Florida Gun Law

This past Wednesday, US federal court blocked a Florida law that sought to limit doctors’ ability to question patients about their personal gun possession. District Judge Marcia Cooke argued that the law violated the US Constitution’s First Amendment’s free speech protections. The Florida gun law aimed to ban inquiries both regarding ownership of firearms and recording the given answer in the patients’ chart. The law did provide exceptions for information “relevant to the patient’s medical care or safety, or the safety of others”. Medical societies, including the American Medical Association, protested the law, while the National Rifle Association supported it, claiming Second Amendment right to bear arms. This case presents an interesting contrast of ethics and constitutional law.

Edmund D. Pellegrino argues that a physician’s obligations are, in ascending order of ethical importance, (1) adherence to law, (2) fulfillment of moral rights and duties, and (3) exercise of virtue. A physician’s duty is to prevent harm, according to the Hippocratic oath, and to promote general welfare of the individual. Accordingly, laws should be designed to protect a physician’s ability to prevent harm and promote this welfare.

One side of the ethical argument is that there are “more than 4,000 children and teens shot in gun accidents every year” and hence it is crucial that doctors allowed to inform parents about safe gun storage and safety provisions. Granted, there are limits on a doctor’s free speech. However, those limits are defined by the same standards of prevention of harm: a doctor is not free to say things that will cause any harm. For example, a doctor does not have the freedom to pass moral judgments on patient behavior outside the realm of medicine, such as their personal relationships. Even within the realm of medicine, the doctor is not free to give advise in such a way that harms the patient, for instance, insulting them.

As such, the reasonable limits placed on the supposed free speech of the doctor are defined by the same rules that allow the doctor to ask about firearm possession: welfare of the patient and prevention of harm. The physician should be allowed to inquire about the possession of an object that could severely compromise welfare and induce harm. Just as a physician may (and should) question parents whether sharp objects and rat poison are placed out of reach and outlets are guarded by plastic fixtures, a physician may (and should) inquire about gun ownership.

The real ethical concern is the welfare of the patient, not the First Amendment rights of the doctor. However, the duty of federal judges is to rule based on the constitutionality of each case, and the Constitution gives no guidance as to the role of the physician or physician-patient relationship protocols. Should we be concerned that judges must base decisions of medical ethics on the rights prescribed by the constitution, rather than ethical guidelines of the medical occupation? On the one hand, society needs a unified basis or platform upon which each judge can evaluate laws. This supposedly prevents the inappropriate application of political or personal ideologies and provides cohesion and protection of rights for all. On the other hand, when deciding purely based on an interpretation of an original text (as well as the cannon of decisions that constitute past precedent), society can circumvent crucial values or impose the wrong values. Many judges are accused of “legislating from the bench” or imposing their values via methods beyond the realm of acceptable constitutional interpretation. If laws are intended to protect our rights and freedoms, is there a contradiction when judges are charged with the interpretation of the constitution rather than the interpretation of morals? In the case of medical ethics and the physician-patient relationship, is it possible to satisfy competing claims of societal cohesion and safeguarding of values? While the Florida ruling was, both, constitutional by protecting free speech, and ethical by protecting of the welfare of the patient, it is not always the case that values and constitutionality align. When in conflict, which should prevail?

(Stock photo courtesy of sxc.hu)