From the Journals

ACP beefs up firearms policy

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A simple question

“Do you have guns in the home?”

This simple question should be asked as if it were any other question about health status and potentially unsafe behavior that doctors routinely ask.

It opens the door to further discuss firearms-related issues, especially if there is a concern regarding the patient’s mental state that could impact the health and safety of the patient or others around the individual.

James Kahn, MD, of Stanford (Calif.) University, makes this suggestion in an editorial accompanying the ACP policy statement (Ann Intern Med. 2018 Oct 29. doi: 10.7326/M18-2756).



The American College of Physicians supports appropriate regulations surrounding the purchase of firearms; best practices ownership, storage, and safe use to minimize the risk of accidental or intentional death or injury; and a ban on civilian use of semiautomatic weapons and large capacity magazines, according to an expanded and updated policy statement issued Oct. 29.

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The updated policy statement was issued at the end of a week that saw a mass shooting at a Pittsburgh synagogue where 11 people were killed as well as an incident in which two others were shot to death in a Kentucky grocery store.

“Physicians regularly come face to face with the tragedy that gun violence brings, whether maliciously or unintentionally,” ACP President Ana María López, MD, said in a statement after the synagogue shooting. “The rate of injuries and deaths related to firearms and the growing incidence of mass shootings brings to light, once again, the glaring lack of firearm policy in the United States – a country with one of the highest rates of gun violence in the world. This most recent event makes it more important than ever that Congress and states implement common-sense policies that could prevent injuries and deaths from firearms.”

The policy statement reaffirms all policies included in the college’s 2014 policy.

New to the ACP policy is the college’s support for “appropriate regulation of the purchase of legal firearms to reduce firearms-related injuries and deaths.” ACP specifies that any policy “must be consistent with the Supreme Court ruling establishing that individual ownership of firearms is a constitutional right under the Second Amendment of the Bill of Rights.”

The expanded policy calls for universal criminal background checks for firearms purchase and completion of an educational program on firearm safety; strengthening and enforcing laws on prohibiting convicted domestic violence offenders from purchasing firearms; banning firearms that cannot be detected by metal detectors and standard security screening devices; and a reexamining of concealed carry laws. ACP also favors strong penalties and criminal prosecution for those who sell firearms illegally and for those who legally purchase firearms for the sole purpose of acting as the purchaser for someone who is not legally able to possess the firearm.

The policy also “favors enactment of legislation to ban the manufacture, sale, transfer, and subsequent ownership for civilian use of semiautomatic firearms that are designed to increase their rapid killing capacity (often called ‘assault weapons’) and large-capacity magazines, and retaining the current ban on automatic weapons for civilian use.”

As part of this, ACP is calling for a comprehensive definition of semiautomatic firearms that would be subject to the ban as well as a definition of sporting and hunting purposes that should be narrowly defined.

The policy also calls for raising of the minimum age to purchase a semiautomatic weapon to 21 years, prior to the full ban being put in place.

Finally, ACP is calling on firearm owners to “adhere to best practices to reduce the risk of accidental or intentional injuries or deaths from firearms,” including ensuring that firearms “cannot be accessed by children, adolescents, people with dementia, people with substance use disorder, and the subset of people with serious mental illness that are associated with greater risk of harming themselves and others.”

Finally, the expanded policy calls for enactment of extreme risk protection order laws, under which a family member or law enforcement officer can seek a court order to temporarily remove firearms from an individual who is at imminent risk of self-harm or to others, while preserving the individual’s due process protections.

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SOURCE: Butkus R et al. Ann Intern Med. 2018 Oct 29. doi: 10.7326/M18-1530.

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