Theoretical Situation

[Crispin]

What you are about to read is pure fiction. It is contrived. Any resemblance to anyone living or dead is purely coincidental.

Okay, that being said. I was given a theoretical situation to review and asked for my opinion. As this is directly related to the 2nd amendment, I figured I would ask some of my friends here for their opinions on the subject and see what they thought.

The setting is Florida, the time is now. A patient with a long term diagnosis of schizophrenia comes in to see their regular psychiatrist. The pt. has not been doing well lately and reports that he/she is afraid she is going to get fired from his job. The patient reports that IF he gets fired THEN he is going to buy a gun and kill his boss and then take his own life. The psychiatrist is fairly confident that IF the patient gets fired THEN this is exactly what would happen. The patient currently DOES NOT own a gun. Tarasoff rule does not apply as their is no imminent danger. Pt. cannot be hospitalized against her/his own will because their is no imminent danger. Psychiatrist has no grounds to break confidentiality, no mandatory reporting laws in Florida.

Questions for discussion:
1. Does anybody think we need a law on the books so the psychiatrist can stop this patient from purchasing future firearms? If so, what happens to "shall not be infringed?"
2. Is this a Catch-22?

Thanks,
Crispin

 

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[LuckyThirteen08]

Thats some serious food for thought but i truly dont think it would make a difference,If a non psychotic person can get a handgun off the books,so could a mentally ill person,especially one with extreme paranoia issues.In the end it would probably just give big brother more reason to fight for banning guns all together.
But this is a really good issue when you put some thought into it.

 

[pong12211]

That is a seriously tough question to answer.. Do we leave it to the doctors discretion to notify the proper people if he/she believes their patient is a violent threat to peoples livelyhoods.. I for on would not like to be in the situation to have to make that call.. However where do we draw the line for the doctors to act when just involving a gun or do we widen that scope to all violent crimes such as bombings or stabbings ect... This is difficult because if this is the case many people may not seek the treatment that could help them due to this fact.. I for one believe that the doctor in this situation is the only one who could make this judgement call.. That's a huge burden to bear but who would know better wether or not this patient was a threat better than the doctor.. This is a very grey area but I for one would hope that the acting physician would do what he/she felt was morally right and if he/she had the ability to prevent a trajedy should do so.. This patient confidetiality is a serious thing but so are hanious crimes.. This example for me is personally sensitive due to the fact of guns being put into the equation.. Which I realize was done for a reason but a bomb could do just as much damage if not more.. However I would hope that no matter what the weapon was to be used that the loss of a life at the hands of another person could be avoided...

 

[Frankn]

The person has, in effect, threatened to kill someone! It should be a doctors responsibility to help that person, one way or the other. Once you have secured that information and done nothing about it, you become an accomplice. Frank

 

[hvacker]

Would the psychiatrist's oath to do no harm warrant intervention?
As far as the 2nd, the amendment has been infringed in many ways. Even people diagnosed with PTSD as I understand can't obtain a gun but I don't know if that's Federal.. It would seem sane to prevent the person from carrying out their threats.
Wouldn't the Doctors opinion allow for the person to be held for observation?

 

[Crispin]

Would the psychiatrist's oath to do no harm warrant intervention?
As far as the 2nd, the amendment has been infringed in many ways. Even people diagnosed with PTSD as I understand can't obtain a gun but I don't know if that's Federal.. It would seem sane to prevent the person from carrying out their threats.
Wouldn't the Doctors opinion allow for the person to be held for observation?

As that bare bones situation stands:
1. Oath to do no harm does not come into play here. If the psychiatrist refused to treat the patient or over-sedated the patient then it would.
2. In this case, their is no imminent threat to patient or boss. In order to hold somebody against their will the patient must have a plan to carry out harm, the will to carry out harm, and the means to carry out harm. In this situation the patient does not have the means. Now, if the patient said I AM GOING to buy the gun...then the doctor would. However, it is an if then statement. Even if the doctor held them against their will they would be released the next day, especially in the state of Florida.

 

[Crispin]

Frank,

It is not considered to be a threat...yet. If the patient got fired then the doctor could immediately hospitalize. However, the patient would have to notify them directly or the doctor find out incidentally. The doctor cannot call the boss and say, "heh, if you fire this patient please call and let me know first."

 

[Crispin]

That is a seriously tough question to answer.. Do we leave it to the doctors discretion to notify the proper people if he/she believes their patient is a violent threat to peoples livelyhoods.. I for on would not like to be in the situation to have to make that call.. However where do we draw the line for the doctors to act when just involving a gun or do we widen that scope to all violent crimes such as bombings or stabbings ect... This is difficult because if this is the case many people may not seek the treatment that could help them due to this fact.. I for one believe that the doctor in this situation is the only one who could make this judgement call.. That's a huge burden to bear but who would know better wether or not this patient was a threat better than the doctor.. This is a very grey area but I for one would hope that the acting physician would do what he/she felt was morally right and if he/she had the ability to prevent a trajedy should do so.. This patient confidetiality is a serious thing but so are hanious crimes.. This example for me is personally sensitive due to the fact of guns being put into the equation.. Which I realize was done for a reason but a bomb could do just as much damage if not more.. However I would hope that no matter what the weapon was to be used that the loss of a life at the hands of another person could be avoided...

Bingo! You hit the nail on the head. If the doctor were to break confidentiality without an imminent threat then it would be blatant malpractice. The doctor would get sued and it would be all over the news. The Church of Scientology gets commercials that says, "You can't trust your psychiatrist." The end result: people stop going to see psychiatrists and those that do are not completely honest. Without complete confidentiality it destroys the doctor-patient relationship and puts more people with mental illness at risk.

 

[Crispin]

Thats some serious food for thought but i truly dont think it would make a difference,If a non psychotic person can get a handgun off the books,so could a mentally ill person,especially one with extreme paranoia issues.In the end it would probably just give big brother more reason to fight for banning guns all together.
But this is a really good issue when you put some thought into it.

Depends, in this case. If you assume the schizophrenic patients has some degree of disorganization (which would be the norm) than it would be much harder for them to illegally obtain a gun.

 

[bill from lachine]

Crispin,

As others have said....tough call....but if the judgement call that there's sufficient cause for concern.....perhaps approaching a judge and requesting a temporary restraining order when the person's file is restricted legal purchase of a firearm for say 6 months would do the trick.

That said the judgement would have to be sealed so it did not set a precedent for jurisprudence to kick in down the road.

Don't think the medical profession wishes to play King Solomon on these judgement calls on a regular basis....and would rather spend their time treating patients than wasting time in the courts/legal system.

Food for thought......maybe the ethics committee of the governing body could kick this scenario around for future guidance.

Regards + HH

Bill

 

[Rebel - KGC]

What you are about to read is pure fiction. It is contrived. Any resemblance to anyone living or dead is purely coincidental.

Okay, that being said. I was given a theoretical situation to review and asked for my opinion. As this is directly related to the 2nd amendment, I figured I would ask some of my friends here for their opinions on the subject and see what they thought.

The setting is Florida, the time is now. A patient with a long term diagnosis of schizophrenia comes in to see their regular psychiatrist. The pt. has not been doing well lately and reports that he/she is afraid she is going to get fired from his job. The patient reports that IF he gets fired THEN he is going to buy a gun and kill his boss and then take his own life. The psychiatrist is fairly confident that IF the patient gets fired THEN this is exactly what would happen. The patient currently DOES NOT own a gun. Tarasoff rule does not apply as their is no imminent danger. Pt. cannot be hospitalized against her/his own will because their is no imminent danger. Psychiatrist has no grounds to break confidentiality, no mandatory reporting laws in Florida.

Questions for discussion:
1. Does anybody think we need a law on the books so the psychiatrist can stop this patient from purchasing future firearms? If so, what happens to "shall not be infringed?"
2. Is this a Catch-22?

Thanks,
Crispin

It IS a "Catch-22", AND! SITUATION SPECIFIC. Yes, Florida DOES need a "Law on the Books" pertaining to POTENTIAL imminent danger to one's self or others. HOWEVER! How does the CATHOLIC CHURCH get away from confessions, of similar kinds...? I get PO'ed when cops can't even INVESTIGATE criminal wrong-doings, etc... INDEED! 'Nuff said! (MHO)

 

[bill from lachine]

Crispin/Rebel,

At the very least this type of issue should be kicked upstairs to the ethics committee of your governing association....to see if they'll push for having a ruling on these one off type situations.....

Regards + HH

Bill

 

[Rebel - KGC]

Crispin/Rebel,

At the very least this type of issue should be kicked upstairs to the ethics committee of your governing association....to see if they'll push for having a ruling on these one off type situations.....

Regards + HH

Bill

It WOULD be interesting, indeed!

 

[Crispin]

Crispin/Rebel,

At the very least this type of issue should be kicked upstairs to the ethics committee of your governing association....to see if they'll push for having a ruling on these one off type situations.....

Regards + HH

Bill

Bill,

Don't hold your breath. It would immediately become a 2nd amendment rights issue. "Shall not be infringed" is pretty clear. Ethics will not touch it until it becomes imminent. Good idea, but not the way this country works. The problem is the ability to predict the future. "If...then." One two many steps. Has to be, "I will" before we can step in. Scary stuff...

Crispin

 

[bill from lachine]

Crispin,

Well in that case....you/they have my sympathy......my gut/street smarts instinct tells me if the odds are like 80% that the guy/gal could follow through I'd definitely feel the obligation to nip it in the bud so to speak....however, given the laws/ethics your/their hands appear to be tied.

Certainly not an easy situation to deal with.

Regards + HH

Bill

 

[worldtalker]

Crispin, Let your conscience be your guide,only you will know. GodBless Chris

 

[bill from lachine]

Chris,

The downside is based on the confidentiality issue Crispin's or one of his colleagues hands are tied due to the laws/confidentiality issue....stalemate so to speak.....I certainly wouldn't want to be caught between that rock and a hard place.

Regards + HH

Bill

 

[worldtalker]

Chris,

The downside is based on the confidentiality issue Crispin's or one of his colleagues hands are tied due to the laws/confidentiality issue....stalemate so to speak.....I certainly wouldn't want to be caught between that rock and a hard place.

Regards + HH

Bill

That is what I call a Pisser!

 

[onfire]

Why would a person like this see a phyc. if one of the symptoms was...typically separated into 2 categories: Positive symptoms: Extra feelings or behaviors that are usually not present, such as:

• Believing that what other people are saying is not true (delusions)
• Hearing, seeing, tasting, feeling, or smelling things that others do not experience (hallucinations)
• Disorganized speech and behavior
• Negative symptoms: A lack of behaviors or feelings that usually are present, such as:
  
• Losing interest in everyday activities, like bathing, grooming, or getting dressed
• Feeling out of touch with other people, family, or friends
• Lack of feeling or emotion (apathy)
• Having little emotion or inappropriate feelings in certain situations
• Having less ability to experience pleasure

These symptoms could be associated with at least 545 people I could name. oh! plus 1

 

[Rebel - KGC]

Chris,

The downside is based on the confidentiality issue Crispin's or one of his colleagues hands are tied due to the laws/confidentiality issue....stalemate so to speak.....I certainly wouldn't want to be caught between that rock and a hard place.

Regards + HH

Bill

Here's the thing; it's a LEGAL "issue" vs a MORAL "issue". IMMINENT danger...? MORAL "issue"! I can fight LEGAL "issue" in a court of LAW! If need be... APPEAL!