1. Section Editor(s): Newland, Jamesetta A. PhD, FNP-BC, FAANP, DPNAP, FAAN

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A well-regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed.

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-Amendment II, U.S. Constitution


I was recently in Las Vegas for the Fall National Conference for Nurse Practitioners. There were signs everywhere that read, "Vegas Strong," a reference to the mass shooting that occurred on October 1-1 week before I arrived. There were many tourists on the Las Vegas Strip, and everything looked like business as usual. No one seemed afraid or extra cautious. People who lived there did not spontaneously bring up the event in conversation, and neither a taxi driver nor my uncle offered a comment until prompted.


However, newscasters on the local TV stations repeatedly mentioned the massacre and reminded everyone about the gun shows that are held in Las Vegas almost every weekend where there were few, if any, restrictions on purchasing a gun on the spot. The debate regarding an individual's right to own a gun was again a national discourse with no foreseeable resolution or action in the near future.


Gun control

Some people in this country are having a discourse about gun control, while others are sincerely engaged in a discussion of the topic. Clearly, not everyone should have access to guns, but how are the haves and the have nots determined, and who decides? Common citizens today do not form a militia to be called up suddenly to collectively defend property and state against a general threat. It is evident that a consensus regarding circumstances of personal defense is absent.


What is the provider's role?

Patients are routinely asked about safety in the home to identify health risks and the potential for domestic violence. Standardized questionnaires or prompts in electronic health records focus on the individual's perception or reality of safety/threats in their environment and relationships. However, there is much controversy over whether it is legal or if it violates an individual's privacy and Second Amendment right to directly ask about guns or other weapons in the home, their accessibility, and safety precautions in place.


In 2011, Florida passed legislation prohibiting physicians from specifically asking patients about gun ownership or offering counseling on gun safety. This legislation was overturned by the 11th U.S. Circuit Court of Appeals earlier this year, stating that the law violated healthcare professionals' right to free speech.1


In a 2016 commentary featured on Medscape, ethicist Arthur Caplan led a discussion on the ethical considerations of medical professionals involving themselves in the gun safety discussion. His interview with several medical professionals can be found here:


In New York State, the Secure Ammunition and Firearms Security (SAFE) Act of 2013 requires mental health professionals, including physicians, psychologists, RNs, and certified social workers, who are currently providing treatment services to an individual to, "make a report if they conclude, using reasonable professional judgment, that the individual is likely to engage in conduct that would result in serious harm to self or others."3


Know your state's laws

All existing or proposed laws about gun control or counseling on gun safety across the nation are being challenged by opposing interest groups. As a healthcare professional, you have to know what is permissible in your state and how to approach the subject with your patients. You also need to document the information gathered so there are no negative consequences or challenges for you or your patients.


Jamesetta A. Newland, PhD, FNP-BC, FAANP, DPNAP, FAAN

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1. Parmet WE, Smith JA, Miller M. Physicians, firearms, and free speech - overturning Florida's firearm-safety gag rule. N Engl J Med. 2017;376(20):1901-1903. [Context Link]


2. Caplan AP. Should physicians have a role in gun safety counseling? Medscape. 2016. [Context Link]


3. New York State Psychiatric Association. 2013. [Context Link]