How Should Physicians Make Decisions about Mandatory Reporting When a Patient Might Become Violent?

Amy Barnhorst, Garen Wintemute, and Marian Betz
AMA Journal of Ethics. January 2018, Volume 20, Number 1: 29-35.

Abstract

Mandatory reporting of persons believed to be at imminent risk for committing violence or attempting suicide can pose an ethical dilemma for physicians, who might find themselves struggling to balance various conflicting interests. Legal statutes dictate general scenarios that require mandatory reporting to supersede confidentiality requirements, but physicians must use clinical judgment to determine whether and when a particular case meets the requirement. In situations in which it is not clear whether reporting is legally required, the situation should be analyzed for its benefit to the patient and to public safety. Access to firearms can complicate these situations, as firearms are a well-established risk factor for violence and suicide yet also a sensitive topic about which physicians and patients might have strong personal beliefs.

The commentary is here.

To Reduce Suicide Rates, New Focus Turns to Guns

By SABRINA TAVERNISE
The New York Times
Published: February 13, 2013

Craig Reichert found his son’s body on a winter morning, lying on the floor as if he were napping with his great-uncle’s pistol under his knee. The 911 dispatcher told him to administer CPR, but Mr. Reichert, who has had emergency training, told her it was too late. His son, Kameron, 17, was already cold to the touch.

Guns are like a grandmother’s diamonds in the Reichert family, heirlooms that carry memory and tradition. They are used on the occasional hunting trip, but most days they are stored, forgotten, under a bed. So when Kameron used one on himself, his parents were as shocked as they were heartbroken.

“I beat myself up quite a bit over not having a gun safe or something to put them in,” Mr. Reichert said. But he said even if he had had one, “There would have been two people in the house with the combination, him and me.”

The gun debate has focused on mass shootings and assault weapons since the schoolhouse massacre in Newtown, Conn., but far more Americans die by turning guns on themselves. Nearly 20,000 of the 30,000 deaths from guns in the United States in 2010 were suicides, according to the most recent figures from the Centers for Disease Control and Prevention. The national suicide rate has climbed by 12 percent since 2003, and suicide is the third-leading cause of death for teenagers.

Guns are particularly lethal. Suicidal acts with guns are fatal in 85 percent of cases, while those with pills are fatal in just 2 percent of cases, according to the Harvard Injury Control Research Center.

The entire story is here.

Suicide in young men

The Lancet, Volume 379, Issue 9834, Pages 2383 - 2392, 23 June 2012

doi:10.1016/S0140-6736(12)60731-4

By A. Pitman, K. Krysinska, D. Osborn, and M. King.

Summary

Suicide is second to only accidental death as the leading cause of mortality in young men across the world. Although suicide rates for young men have fallen in some high-income and middle-income countries since the 1990s, wider mortality measures indicate that rates remain high in specific regions, ethnic groups, and socioeconomic groups within those nations where rates have fallen, and that young men account for a substantial proportion of the economic cost of suicide. High-lethality methods of suicide are preferred by young men: hanging and firearms in high-income countries, pesticide poisoning in the Indian subcontinent, and charcoal-burning in east Asia. Risk factors for young men include psychiatric illness, substance misuse, lower socioeconomic status, rural residence, and single marital status. Population-level factors include unemployment, social deprivation, and media reporting of suicide. Few interventions to reduce suicides in young men have been assessed. Efforts to change help-seeking behaviour and to restrict access to frequently used methods hold the most promise.

Means restriction for suicide prevention

The Lancet, Volume 379, Issue 9834, Pages 2393 - 2399, 23 June 2012

doi:10.1016/S0140-6736(12)60521-2

By Yip, et. al

Summary

Limitation of access to lethal methods used for suicide—so-called means restriction—is an important population strategy for suicide prevention. Many empirical studies have shown that such means restriction is effective. Although some individuals might seek other methods, many do not; when they do, the means chosen are less lethal and are associated with fewer deaths than when more dangerous ones are available. We examine how the spread of information about suicide methods through formal and informal media potentially affects the choices that people make when attempting to kill themselves. We also discuss the challenges associated with implementation of means restriction and whether numbers of deaths by suicide are reduced.