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Bioethics Forum Essay

Staying in Their Lane: Health Professionals Must Address Gun Violence

In the wake of the recent Twitter fight between the National Rifle Association and U.S. physician groups over whether doctors should speak out about firearm policy issues, we argue that professionalism actually requires that doctors take a leadership role in gun policy debates, even if (in fact, especially if) doing so is politically fraught and financially harmful to them.

The recent publication of a position paper, Reducing Firearm Injuries and Deaths in the United States, by the American College of Physicians prompted the NRA to assert that physician groups should “stay in their lane” and not talk about gun policy issues. So far, the push-back against this admonition has been mostly to emphasize the terrible medical consequences of gun violence, which is appropriate. But medical groups have been mostly silent on the basics of medical ethics and what is required of them as professionals, and that’s an oversight.

Why professions matter today

Translated from Latin, the word “profession” literally means “to speak forth.” So a profession is a group of people who have come together to publicly declare – sometimes even out loud in the form of a creed or an oath – the standards and values that guide their work. This is why new doctors often recite the Hippocratic Oath, and it’s why every profession has a code of ethics. Oaths and codes are ways of speaking forth – professing – what members of the public can expect in terms of skills and attitudes from members of the group. They make up one side of a social contract, in which the members of the profession seek the trust of the public, and all the perks that come with that, in exchange for keeping the promises made in their codes and oaths.

For physicians, their main professional promise is to look out for their patients’ best interests, including putting the health of their patients before their own self-interest. That’s critical for patients, because without the assurance that physicians will always put them first, patients could not, and probably should not, rely on physicians for care when they are at their most vulnerable. For the sick, injured, or dying to place their lives in the hands of a physician, sometimes a stranger, they need to be completely confident that physicians are devoted to patients’ health and well-being and not just looking to enrich themselves.

But there’s more. Upholding professional values isn’t just necessary for strong patient-doctor relationships. It also can help sustain a healthy democracy. Professional values can actually serve as a morally stabilizing force in communities. Truth, trust, the willingness to put the interests of others ahead of one’s own, the impartial treatment of all people without regard to race, culture or income – these are the moral values on which the profession of medicine is grounded, and they happen to be the same moral values necessary to sustain a well-functioning democracy.

Today these values are at risk. Mistrust, xenophobia, hate, bias, partiality, and selfishness sometimes feel like they are becoming new moral norms. Since 2017, trust in government “to do what is right” dropped by 14 percentage points among the general U.S. population. Businesses, NGOs, and the media are experiencing similarly dismal levels of trust, and the Edelmen Trust Barometer is warning of an impending “trust crash.”

Physicians continue to score quite high in public trust, with 65% of U.S. adults saying physicians have “high /very high honesty and ethical standards.” Physicians rank fourth among the most trusted professions, following only nurses, military officers, and grade school teachers. Given the crisis of mistrust all around us today, it is more essential than ever that medical professionals uphold their promises and step up to safeguard the moral norms that our society needs to thrive.

Professionalism demands that doctors speak out

If a profession is a group seeking to earn the public’s trust by openly speaking forth on a set of shared promises, then professionalism is best understood as the belief system (the –ism) underlying these promises. In medicine, professionalism is the notion that society can and should trust medical groups to set and enforce standards of practice and ethical norms, based on their promise that they will always use these prerogatives to help improve the health of the community. In other words, professionalism means that with the privilege of self-regulation comes the responsibility to use medical skills and knowledge to promote public health, even when doing so is politically uncomfortable or financially harmful to doctors.

Obviously, speaking out against the NRA can be politically uncomfortable. But what’s rarely said is this: just as gun manufacturers make money from selling guns, physicians make money from treating the victims of gun violence. Bluntly speaking, that means reducing gun violence would actually be financially harmful for doctors, so the self-serving path would be for medical groups to stay silent and for doctors to just keep getting paid to patch up the people injured and killed in gun violence.

Of course, the idea that physicians would stay silent to prop up high levels of gun violence is ridiculous. After all, doctors would never urge people to keep smoking, drinking, or eating fast food, even though those are good for business too.

But why are these ideas ridiculous? They are ridiculous because we all, deep down, actually believe in physician professionalism, which demands that doctors tackle these issues. If physicians were to remain silent in the face of an epidemic – whether of gun violence or from any other source – it would rightly be interpreted as opportunistic, uncaring, and professionally incompetent. Worse, it would be a blatant breach of doctors’ collective promise to always seek to improve the health of the public, even when it’s not easy and even when it might cost doctors some revenue.

And guns are like smoking, drinking to excess, and eating junk food in more ways than one. For each of these products there are self-serving constituencies, uninterested in the health of the public, who wish doctors would just stop talking about the role of their products in hurting people.

But doctors won’t stop, because speaking out when it is difficult and costly is exactly what makes the profession of medicine worthy of the public’s trust, and thank goodness for that. The willingness of physician groups to speak out on gun policy is critical for public trust in medicine, and today it might also be reinforcing the values that are at the heart of our democracy. It proves that professional norms of truth, trust, impartiality, and placing the interests of others before self are more resilient in the medical profession than some might have realized – and maybe seeing physician groups uphold these values  will help preserve these values among the general population, too.

So, while it might be inconceivable to the leadership of the NRA that  the American College of Physicians and the American Medical Association—which perhaps it regards as mere trade groups — could act against the financial best interests of their constituents, for these medical groups it’s actually business as usual when it comes to public health issues. After all, speaking out on issues like gun violence is what proves medicine really is a profession and not just a trade.

Patricia Illingworth, JD, PhD, is a professor at Northeastern University and a senior fellow at the Carr Center for Human Rights Policy at the Harvard Kennedy School. Matthew Wynia, MD, MPH, is a professor of medicine and director of the Center for Bioethics and Humanities at the University of Colorado, Anschultz Medical Campus. Twitter: @matthewwynia.

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  1. While I agree that professionals have a duty to speak out and profess on behalf of their patients/clients to say, “their main professional promise is to look out for their patients’ best interests” is incorrect. This assumption would be in direct contradiction to patient autonomy. The author is suggesting that medical professionals are paternalistic and that is simply not true. Healthcare professionals have a duty to their patients/clients to present the facts and allow their patients/clients to make a well informed decision. As members of a society we, healthcare professionals, have an obligation to become active in directing society and shaping the communities we live and work in. There is no mandate in an oath or creed to dictate the course of action any member of society elects.

    I find it curious that gun violence is on the rise more so in this day and age than any time before in our history. What people tend to focus on is the people who own these tools legally. As a society we have chosen to focus on the devastation left in the aftermath of horrific assaults on members of our communities and as a result we brainstorm on ways to stop the tools from being purchased. It is not the tool (gun) nor is it the legal tool owner that is responsible for the horrific assault; it is the criminal. We should as healthcare professionals speak out about the ease by which criminals obtain these tools and plot to assault members of the communities for which we are charged with the health, welfare, and care of. We should change the narrative, empower communities to once again become beneficent, and embrace the golden rule, “do unto others as you would have done to you”. Every religion has a form of the golden rule, and every child once followed the rule. When a society is civil and accepting of differences the love of and for your neighbor is stronger than any act of hate or violence. That is the truth healthcare professionals should be speaking.

    1. I do believe that promoting the golden rule is always a good idea and hopefully one that our society will continue to instill in its members. At some point it must also be realized that guns or any tool can be used for protection as well as for endangerment. The problem with gun control is that criminals still get guns. Violence against people via crimes with guns is a terrible thing but let’s also say that guns can protect people from violence. I’d like to see less exposure of the rift as presented apparently between organization agendas and more about statistics of gun violence involved with crimes as well as prevention of them.

  2. I would like to see other professional views besides just doctors on the issue of gun control. While there may be a division as called up here between the NRA and the ACP , “The recent publication of a position paper, Reducing Firearm Injuries and Deaths in the United States, by the American College of Physicians prompted the NRA to assert that physician groups should “stay in their lane” and not talk about gun policy issues, ” there should be an even-handed accumulation of evidence about gun violence with statistics showing the results of both proponents for guns and opponents. There are many times where guns protect people from crimes and decrease violence. I am hoping that this is just one article from the Hastings Center like this and not a reflection of general political leaning.

  3. Professor Illingworth and Professor Wynia,
    Thank you for fighting back against the resistance towards health professionals speaking out against gun violence as a health threat and political issue. Politicians require the assistance of experts to craft laws and there is no closer witness to the devastation of gun violence than health care professionals. I strongly agree that physicians have the right and the duty to use their education, experience, and position of respect to advocate for their patients in the political realm.

    I see that a common rebuttal to your position is the danger of paternalism, however, I do not believe that applies here. Paternalism seeks to restrict or make decisions on behalf an individual for their own best interest. While gun control can protect the gun owner, it is focused on the safety of the hundreds of thousands of non-consenting bystanders who are irrevocably affected by gun violence each year. As set by the Tarasoff case, you lose your rights to privacy when you endanger others. There is no reason why autonomy should supersede this precedent in the case of gun control.

    Physicians have taken a stand against other public health concerns in order to influence policy. Consider the example of smoking. As physicians determined cigarettes were a health crisis, they fought for public policy that ran PSAs, banned forms of tobacco company advertisements, enacted a higher age limit on the purchase of tobacco products, and prohibited smoking in public areas. The policies promoted by physicians did not take cigarettes out of the hands of autonomous adults, they simply restricted who could access them and where they could use them in order to protect public health. There is a direct comparison to gun control.

    Physicians are charged with the health of our communities, and gun violence has become a public health crisis. Public health professionals ethically can and should use their platform to enact legal change. It is well within their lane.

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