by Craig Klugman, Ph.D.

Last month the dean of the architecture school at the University of Texas announced he was leaving, in part because he disagrees with the new Texas campus carry law that forbids banning guns from classrooms and offices. How does this relate to medicine?

• In July 2014, a psychiatrist going against hospital policy, pulled the gun he was carrying and wounded his armed patient (whether the argument would have escalated to a deadly shootout—1 person died—if guns had not ben present can never be known).
• Last year a surgeon in Boston was shot by the son of a patient.
• In November, a shooting at a Planned Parenthood Clinic left 3 dead and more injured.
• And on a more personal note, a friend and former physician colleague was shot and killed this past week in her home by a family member.

Guns are a current source of controversy in our society. From President Obama taking action to enforce background checks and close loopholes, to concealed carry laws, to record sales of firearms, to the epidemic of shootings in our cities, guns are a big deal.

Which leads me to the question, “Should doctors carry guns as part of their job?”

On the one hand, the role of the physician is to bring people back to health. Physicians are surrounded by images of healing—the white coat, stethoscope, caduceus—does the gun belong in that same pantheon? After all, the psychiatrist above shot his own patient (to stop him)—that would seem to violate the Hippocratic Oath and the principle of nonmaleficence. Even if that patient was threatening or harming another person, is pulling a device whose only purpose is to cause damage to an organism, the professional response for a healer?

Not to mention that the physician-patient relationship is based on trust. Some patients might be comforted by seeing a piece of hard steel poking out from a physician’s white coat, but for many people, especially those with white coat syndrome or who come from a community that distrusts the medical establishment to start, the presence of a gun would most likely chill the relationship. I have no evidence here, but I imagine that a person might be less likely to lie to Dr. Harry. The patiente would also be less likely to ask questions or even to disagree. I know that I certainly would feel that way.

On the other side, there is the Second Amendment that has been interpreted (DC v. Heller) as giving individuals a right to own firearms. Also consider that physicians have a duty of beneficence, which includes taking action to protect a patient from harm. If the ceiling was about to cave in, you move the patient so as to avoid her or him for being hurt. If patients and staff are being threatened and are at risk of death, then shouldn’t the physician wield the gun and protect others? A recent blog by Dr. Sean Brodale, a family practitioner in Iowa appeared on the Doctors for Responsible Gun Ownership website. Dr. Brodale says “Sometimes caring for others means keeping them safe from a violent attacker, whether the attacker is armed or not. Even though no shooting has a perfect outcome, the best outcome possible is when a defender has saved innocent people from injury or death.” He also cites the discredited idea that people target gun-free zones for gun play, assuming that only another gun would ever prevent someone from doing wrong.

An anonymous physician author wrote in KevinMD back in October that he or she should have the right use a gun for defense: “So, I’m a doctor with a firearm who is ready to use it.” Anonymous says that doctors should be encouraged to carry because hospitals are dangerous places. He cites an article in The Annals of Emergency Medicine that conducted a literature review and found discussions of 154 hospital shootings over an 11-year period. What anonymous missed was the conclusion: “Although it is likely that not every hospital-based shooting was identified, such events are relatively rare compared with other forms of workplace violence.”

An analysis in the left leaning Mother Jones, found that over 30 years, civilians with guns do not stop shooters. A poll in MD Magazine found that over 90% of all physicians (including the two-thirds of the respondents who said they owned guns) were in favor of stricter gun controls.

If not doctors, then who will keep us safe from marauding, gun-toting bad guys? A New York Times article from January reported on a security guard shooting a patient in a Houston hospital. The article reports on the increasing incidence of hospital guards carrying weapons—nearly 52% of all hospitals. The report shows that the people most likely to hit by these bullets are patients, especially those with psychiatric disorders who may not act in predictable ways.

As our national and locals debates continue on expanding places where people can carry guns, it’s important to think about their role in the hospital and medical worlds. If guards are well trained (clearly more training than is happening now) then it might make sense to arm them, though Tasers which immobilize without putting holes in people, might be a better choice. The liability of having a weapon and not using it when needed, or of accidental shooting or shooting the wrong person is not inconsequential. As for physicians being armed, they have a right to carry them at home and in their cars. But hospitals are places of healing and doctors are healers. Guns do not belong in the clinic. I suppose I will have to start asking my doctors “do you pack heat” and for every patient like me they lose, I am sure they will have a supporter waiting in line.