The American College of Physicians on Gun Violence

The American College of Physicians (ACP) this year published a position paper on reducing firearms deaths and Injuries. [1] It is partially a repeat of its policies as published in 2014, and a broadening of the discussion, as it advocates the need for a multifaceted and comprehensive approach consistent with the Second Amendment. The following is a synopsis of its key provisions.

Firearm violence continues to be a public health crisis in the United States, and firearm related mortality rates are still the highest among high income countries in the world. The problem requires immediate attention. After review of data available to it, and study of the literature in a wide variety of disciplines, the ACP makes the following policy recommendations:

  1. There should be a public health approach to firearms-related violence and the prevention of firearm injuries and deaths. This should involve the development of coalitions from a variety of interest groups.
  2. The medical profession has a special responsibility to speak out on prevention of firearm-related injuries and deaths. The government should not interfere with physician free speech or with the patient-physician relationship. Physicians should discuss the risks associated with firearm ownership and recommendations for best practices to avoid death and injury. Firearm violence prevention should be part of all medical training and continuing education. Physicians are encouraged to advocate for gun safety legislation.
  3. There should be appropriate regulation of the purchases of legal firearms, including universal background checks, firearm safety training, limitation of firearm ownership by domestic violence offenders, gun purchase waiting periods, careful evaluation of data regarding concealed carry permitting, a ban on non-detectable firearms, and strong penalties for straw purchases.
  4. Firearms should be subject to consumer product regulations regarding access, safety, and design, as well as law enforcement measures, including tracers, to aid in the identification of weapons used in crimes.
  5. Firearms owners should be required to adhere to best practices to reduce the risk of accidental or intentional injuries or deaths from firearms, including access prevention laws which hold owners accountable for the safe storage of firearms, and the mandatory reporting of lost and stolen weapons within 72 hours.
  6. Stronger efforts by the mental health community toward reducing the risk of violence and suicide, with caution toward over-categorizing as violent those with mental illness. The efforts to reducing risk should include health professional training in the response to at-risk individuals, improved access to mental health services, community education toward de-stigmatization of mental illness, mandatory reporting of individuals who pose imminent threat to self or others, and laws protecting physicians from liability in the exercise of professional judgment of risk.
  7. The enactment of legislation to ban the manufacture, sale, transfer, and subsequent ownership for civilian use of semiautomatic firearms designed to increase killing capacity (“assault weapons”) and of large-capacity magazines. This includes a comprehensive definition, including generic tests, of semiautomatic firearms and raising the federal minimum age for long gun purchases to 21, to match the minimum purchase age for hand guns.
  8. Efforts to improve and modify firearms for safety, including built-in safety devices such as trigger locks.
  9. More research on firearm violence and on intervention and prevention strategies.
  10. The enactment of Extreme Risk Protection Order (ERPO) laws which allow family members or law enforcement to petition a court to issue an order preventing an at-risk person from purchasing firearms and to confiscate firearms they already possess.

These recommendations are supported by current data, although there are several areas in which the relevant data is scarce. For example, there is ample evidence which suggests that waiting periods reduce the incidence of death by suicide, but only limited evidence as it relates to homicide. Also, there is only a limited but growing body of evidence which suggests that permissive concealed-carry laws may create a greater risk of firearms injuries and deaths. More research is necessary in this area, as it is in the area of effectiveness on the ban of assault weapons. Research on these sub-issues, as well as on firearm violence generally, should be a priority for the Centers for Disease Control, National Institutes of Health, and National Institute of Justice, and should receive adequate funding. All research should be made readily available to the public.

  1. “Reducing Firearms Injuries and Deaths in the United States: A Position Paper From the American College of Physicians,” Butkus, R., Carney, J.K., Doherty, R., Henry, T.L., Annals of Internal Medicine, October 30, 2018