Understanding the Role of Law in Reducing Firearm Injury through Clinical Interventions

Survey of Washington clinicians' willingness to use and preferences related to extreme risk protection orders

Extreme Risk Protection Orders (ERPOs) temporarily restrict access to firearms if an individual is deemed a significant risk of harm to themselves or others. Some states allow clinicians to initiate ERPO petitions for their patients and a new Justice Department model statute recommends clinicians should be eligible petitioners. Washington clinicians cannot currently file ERPOs independently. This article presents the results of an electronic survey of all actively licensed Washington physicians and advanced registered nurse practitioners in 2021 to gauge clinicians' familiarity, willingness, barriers, facilitators, and preferences for initiating ERPOs by counselling a patient or patient's family, contacting law enforcement, or filing independently. 3021 Clinicians responded. 75.2% were not familiar with ERPOs but reported being willing to counsel patients about ERPOs if they encountered a patient at substantial risk of harm to themselves (96%) or others (97%). Counselling was the preferred approach to filing; however, approximately 75% would be willing to file independently if allowed. Lack of knowledge about ERPOs was the most reported barrier and training the most common facilitator for all initiation approaches. Having a trained social worker to refer patients (81.5%), an ERPO liaison to law enforcement (70.9%), or coordinator to assist with filing (71.3%) was highly desired. Survey response rates were: 13.5% for physicians, 17.2% for nurse practitioners. Washington clinicians are willing to use ERPOs for their patients, but they need training. Counselling was the preferred initiation approach, and there was a strong preference for a social worker or ERPO coordinator to assist in counseling and filing.

The "Rules of the Road": Ethics, Firearms, and the Physician's "Lane"

Physicians play a critical role in preventing and treating firearm injury, although the scope of that role remains contentious and lacks systematic definition. This piece aims to utilize the fundamental principles of medical ethics to present a framework for physician involvement in firearm violence. Physicians' agency relationship with their patients creates ethical obligations grounded on three principles of medical ethics - patient autonomy, beneficence, and nonmaleficence. Taken together, they suggest that physicians ought to engage in clinical screening and treatment related to firearm violence. The principle of beneficence also applies more generally, but more weakly, to relations between physicians and society, creating nonobligatory moral ideals. Balanced against physicians' primary obligations to patient agency relationships, general beneficence suggests that physicians may engage in public advocacy to address gun violence, although they are not ethically obligated to do so. A fourth foundational principle - justice - requires that clinicians attempt to ensure that the benefits and burdens of healthcare are distributed fairly.