What is the physician’s proper role in reducing violence?

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People suffering some form of violence routinely seek health care. As first responders, physicians and other health professionals are required to treat these patients equitably and promote their best interests. In clinical practice, guidelines can help or hinder clinicians’ capacities to fulfill these duties to patients who are victims of gun violence or rape, for example.

Standards of care regarding sexual assault protocols and forensic examinations have important limitations that need clinical and ethical consideration. At the macro level, clinicians can work with organizations and governments to implement prevention strategies.

This month’s AMA Journal of Ethics® features numerous perspectives on the nature and scope of clinicians’ obligations to respond to violence clinically and as a public health threat.

Take a moment to consider this question: A patient confesses to his physician that he is struggling with insomnia and having violent thoughts about his ex-girlfriend, and he owns a gun. How should his physician respond?

  • Suggest that the patient turn his gun over to a friend for temporary safekeeping.
  • Consult state law to determine whether she is obligated to report the patient to law enforcement.
  • Report the patient to law enforcement and warn him that she will do so.
  • Report the patient to law enforcement without warning him that she will do so.

Give your answer and find responses to this question in the January issue of the AMA Journal of Ethics.

Articles include:

How the Health Sector Can Reduce Violence by Treating It as a Contagion.” Violence is best understood as an epidemic health problem, and it can be prevented and treated using health methods to stop events and to reduce its spread, argue the authors of this article. This health framing is important because it recognizes that violence is a threat to the health of populations, that exposure to violence causes serious health problems, and that violent behavior is contagious and can be treated as a contagious process.

Stop Posturing and Start Problem Solving: A Call for Research to Prevent Gun Violence.” Gun violence is a major cause of preventable injury and death in the United States. Yet, gun-violence prevention is an understudied and underfunded area of research. This article reviews the barriers to research in the field, then outlines potential areas in which further research could inform clinical practice, public health efforts and public policy.

What Should Be the Scope of Physicians’ Roles in Responding to Gun Violence?” Physicians do have important roles to play in the larger landscape of advocacy, public opinion and reduction of gun violence, the authors argue. But, they write, it is not ethically or legally appropriate for them to serve as gatekeepers of gun privileges by assessing competency.

Clinicians’ Need for an Ecological Approach to Violence Reduction.” Social policies, such as those that deny health care to some people, can generate structural violence and be far more harmful than any type of direct violence, the authors argue. A health professional who engages in public health promotion must thus consider the adverse effects of structural violence generated by bad policies. An “ecological approach” entails recognizing our responsibility to care for one another and for the larger human community.

    What the Code says

    The AMA has several policies regarding physician response to violence. These policies specifically encourage awareness and prevention on local, state and national policy levels as well as physician education in these areas. The AMA Code of Medical Ethics also addresses violent harm to patients. Read more.

    In the journal’s January podcast, Gary Slutkin, MD, the founder and executive director of Cure Violence, discusses how the organization works to stop the spread of violence using the methods of infectious disease control.

    And earlier this month, a panel of experts weighed in on the question, “How Should Physicians Intervene in the Debate Over Gun Violence?” in the AMA Journal of Ethics Discussion Forum. Check in on the discussion.

    Submit manuscripts and artwork

    The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

    A look ahead



    In February, the AMA Journal of Ethics will focus on graphic medicine and health care ethics. March’s issue will examine global reproductive health ethics in the 21st century.

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    Comments

    The AMA should consider recommending media products that may reduce violence. For example, One Punch Homicide, made to reduce punching incidents, is a documentary it should recommend. It's getting great reviews and can be seen free online. The United Nations' World Health Organization says every year billions of dollars are spent on injuries related to punching incidents. Punching incidents often escalate in to using more deadly weapons - guns, knives, etc. So if you reduce punching incidents, it should reduce more deadly violence too.
    Show Comments (1)
    Ethics of prescribing opioids
    Aug 10, 2018
    Patient-centered decision-making can help physicians resolve ethical issues in pain management that arise when prescribing opioids or treating substance-use disorder.