Determining who is dangerous?

In the commentary "Guns, violence, and mental health," psychiatrist Dr. Richard Elliot agrees with President Obama that it is OK for physicians to intrusively ask patients about guns in the home, which, as a medical ethicist, he should know constitutes an unethical boundary violation,(1) not to mention makes physicians potentially effective snitches for the State against their own patients who have not necessarily expressed a threat to anyone.(2)

But then it is NOT OK for a psychiatrist to report a potential threat by a mentally disturbed patient. Does that make sense? If not a psychiatrist, then who would be in a better position to determine with the greatest level of medical confidence that an individual is dangerous? With all due respect to Dr. Elliot, I believe psychiatrists, among physicians, to be most competent in recognizing mental illness and potential criminal insanity in their patients. And, as he pointed out, given limited resources, it should be those threats likely to be dangerous that should be reported to and investigated by law enforcement. Moreover, it has been psychiatrists, who up to now, have been least likely to report threats because of the psychiatrist-patient medical confidentiality, which is most protected legally, second only to the attorney-client privilege.

I do agree with Dr. Elliot we must proceed with caution to protect civil liberties and prevent the inception of a police state in the name of unattainable perfect security. But a reasonable balance should be reached. Just like with the First Amendment, we cannot scream "Fire!" in a crowded theater, and with the Second Amendment we cannot hunt deer off-season! A serious, specific threat made to a thoughtful psychiatrist by a disturbed patient, whether with guns, knives,(3) automobiles, baseball bats, or bare hands, should be reported. I remain less keen on the idea of family physicians asking intrusively about gun ownership in an otherwise non-threatening patient.


1. Wheeler T. Boundary Violations — Gun Politics in the Doctor's Office. Medical Sentinel 1999;4(2):60.

2. Faria MA. Public Health and Gun Control: A Review (Part II: Gun Violence and Constitutional Issues)., April 19, 2001.

3. Bodeen C. China: 22 kids, 1 adult attacked by knife wielding suspect., December 15, 2012.

Written by Dr. Miguel Faria

Miguel A. Faria, Jr., M.D. is a retired professor of neurosurgery, and serves as associate editor-in-chief and World Affairs editor of Surgical Neurology International (SNI) and is the author of “Cuba in Revolution — Escape From a Lost Paradise.”

This letter to the editor was published in the Macon Telegraph on January 25, 2013, p. 7A.

Copyright ©2013 Miguel A. Faria, Jr., M.D.



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