated industry and unprofessional conduct is already otherwise defined.

    The legislation in no way prevents any doctor from giving a speech or advocating the abolition of guns. What it seems to be designed to do is limit doctors, under color of they professional duties, to collect data on a subject when that subject has no bearing on their professional responsibilities. It seems to me that the Libertarian position would be to reduce rather than increase the amount of data gathered by either the government or licensed professionals about our private affairs -- especially if those affairs happen to have specific constitutional protections.

    However, Professor Volokh has not addressed the issue of physician liability if it becomes standard practice for doctors to give gratuitous advice not directly related to medical procedures. As someone who operates in the financial field, I assure everyone here that the legal profession is incredibly skilled at finding liability for either actions or non-actions that could possibly lead to bad outcomes.

    I, for one, would welcome the creative members of the legal community to find a doctor who either through action or non-action cause a patient to come to harm as the result of a gun incident.
    2.26.2006 3:38pm
    Henry Schaffer (mail):

    In the 1930's Congress didn't believe it had constitutional authority to outright ban the ownership of machine guns. Therefore, they tried to accomplish the same thing by creating a discretionary licensing scheme that only the Rich or Politically connected could get around, and the $1,000 license fee in the 1930's was so prohibitive cost wise that only the very wealthy could afford to pay it.

    $200? That still was a huge sum back then.


    Skip to the 1980's with no intervening change in the constitution suddenly congress has all the authority it needs to make an outright ban on the ownership of machine guns. Such an outright ban would have been illegal in the 1930s and is illegal and unconstitutional today, irrespective of opinion or any court rulings to the contrary.


    (It wasn't a ban on ownership - but it affected the manufacture of new machineguns for non-government-agency ownership.) I don't remember if it
    was a "ban", or just a decision to stop accepting registrations? :-)
    2.26.2006 3:45pm
    Mikeyes (mail):
    It is still a pretty draconian law, taking a person's livelihood away for expressing a view that if not part of the healing art is then opinion or political speech. If the purpose was to make sure that people are not harmed by physicians and other health professionals it would make sense, but I think that telling someone to secure their guns in the presence of little children is not on the same level as having sex with them. In the latter case undue influence can be a factor and in the case of a psychotherapist probably an illegal act in VA. The former case may be bad manners, but if you are offended, you would probably change doctors. Besides, do you do everything your doctor or dentist tells you? (Studies show that very few people are complaint with physicians suggestions or in taking their medications.) I doubt that my status as a physician is having much sway in this dialogue if you don't agree with what I am saying.

    In most states "unprofessional conduct" does not usually include speech but does include being intoxicated, stealing from patients, forced sex, assault, and committing a felony. The state medical board has jurisdiction over these issues under this proposed law, and they could issue a reprimand each time it was reported assuming the investigation would bear out the facts and would probably not do much more than that. Even then it is the board's decision to set a penalty.

    The board would also be sued under whatever state or federal statute that assures free speech (the First Amendment?). The most likely in the initial hearing argument would be that the advice was given as part of the exam and treatment and there will be a challenge to the wording involving "counseling" since part of health care is counseling patients about various issues such as smoking and diet. I understand that some of us on this list think it is inappropriate or insulting to ask patients about guns and consider anything that a physician does in this regard as undue influence. I don't think so, but I do object to physicians actively pushing their own agendas, including any pro-gun agenda.

    In addition this law means that no research could be done into the relationship of gun presence and illness or injury by a health professional. Thus the present research, which is generally used by anti-gun forces, is the last word.

    The AAP has always been very liberal and is not the spokesperson for all of medicine. In fact they only represent about 10% of physicians and I am sure that all pediatricians are not in accord with them. It would be like saying the ACLU represents all lawyers.
    2.26.2006 3:51pm
    Anderson (mail) (www):
    Mikeyes: but I think that telling someone to secure their guns in the presence of little children is not on the same level as having sex with them

    Gotta agree with you there.

    It's really remarkable, reading this thread, how few people can bear to have their ideologies even questioned. Doc sez maybe having a gun isn't a good idea? Pass a law shutting him up!

    One of my pet ideas is that America has lost, if it ever possessed it, the ability to politely disagree. Perhaps debate should be a required topic in school; people might at least have higher standards for what they see on TV and read on the Internet.
    2.26.2006 4:21pm
    Enoch:
    For a long time, free speech was seen as the province of liberals but more recently it's claimed as that of conservatives. This thread makes clear that suppression of free speech is no monopoly of the left. Conservatives are just as eager to suppress speech that they find objectionable. IMHO, the biggest problem with this thread is the people claiming that it's somehow ok to limit the speech of doctors because the doctors are biased or wrong in what they say, which seems totally irrelevant to the question. That's what free speech is all about -- the ability to be biased and wrong. Take that away and there's no free speech.

    Would you argue that the doctor's right to "free speech" extended to the use of derogatory racial epithets in the presence of the patient (even if not directed specifically at the patient), or simply saying "many blacks lead an unhealthy lifestyle, I need to warn you against these dangerous behaviors", or hectoring the patient about the negative health implications of his religious views, or lecturing him on the negative health effects of the homosexual lifestyle? Does any place of business have an unlimited right to create a hostile or intimidating environment for its customers simply through the right to "free speech"?
    2.26.2006 4:23pm
    lisamarie (mail):
    This law is stupid, but it's probably an example of one of the things that's wrong with the way government works. Once you get elected to office, you have the power to introduce legislation. With that, it's easy to start thinking that There Oughtta Be A Law about everything that bugs you. I'm speculating, but it wouldn't surprise me if what's going on here is that a legislator got a complaint from a constituent who went to one doctor, said they kept a gun, and happened to get a lecture from that particular doctor about how unsafe having a gun in the house is. You can just tell the doctor it's none of his, or find another doctor. But if you're a legislator, you can transform your indignation into stupid law. I personally think that's what's behind a lot of crappy legislation in this country.
    2.26.2006 4:29pm
    GONZO (mail):
    Interesting that you chose only to address "sex with patients" issue which is a stark enough difference from the guns issue to make it an easy call.

    But what about:

    1. A concerted information collection and "public health" campaign attempting to coerce people against homosexual lifestyle itself based on political motivation of the medical group. (i.e., imaging a group of christian physicians not so concerned about health as they are focused on eradication of homosexuality).

    2. A concerted campaign relative to illegal migrant workers under the auspices of "public health" again, but as before instituted by a medical association with another axe to grind (i.e., wanting to expose and harass undocumented workers).

    3. What about a concerted campaign relative to the circumcision issue but where the medical association pushing it had documented anti-semetic tendeancies.

    4. What about a pediatrics group that organizes an information collecting campaign on whether their single-mother patients are having dating partners sleep over when the children are home (there is statistical evidence this is an impact on the children), but where the group pushing this is a "men's rights" group with an agenda puntivie to the mothers and not so focused on the kids.

    These examples, I think, would all result in outrage. Its amazing to me that the medical associations issue joint press releases with anti-gun groups about this stuff, and then people are surprised when folks start to question the motivation and medical bona-fides of this information collection and patient lobbying. The issue here is not to constrain doctors from giving good faith input, its to challenge them when they become pawns for zealots of various stripes. The AAP has, I believe it is reported, accepted finacial considerations and partnered in research studies with anti-gun groups. Its the dressing up of an ideological agenda as a "public health" issue (i.e., doctors suggesting to patients that the only basis for their belief is a health or medical issue, when their or their organizations personal politics are actually driving things) that becomes a concern.
    2.26.2006 4:30pm
    Moneyrunner43 (www):
    Sorry people, this is a medical ethics issue dressed up in "free speech" drag. As I said, no one is going to prevent doctors from making any kind of a public statement on anything. But in a doctor-patient relationship we have a situation analogous to a work environment. If, in the workplace I make suggestive comments to a co-worker, under present law I may be charged with sexual harassment, especially if I am the woman's manager.

    Until I got fairly ancient, I called Dr. John Jones "doctor" not John. Doctors have the same relationship to their patients as supervisors to the people below them.

    This may not have been an issue until certain medical groups became advocates for gun abolition. I, for one, do not like to have my rights infringed by a medical professional who can be required to turn over his records via a subpoena. This is not a proper venue of the medical profession. I am rather surprised that a Libertarian leaning group believes that it is.
    2.26.2006 6:21pm
    Anderson (mail) (www):
    GONZO, the answer to your Parade of Horribles is that the patient says to the doctor, "Buzz off," and finds another doctor.

    What is *with* you people? Why do you have to protect yourselves from even encountering a different point of view from your own?
    2.26.2006 6:29pm
    Alec Rawls (mail) (www):
    If doctors are asking about gun ownership then they could well be entering this information into medical records, which becomes both a Second Amendment issue and a privacy rights issue.

    There IS a constitutionally protected right to privacy, even if it cannot be plausibly interpretted to encompass a right to abortion. (Something is private if it does not involve harm to non-consenting parties, which at the very least is not clear-cut in the case of abortion. Click on my link to see my post on saving privacy rights.)

    Keeping doctors from pursuing politically sensitive information, on the basis of political motivations, seems a perfectly reasonable step to protect privacy, which is particularly important related to guns, given that the same people want to pass laws to take everyone's guns away.

    In sum, speech rights are not the only constitutional values at stake here, and they are overweighed in this instance by the other constitutional concerns.
    2.26.2006 6:46pm
    GONZO (mail):
    >>>>GONZO, the answer to your Parade of Horribles is that the
    >>>>patient says to the doctor, "Buzz off," and finds another
    >>>>doctor.
    >>>>
    >>>>What is *with* you people? Why do you have to protect
    >>>>yourselves from even encountering a different point of view
    >>>>from your own?

    Oh, come off of it.

    In addition to taking their business elsewhere, many of those consumers in my examples will be in contact with the licensing authorities to discuss just HOW the actions of the physician have anything to do with the practice of medicine. Likewise, they'll be promptly in touch with their liberal democratic politicians who have demonstrated time and again that THEY have no problem overlooking free speech issues in order to protect the liberal shibboleth of the moment.

    Speaking of "you people," I for one (as a mall "l" libertarian and Ayn Rand objectives) continue to be amazed at the condescending mindset that posits that university or otherwise "higher" educated folks (like doctors) gain by their schooling an almost "philosopher king" status by which they deign to guide the unwashed masses even as to things that are wholly unrelated to their area of expertise and the framework of their license.

    Until I hear of medical doctors stopping patients before any diagnosis or procedure and advising them that more people die each year at the hands of their physicins than die of firearms, I'll contine to question whether those folks are abusing their position of trust to further ideological agendas.

    Have a nice day.
    2.26.2006 6:53pm
    Frank Drackmann (mail):
    The transfer tax to buy a machine gun, sawed off shotgun/rifle, or silencer has been $200 and hasn't been changed since the law went into effect in 1934. There is also a category called "any other weapons" which includes all sorts of cool things like"cane guns"(a cane with a built in gun), and variants, and only has a $5 tax. The law restricting new manufacture in 1986 only applied to machine guns, so sawed off shotguns and silencers are still reasonably priced. Also, before the ban in 1986 individuals could manufacture their own machinegun by converting a semiautomatic weapon as long as they got ATF approval and paid the tax.
    2.26.2006 7:10pm
    GONZO (mail):
    **What is *with* you people? Why do you have to protect
    **yourselves from even encountering a different point of view
    **from your own?

    By the way, I don't think anyone is saying that M.D.'s can't have a contrary view on gun control, and write as many letters to the editor, give as many public speeches, or donate to as many groups as they want.

    What WE are saying is that they don't get to abuse the sanctity of the physician-patient to advance a political agenda. Its really not that difficult. I don't mind anyone challenging a view different from my own. But its a little different when the person pontificating to me is in the middle of giving me an annual and wants to recite the bullet points from VPC propaganda whilst his gloved finger is up my rectum searching for prostate enlargement. Don't want to get this kind of pushback, stick to MEDICINE while you practice medicine.
    2.26.2006 7:16pm
    frankcross (mail):

    Would you argue that the doctor's right to "free speech" extended to the use of derogatory racial epithets in the presence of the patient (even if not directed specifically at the patient), or simply saying "many blacks lead an unhealthy lifestyle, I need to warn you against these dangerous behaviors", or hectoring the patient about the negative health implications of his religious views, or lecturing him on the negative health effects of the homosexual lifestyle? Does any place of business have an unlimited right to create a hostile or intimidating environment for its customers simply through the right to "free speech"?


    I think so. I'd want to know a little more info. For example, are there alternatives. If the patient had no realistic choice in doctors, I would be more concerned. But I assume that for the overwhelming majority of places of business, free consumer choice pretty much cures the problem. And incidentally prevents the problem because businesses want customers.

    I'm no fan of hostile or intimidating speech. But I'm less of a fan of the government deciding what constitutes hostile or intimidating speech.
    2.26.2006 7:29pm
    Anderson (mail) (www):
    What WE are saying is that they don't get to abuse the sanctity of the physician-patient to advance a political agenda.

    Beware of The Argument From Sanctity, is one of my axioms.

    Gonzo, it appears that some *doctors* may have a different view of that relationship than yours. So let's just declare their opinion illegal, okay?
    2.26.2006 7:34pm
    RTG:


    In addition to taking their business elsewhere, many of those consumers in my examples will be in contact with the licensing authorities to discuss just HOW the actions of the physician have anything to do with the practice of medicine. Likewise, they'll be promptly in touch with their liberal democratic politicians who have demonstrated time and again that THEY have no problem overlooking free speech issues in order to protect the liberal shibboleth of the moment.

    And your point is that you are no more principled then these people? People who hold different political views then you promote the "nanny-state" and the "right not to be offended," so you have decided to throw your libertarian principles to the wind and promote nanny-state legislation more to your liking?
    2.26.2006 7:48pm
    GONZO (mail):
    No, my point is that the "Free Speech" concerns are a smokescreen conveniently erected in this case to facilitate social engineering by persons in a position of power and whose profession is being coopted by a politically motivated interest group. I point out that the champions of free speech here are silent when they seek to regulate a professional through his license for purposes of advancing a liberal issue. Anyone remember the license actions taken against pharmacists who did not want to dispense the "day after" pill? What about the recent much to do when Walmart indicated it did not wish to carry such medications in its pharmacies. Hey, the patients can go elsewhere right?

    As Mr. David Kopel wrote elsewhere:

    "People in pain, people fearing cancer, and people who are injured and weak are vulnerable. They all look to their doctor to do right — right for the patient, rather than for the insurance company, or for the doctor's view of social policy. Doctors have a fiduciary relationship with their patients. They are obligated to set aside personal agendas and put the patient first. Putting the patient first means that the doctor must respect boundaries in the relationship with the patient. So when the doctor makes a pass at a patient, or tries to sell her real estate, or lobbies patients against gun ownership, the doctor is committing an ethical-boundary violation. Patients notice when a doctor abuses their trust or takes advantage of their pain and fear."

    And to the a couple posts up: Again, no one's saying that doctors who believe they are philosopher kinds should have their opinions made illegal.

    But if they want to be licensed by the state, they should limit their "practice" to things to which that license applies.

    An OBGYN, for example, must ask a lot of very invasive questions to a woman in her care: Whether she's sexually active; how often; how many partners; whether it hurts. Those questions all go, however, right to the practice of medicine, and the reason she is there.

    But that OBGYN who tells the woman "You know, statistics teach us that its really bad for women to bring up children without a proper male role model, and by the way, my brother is a nice guy and he's available" engages in a boundary violation. At the behest of someone to whom the doctor owes no medical duties, that doctor is taking advantage of access to the patient to advance a personal agenda.
    2.26.2006 8:13pm
    logicnazi (mail) (www):
    Mikeyes,

    You accuse me of having no knowledge of the subject (which I believe to be in error) but then offer no reason to believe what I say is wrong and offer a litany of dogmatic claims with little support, or true statements with no relevance.


    Psychiatrists deal with mental illnesses which, for the most part, are biologically and genetically determined and usually quite severe. Suicidal patients brought to the attention of a psychiatrist are driven to kill themselves in many cases. These are not the worried well. Studies show that untreated Major Depressive Disorder has a 15% mortality (that means death) rate, so any effort to change that statistic is in the pervue of the physician. To imply that suicide is always a rational option in these cases is evidence of ignorance of the facts.


    Yes, depression is biologicall determined but then again so too is every psychological fact from belief in religion, to cruelty to morality. There is also good reason to believe depression is genetic (as in reasonable correlation with incidence in ancestors not on/off type mischaracterization of this) but what is the significance of this? I seem to vaguely remember a study that showed that disposition to religiousity is genetic. Does this mean we ought to treat people for being too little/too much religious? Hardly! The genetic effects are interesting things to know and might help developing treatments but don't make any difference to this discussion. Ultimately the idea that we can draw some kind of distinction and say that depression is a disease of the brain with a biological cause but that happiness, love, staisfaction, faith (or disposition thereof) aren't similarly biological is just an appealing fantasy.

    The actual percent of people who commit suicide is also totally irrelevant. In case you hadn't noticed I wasn't saying that doctors are somehow hurting people with depression, nor was the example of 2 patients killing themselves supposed to be anything more than an arbitrary example. I was just saying that the feedback is imperfect because physical harm/damage shows up on the radar screen much better than low scale unhappiness. In other words I am suggesting that doctors are not maximizing the expectation of patient utility but instead maximizing the expectation of patient bodily health. I also obviously believe they should be doing the former and I think this is part of what is happening in the gun situation.

    Also I never made the claim that suicide is always a rational option in these situations. I do happen to think it is a rational option for people with extreme depression after availible treatment has failed, the condition has persisted long enough to have give good reason to believe it isn't temporary, and your death won't cause excessive hardship to others. HOWEVER, suggesting that even the way you misunderstood my claim demonstrats an ignorance of the facts itself demonstrates a great deal of ignorance. As Hume observerd "Tis not contrary to reason to prefer the destruction of the whole world to the scratching of my finger." Ultimately whether or not suicide is rational depends on what you accept as a viable end. I could believe that suicide was morally required for everyone and there just wouldn't be an empirical fact you could point to which would demonstrate this was wrong. However, even on a reasonable conception of what is valuable/worthwhile, e.g., a utilitarian one, if one has good reason to believe that your life in the future will involve more suffering than pleasure and this isn't outweighed by the pleasure your life brings to others it is rational to commit suicide.


    As for narcotics, for the most part they are not treatments for mental illness, any more than alcohol is even though many people self-medicate with both substances.


    If you are just saying that doctors don't use them you are agreeing with me. If you are saying that most depressed people shouldn't take such substances then you are still agreeing with me. All I suggested was that in the above cases where suicide would be rational if narcotics weren't an option then doctors should try narcotics. Living in a drugged stupor might not be the best thing in the world but if it makes life better than killing yourself there isn't much of a downside. Additionally there is some dispute over the efficacy of opiates as medications for depression but this mostly focuses over the use of codeine/subutex/other weak opiates or mixed agonists/antagonists and is really a completely different issue.

    I presume the rest of your comment is not a response to me since I agree with much of it. All I'm saying is that many doctors fail to take into account the benefits in enjoyment from gun use because that idea may be very foreign to them.
    2.26.2006 8:48pm
    therut:
    Just to show how hysterically politically correct physicians can become I will tell about my fellow physicians at the hospital where I work. Now I hate authoratarian personallities and laws. Arkansas has been bitten by the ban smoking laws. A recent law has banned smoking on all hospital owned property but there is an exception of psychiatric hospitals and the physician can write an order at any other type of hospital and let the patient go outside and smoke. But this was not good enough for my hypocrites (some who smoke,chew,get drunk, drive too fast, commmit adultry, date hospital staff etc) they even will not allow that. I asked them if there was a patient(and we have them like this) who was a diabetic who came in with ketoacidosis but after the initial crisis wanted to go smoke. This patient said she would leave immediately if not allowed to go outside and smoke. Would they just let the patient go knowing it could cause her death or at least she would show up again within 38 hours as sick as she was from the beginning. They all said it would be her fault if she died. Not one of them cared as not allowing smoking is more important. I still write the orders. My patients still get to go outside and smoke. I tell them to call the administrator at 0200 and complain to him. I haven't had him yet say a word to me. Some people are hollier than now.
    2.26.2006 8:58pm
    Anderson (mail) (www):
    Some people are hollier than now.

    So true. Particularly in December.

    But would you say that a physician's asking a patient whether she smokes could be made illegal by the State?

    What about asking a parent whether she smokes in the course of evaluating the child.
    2.26.2006 9:33pm
    The NJ Annuitant (mail):
    How about an anti-gun doctor group coming to the conclusion that gun ownership is child endangerment , per se.
    Since the State gives the docs a monopoly on the practice of medicine, I believe the State can regulate the practice of medicine, including banning intrusive questions based on a political/social agenda.
    The State can require professional speach in the case of reporting suspected child abouse. It all comes from the power to regulate the practice of medicine.
    2.26.2006 9:54pm
    Mikeyes (mail):
    logicnazi,

    I haven't had Hume quoted to me since college. ;-)


    The genetics of depression, bipolar illness and schizophrenia are all well documented in thousands of papers from early twin studies to mosern gene mapping and I would be glad to send a few abstracts to you if you wish. and the question of rational suicide is not what I was referring to.

    My concern about suicidal patients is a here and now issue. If the police bring in and acutely suicidal patient, I have to ascertain whether or not they are a danger to themselves using incomplete knowledge. Asking if they own firearms is one of the questions I ask (I also ask if they have been drinking) but under this proposed law, it would be part of my workup and not subject to sanctions. When I made my remarks (and I apologize if I offended you) I was under the impression that the law proposed a universal ban which would have been disastrous.

    This is not the place for a discussion of rational suicide and while we differ in our views, I respect your right to say what you said about it. I just happen to think you are wrong. Perhaps the difference between and intellectual and a practitioner, both have legitimate points of view.

    NJAnnuitant,

    Does the state have that kind of power that it can micromanage every aspect of a profession beyond public safety and competency? I'm not sure that your example of child abuse is the same thing as most states have a reporting requirement that is broad based (teachers, police, health care professionals, social workers, and others all required to report) and has an obvious public benefit. Banning certain types of specific political speech is pretty narrow. I'd be very concerned if that were true.

    My personal opinion is that such speech is not professional and will not do a doctor's practice any good if he or she offends patients. I'm not sure that being an asshole is subject to criminal sanctions, however. I think a physician should keep his or her religious, political, and sexual preferences to himself as it has nothing to do with doctor-patient relationships. The focus is not on the doctor, but on the patient and the patient is all important in that professional encounter. I'm not sure that every instance of this has to have a corresponding law to regulate it simply because a powerful lobby group is offended.
    2.26.2006 10:41pm
    therut:
    Anderson--------I do not think you have a constitutional right to smoke. Plus I gave up asking parents if they smoke. I could care less as far as their children go. I do not buy into the 2nd hand smoke propaganda. I could ask all kinds of things as mentioned above. A single mother who lets a boyfriend live in is probably more dangerous to her children than her smoking ever would be. So is getting drunk with said boyfried and children in the home. So is parents smoking pot with and in front of their children. Or watching porn with their children. Do you really want me to be my patients moral policeman. Firearms in the home is very very far down the list. I see children that I can probably predict with 90% accurancy their life will involve an illegal act that gets them arrested just by seeing and knowing their parents. What am I to do????????????????? Call the police or the social service nannies because they are what I consider poor parents. We do not have enough money to even put a dent in that problem. Plus social services in my experience do very little. Sometimes they make things worse. Academic medicine is like everything else academinc it is far removed from the real world.
    2.26.2006 10:55pm
    Dilan Esper (mail) (www):
    Folks:

    1. Nobody has the right to have the government protect them from offense. Apparently some people are offended because some doctors' groups support gun control or even gun bans. But that's their right! Guess what-- the Second Amendment is controversial. Some people think that guns do more harm than good. Some people don't believe that the Second Amendment should confer an individual right.

    Perhaps those people are wrong (I happen to think they are wrong), but they have the right to that opinion and they have the right to express it.

    2. Apparently many posters have a crabbed view of medical practice. Is a doctor's sole role to simply treat the specific ailment that is brought to his or her attention? That certainly isn't the traditional conception of the doctor's role. Family doctors, in particular, ask about their patients' lives and make recommendations that might preserve their health or extend their lives. But even other doctors sometimes ask about things that are outside the scope of whatever the consultation is about.

    For instance, if you come in for a broken elbow, but it happens that you are also grossly obese, the doctor-- even if he is a surgeon who has no specialty in obesity-- might very well tell you to lose weight and recommend diet and lifestyle changes. That is well within the scope of proper medical advice. And don't think that doesn't offend some patients, either-- I am sure that some people, especially those who are defensive about their weight, will react by taking offense and saying or thinking it is none of the doctor's business.

    Now, if the Fat Acceptance Society came in and tried to get a law passed that doctors must not mention a patient's being overweight unless specifically consulted to treat obesity, would that be a wise law? Would it comport with the First Amendment?

    Of course, one could say that obesity is a health issue while guns aren't. That's true in a sense, but guns ARE a safety issue. Further, doctors-- again, especially family doctors-- may very well provide information about household safety. Doctors, after all, sometimes recommend specific baby products, cribs, strollers, and the like. These aren't health products-- they are safety products. Recommending that a gun owner buy a set of trigger locks is a safety recommendation as well.

    3. I realize that the NRA and many gun owners have slippery slope concerns about gun registration (i.e., that it will create a government database that will later be used to take away your guns), but really, that ISN'T likely to happen. America has been a nation of firearms owners since its founding. Many Americans hunt, many others have guns for self-protection.

    But even if the slippery slope concerns are valid in general as an argument against gun registration, it seems like a huge jump to raise slippery slope concerns about your DOCTOR asking you about your guns. Your doctor is not the government, and many doctors won't ask anyway, so there isn't much chance that the government will get a workable gun registry out of the ad hoc questions of certain doctors. So you have two levels of implausibility with a slippery slope argument in this situation.

    I think that gun owners have a strong argument that owning firearms is protected under the Constitution. But the knock on NRA types is that they are paranoids, always convinced that the troops are going to come jumping out of the black helicopters on their back lawn to confiscate their guns. Support for this sort of legislation on slippery slope grounds feeds that impression.

    Professor Volokh is right. If you don't like your doctor asking you about guns, go to a different doctor. But doctors who do ask are not doing anything outside the scope of medical practice, traditionally understood. And the government has no business passing a law just because you are offended, and the extremely ephemeral slippery slope concerns raised here do not justify infringing on doctors' free speech rights.
    2.26.2006 11:05pm
    therut:
    Maybe gun owners are "paranoid" because there are gun bans. Maybe because the USSC semms to keep quiet on a issue of great importance to millions. Maybe because they refuse to protect the 2nd amendment not only from Federal infringement but also they have never protected it aganist State infringement. Maybe we arn't paranoid. There are places in this country I can not live because my private property that I legally own would make me a felon. Maybe I am just paranoid. I don't think so. And the NRA is less vocal than the gay rights, and abortion activists no matter the screeds written by the NYT saying otherwise. When is the last time you saw a protest march of gun owners in DC. Or how about a gun rights parade. Think NYC would host that? I think we are a very low key and long suffering bunch of citizens who try to work through the democratic process since the USSC will not protect our rights or yours. So what if it is controversial when has the protection of rights not been.
    2.26.2006 11:23pm
    Ken Arromdee (mail):
    Does the state have that kind of power that it can micromanage every aspect of a profession beyond public safety and competency?

    Trying to stop one pediatrician from asking kids about their parents' guns is micromanagement.

    Trying to stop an organized campaign involving many doctors and a major pediatricians' association isn't micromanagement. It's just management.
    2.27.2006 12:38am
    subpatre (mail):
    Professor Volokh, the reporter wasn't inaccurate, just had a slight bias; unfortunate when the actual impassive wording's available. It's far clearer in the text that medical professionals can't make "Oral or written inquiry..." A small quibble to be sure.

    The article also says that the bill "...blocks a common practice by medical professionals to inquire about gun ownership and safety when they go over a safety checklist with parents..."

    It's not common, when "common" means general, usual, ordinarily, or normal practice. It's probably not rare either, but less than 10%. I've never met a doctor that asked those questions.

    Virginia is a moderately pro-rights state concerning firearms. The General Assembly is 58-Rep, 40-Dem, 3-Ind; their vote for the bill was 88-Y 11-N. As several other comments made clear, doctors [overall, and especially in Virginia] likely own guns at a higher proportion than the general population.

    The bill allows doctors full latitude to answer queries, review dangers, even lecture or harangue. It prohibits non-health questioning camouflaged as board-certified medicine. This is especially relevant to pediatrics, where the patient may not be able to distinguish relevance or privacy; especially unfortunate that field is the one most at fault.
    2.27.2006 12:54am
    subpatre (mail):
    Correction: The Virginia General Assembly has 57-Rep, 40-Dem, and 3-Ind; 100 members in all. Dunno how that slipped by.
    2.27.2006 1:20am
    Visitor Again:
    Why does the pediatrician have to ask about the parents' gun ownership when just talking about gun safety in general will do the trick?

    Almost 40 years ago, as a young father I twice dislocated--or at least hurt--the shoulder of my two-year-old daughter in physical play, first by pulling her by the arms and a few months later by swinging her by the arms. Both times a visit to the emergency room quickly took care of it, but I felt horribly guilty about causing pain to my precious little girl. The second time the doctor interviewed my daughter alone, presumably to make sure it was an accident and not deliberate abuse After the first incident, the doctor told me to be careful in play and not to yank her arms. I didn't but I did swing her, thinking that was okay since it did not involve a yank. I'd done it many times before without incident.

    I wish some doctor had told me BEFORE THE FIRST OCCASION to be careful how I played with my duahgter, not to swing her or pull her by the arms and the like. Common sense to most of you perhaps, but it was not to me. And I suspect some young parents are as stupid as I was.

    I'm all for doctors generally discussing child safety with parents. It need not be intrusive. If it is, move on to another doctor.
    2.27.2006 1:21am
    Max (mail):
    If you are worried about doctors keeping databases of gun owners, why not ask Virgina to pass a law that forbids them from recording any information about gun ownership? They could ask about guns if they wanted, give you advice if they wanted, but they couldn't write it down in the records.

    Virginia might even forbid any databases by anyone on gun ownership, if that was their inclination.
    2.27.2006 1:25am
    Ken Arromdee (mail):
    why not ask Virgina to pass a law that forbids them from recording any information about gun ownership?

    Because there's no way to tell if the doctor's recording the information (unless he's dumb enough to do it in front of the parents). Banning recording instead of questioning would be unenforceable.
    2.27.2006 2:56am
    Becky Dale (mail):
    VA Pilot columnist Kerry Dougherty has acolumn on this that you all would find interesting.
    2.27.2006 6:32am
    The NJ Annuitant (mail):
    I think that State has very broad powers to regulate the practice of medicine, and the State has very broad powers to protect the privacy interests of patients. In terms of the First Amendment, barring intrusive political/social questions is, in my opinion, reasonable regulation of commerical speach.
    Doctors are perfectly free to write letters to the the editors of peiodicals, post on the internet, and generally carry on in public about why private gun ownership is a bad thing.
    2.27.2006 10:12am
    Max (mail):
    > Because there's no way to tell if the doctor's ....

    Sorry, but that doesn't sound very convincing. If this issue is important enough, Virginia's legislature would presumably attach a severe enough penalty to the crime that the doctors wouldn't dare write it down. To be completely ridiculous, if the penalty was twenty years in prison or life without parole, I doubt there would be a problem.

    More realistically, even a fine of $100,000 and loss of license would be sufficient.
    2.27.2006 10:23am
    Mikeyes (mail):
    Max,

    If there was such a law, then there would have to be a mechanism to check on whether the law was being adhered to which would involve an Office of Medical Records Compliance (OOMRC) that would be able to come in and check your records, without warrant probably, at any time and copy or sequester those records. I think this would engender a lot more concern about privacy than some doctor asking if you had guns in the house. Would you want that?

    I still think it is micromanagement to shelter patients from political speech (of course, it is my ox being gored.) The present Virginia law already has this provision: "16. Performing any act likely to deceive, defraud, or harm the public" which may cover this problem if a there was a complaint to the board. (They also have a provision concerning the performance of "criminal abortion".)

    The law does not have a preamble that addresses a class of doctors: "These laws are being promulgated because AlQaida the American Academy of Pediatrics has held such thrall over many (as in the primitive counting system of 'One, two, many") doctors who uncritically accept the advice that guns are harmful to families. These treasonable acts must be stopped." Rather the rules, which seem fairly obvious to me since they address criminal acts, incompetence and gross abuse of position, are common sense ones which reflect the experience of medical boards across the country.

    I suspect that there are some limits to the state's ability to regulate any profession. I think that all of the Bill of Rights would be involved in setting those limits along with the various state constitutions. I just wonder if it is worth the unintended consequences that might come out of such specific regulations such as the formation of an OOMRC (which exist in some forms in many states due to over-regulation, the mental health clinic laws in WI being one example.)
    2.27.2006 11:44am
    Gordo:
    The NRA is to the 2nd amendment what the ACLU is the 1st amendment.

    A one-trick pony.

    The difference? The NRA has more power than the ACLU.

    Can you imagine if a state legislature was completely beholden to the entire ACLU agenda?

    That'w what we have in most states of the nation. Only with the NEA, not the ACLU.
    2.27.2006 12:39pm
    Gordo:
    Well, actually that's the NEA, not the NEA.

    But, completely off the point, that really wasn't a typo, was it!
    2.27.2006 12:39pm
    Gordo:
    AAAAIIEEEEE! NRA.

    My fingers were misaligned on the keyboard. Again.
    2.27.2006 12:40pm
    therut:
    Maybe these politicians are beholden to the 2nd amendment. THE ACLU theories and such cover many more topics and are not based necessarilty on the constitution but their current pet theory and agenda. The 2nd amendment is well just the 2nd amendment. No matter how hard some have tried to make the amenment mean something other than what is written (kinda like the ACLU does) very few buy it. Unfortunately the US citizens can read for the most part.
    2.27.2006 1:20pm
    Max (mail):
    Mikeyes writes:

    ...(OOMRC) that would be able to come in and check your records, without warrant probably...


    Yes, this is a convincing counterargument. I hadn't considered that aspect. It might be possible to have some less intrusive enforcement mechanism, but I don't know enough to say one way or the other.

    My original thought was that the law as described by Eugene seems to address the wrong problem. I doubt that any of the supporters of the law really worry about doctors or anyone else asking the questions. The supporters are quite capable of saying "Mind your own business". They care (I suspect) about records of the answers being maintained. So if they really want to prevent that, the laws should address that problem directly to the extent possible.

    This all assumes that getting the government involved is a good thing. The supporters believe it is. If I read you correctly, you believe we have enough government interference in our lives already.
    2.27.2006 1:33pm
    Gordo:
    That's funny, Therut, since the 2nd amendment is written rather ambiguously to any dispassionate observer. The argument that it only applies to state militias was dominant in constitutional law circles until Professor Volokh and others started challenging it, and still could be described as the "clear majority" view.

    Whereas, the First Amendment, taken literally, is quite less ambiguous.
    2.27.2006 1:34pm
    ray_g:
    Not exactly off topic, but a step sideways: I think a big problem is too many people believe as posted above: " Fact is, that Physicians are in a "power" position with the capability of exercising undue coercion". No they are not. You are hiring them, just like you would an auto mechanic. If they won't listen to you, fire them, i.e. get another doctor. If they ask intrusive or stupid questions, tell them it is none of their business.

    I have no wish to offend any doctors out there, but due to a couple of incidents I now assume all doctors are idiots until proven otherwise. Happily, > 99% of the time they aren't, but they still have to prove it to me. I think this is a wise policy for everyone.

    It is funny how each doctor has their own prejudices. After a motorcycle accident, I was seeing a top notch orthopedic surgeon in Los Angeles. He specialized in sports injuries. Each time I saw him he would ask if I had given up motorcycle riding and give me mini-lectures when I said no. Finally I got fed up and told him that unless he asked the football players he treated for torn up knees if they were giving up football he could STFU. He stopped lecturing me. (BTW he was a very good doctor and I was very happy with the service he gave me.)

    In summary, I think people need to be a little more assertive with their doctors. I think this would be good for both the doctors and the patients.
    2.27.2006 2:06pm
    Mark Hagerman (mail):
    Since physicians are "mandatory reporters" to "child protection" authorities, actively preventing them from discovering the presence of guns in a household may be necessary to keep people from having their kids kidnapped by the State.
    2.27.2006 2:20pm
    Dilan Esper (mail) (www):
    therut:

    I don't disagree that Second Amendment rights should be protected, but the fact that they aren't does not mean that anyone's going to take away your guns (remember, despite the fact that courts permit gun control and gun prohibition, only a few places in the entire country in fact prohibit gun possession, and in most places, your right to bear arms is broadly respected), and it certainly doesn't mean that the government needs to render guns off limits in doctor-patient communications because the doctors might somehow collect gun information that might somehow become the basis for a later governmental action to confiscate anyone's guns. If you can't see that the latter scenario is paranoid, I can't help you.
    2.27.2006 3:08pm
    Bill Twist:
    Gordo

    The argument that it only applies to state militias was dominant in constitutional law circles until Professor Volokh and others started challenging it, and still could be described as the "clear majority" view.



    Actually, the dominant view, pretty much the only view, right up to around the turn of the last century (ie., 1900) was that the Second Amendment guaranteed an individual right. That fell by the wayside about a hundred years ago, and only since the 1980's has serious legal scholarship come to the fore to refute the mistaken idea that it doesn't protect an individual right.

    Back to the subject at hand, however.

    If you expect to get lectured by your pediatrician on guns in your home, tell her that it is none of her (most of the ones I've met were female, might explain a lot...) business how you store your firearms. If pressed, remind her that while firearms accidents cause the deaths of about 40 children under age 14 in the US every year, physician mistakes account for about 50 deaths in children under 14. Then point out that while there are between 40 and 50 million gun owners in the US, there are only 6 million doctors, so that logically the pediatrician herself is a far greater danger to your child than any firearms you may or may not own*. If she questions the source of your data, give her this website:

    http://webapp.cdc.gov/sasweb/ncipc/mortrate.html

    Which is the "National Institute for Injury Prevention and Control" WISQARS mortality database, part of the larger "Centers for Disease Control" (CDC).

    That oughta take the wind out of her sails, and in addition might make her think before she gives advice about things she doesn't know about.


    *Per year, that works out to roughly 1 accident death per million firearm owners, and about 8 deaths by medical mistake per million pediatricians.
    2.27.2006 4:00pm
    Gordo:
    Bill Twist:

    If you want to tell your physician to go to hell and fire her, that's your prerogative.

    It's not your prereogative, or that of any other 2nd amendment absolutist for that matter, to pass a law forbidding her to do her job to protect the health of her patients.

    As for your comparison of the relative dangers of physicians vs. guns, you have quite frankly made a ludicrous argument. While physicianss may kill 50 kids a year, they save thousands, and make the health of millions better. Unless you are willing to argue that the unlocked arsenal cases of gun-happy parents has saved thousands of children's lives, just give it up.
    2.27.2006 4:05pm
    Gordo:
    Bill Twist, nice little bit of misogyny thrown in there too, by the way.
    2.27.2006 4:06pm
    Enoch:
    Fact is, that Physicians are in a "power" position with the capability of exercising undue coercion". No they are not. You are hiring them, just like you would an auto mechanic.

    Yes, they are. It is a fact that they have much more influence over the average person than an auto mechanic. Few people have the strength of will to defy a physician, especially because often when they visit a doctor they are scared and sick.

    most of the ones I've met were female, might explain a lot...

    65-70% of all pediatricians are female. Women are less likely than men to own guns or approve of gun ownership. There you go.
    2.27.2006 8:07pm
    Enoch:
    It's not your prereogative, or that of any other 2nd amendment absolutist for that matter, to pass a law forbidding her to do her job to protect the health of her patients.

    Balderdash, you can't prove that her asking this question is absolutely necessary "to protect the health of her patients." And if it is, that certainly opens up practically endless possibilities for what she can ask you. I mean, if you think about it, what aspect of your life doesn't have a health aspect to it? Who you are, what you do, where you live, what you own... she could justly ask about all of that on grounds of "protecting your health".
    2.27.2006 8:10pm
    therut:
    Gordo---------Absolutists that is a laugh. If I was an absolutist I would demand the government pay for poor people a sufficent number of firearms and ammo. I would demand that adolescents can own them without their parents knowledge and that schools run gun clinics and provide information to adolescents so they know where they can go and get their firearms without their parents knowledge. I do not think I or the NRA even come close to some absolutists on other "rights" even those made up by the USSC.
    2.27.2006 8:53pm
    Bill Twist:
    Gordo:

    Bill Twist, nice little bit of misogyny thrown in there too, by the way.


    What misogyny? Merely observation, in that:

    1. Most pediatricians I have met are women, and
    2. Women are less likely, over all, to have a positive view of firearms.

    Now, I'm not saying that *ALL* women have a bad view of firearms. However, a quick sanity check will reveal this:

    How many nationally known anti-gun people are women? Quite a few, really. I can think of Diane Feinstein, Carolyn McCarthy, Hillary Clinton, Barbra Mikulski, Sarah Brady, Rosie O'Donnell, and quite a few others.

    Now think of nationally known pro-gun women. Having trouble thinking of some? No suprise. I can only think of a couple myself, and they aren't as famous as the people I listed above.

    So, no misogyny here, just an observation, and no more misogynistic than saying women tend to like wearing makeup.

    As for this statement:

    As for your comparison of the relative dangers of physicians vs. guns, you have quite frankly made a ludicrous argument. While physicianss may kill 50 kids a year, they save thousands, and make the health of millions better. Unless you are willing to argue that the unlocked arsenal cases of gun-happy parents has saved thousands of children's lives, just give it up.


    One, we don't have a good idea of how many kids are saved by guns every year, although I would imagine that it is less than those saved by doctors.

    However, I was comparing 'accidents' (ie., medical malpractice leading to a fatality) to 'accidents' (accidental firearms deaths). So the comparison is somewhat valid.

    Actually, I was being generous in that I was using the total number of doctors, not the total number of pediatricians, which is far less. That would make the rate for the doctors soar.

    If the AAP just recommended that you keep your guns secured, I wouldn't have a problem with that statement. It's common sense, really. Heck, I have a toddler at home and my guns are secured out of his reach. They don't stop there, however. From their website at http://www.aap.org/healthtopics/safety.cfm :


    Advice to parents

    The best way to keep your children safe from injury or death from guns is to NEVER have a gun in the home.

    * Do not purchase a gun, especially a handgun.
    * Remove all guns present in the home.
    * Talk to your children about the dangers of guns, and tell them to stay away from guns.
    * Find out if there are guns in the homes where your children play. If so, talk to the adults in the house about the dangers of guns to their families.

    For those who know of the dangers of guns but still keep a gun in the home

    * Always keep the gun unloaded and locked up.
    * Lock and store the bullets in a separate place.
    * Make sure to hide the keys to the locked boxes.


    They don't give the same advice for pools. In fact, other than the common sense measures they say don't get one if you child is under six. They don't say this:

    * Don't buy a pool, especially a kiddie pool.
    * remove all pools presently at your house.
    * Talk to your children about the dangers of pools, and tell
    them to stay away from pools
    * Find out if there are pools at the homes where your children play. If so, talk to the adults in the house about the dangers of pools to their families.

    That, my friend, crosses the line from safety counseling to political advocacy. If as a pediatrician you do that you are crossing a line. And I, as a knowledgeable gun owner, will call you on it.

    Having said all that, preventing them from saying it if they wish is also a blatant violation of the First Amendment. I like *ALL* of my rights, thank you very much.
    2.28.2006 9:58am
    IANAL:
    It might sidestep the whole privacy-in-medical-records issue (in regard to generic pediatric advice) if instead of asking whether the patient owns guns, doctors simply gave some basic advice regarding guns:

    "If you have a gun in the house, make sure you [safety tip], [safety tip], and [safety tip], or just get rid of it/them."
    2.28.2006 2:35pm
    logicnazi (mail) (www):
    Ohh quick point. Yes doctors are in positions of coercion over patients. Sure you can change individual doctors but that is like saying you can always change to a different employer. If every employer out there demands that women who want a job sleep with the boss they are coerced to sleep with the boss and the variety of employers makes no difference.

    In our society doctors are more than mere providers of advice. They control access to medication. It is only with a doctor's good will that you are given the medication which you require and this is an extremely coercive situation.

    Just an example from something you see around campus. If you admit to your doctor that you are a drug abuser he likely will not continue to prescribe your ADD medication. While not so severe there is a real worry that if you refuse to answer questions about gun ownership the doctor will assume you are irresponsible or unwilling to follow his directions and be less inclined to prescribe needed but dangerous medication.
    2.28.2006 3:37pm
    Mikeyes (mail):
    Granted that doctors are in postions of power, but that is why they are so highly regulated. Coercion, on the other hand, is a type of intimidation that compels an individual to do some act against his or her will. Many of the sanctions in the present VA medical act address this issue so by definition if a physician coerces as patient, he or she is in violation of the law.

    And doctors, among others (podiatrists, nurses, physician assistants, optometrists, dentists, and in some states psychologists), not only control the prescription of medicine (for reasons of public safety and common sense) but are responsible on a criminal and civil level if the negligent prescription of these drugs causes harm. The prescribing of drugs is also highly regulated both on a state level and a federal level. There are numerous regulations concerning the prescription of medications and drugs such as those used in ADD are in a special category. Violation of the controlled substances acts can result in incarceration and will always involve an action on the part of the medical board.

    In the scenario you describe, the patient is admitting to having committed an illegal act (drug abuse) but more importantly is also admitting to drug dependence or abuse which is a treatable illness. Before I would continue to prescribe an addicting substance to a patient who has problems with addiction (this could include alcohol which is legal for those over 21) I would ask them to have an AODA (Alcohol and Other Drug Abuse) evaluation and then treatment if the evaluation warranted it. I would then give the ADD medications to the patient and ask that they submit to random urine monitoring in a written contract. If I did not do all of these things but just continued to give out the stimulants I would be in violation of several federal laws and regulations and laws in every state.

    Drug abuse/addiction is co-morbid with ADD/ADHD at the level of 30-40% depending on the study, so the problem is not unknown. We deal with it all the time. If I see a patient who has signs of using drugs and is on Ritalin, I will ask that patient if there are problems with drugs or alcohol. Because of my obligations to the patient and because of the laws, rules, and regulations involved in this class of medication, I will then ask for a urine drug screen if I continue to strongly suspect a problem (this includes collateral information from family, smelling alcohol on the breath, unsteadiness, red sclera, mood changes, etc. - and many other clinical signs - it is not done lightly.)

    On the other hand, I don't see how the ADD analogy has any bearing on gun ownership. In the first case physicians are bound by law to obtain the information if they suspect a problem and to deny drugs to an addict who is not willing to get help, in the second it is mildy intrusive political speech that may or may not convince. Besides, if you are concerned, you have the right to address these issues if they appear in your record and amend them.
    3.1.2006 10:54am