Firearm legislation and the Cullen inquiryBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7054.374 (Published 17 August 1996) Cite this as: BMJ 1996;313:374
<it>Independent medical advisors and a help line would keep doctors out of</it> <it>the firing line</it>
On 13 March 1996 Thomas Hamilton walked into the gymnasium at Dunblane Primary School and shot dead 16 children and their teacher. The Secretary of State for Scotland, on behalf of both houses of parliament, asked Lord Cullen to inquire into this tragic incident, and his report is expected at the end of September. It will include recommendations on the control of possession and use of firearms and ammunition, school security, and the vetting and supervision of adults working with children. The Secretary of State for Scotland has made it clear that parliamentary time has been set aside to implement any recommendations.
Under current legislation, people wishing to obtain a certificate to acquire, renew, or alter a firearm or shotgun must fill in a questionnaire. This asks for personal details including a specific question about whether the applicant has ever had epilepsy or any form of mental disorder. All applications must be countersigned by someone who is resident in Britain, who has known the applicant personally for at least two years, is not a relative, and is either a member of parliament, a justice of the peace, a minister of religion, a doctor, a lawyer, an established civil servant, a bank officer, or “person of similar standing.” Those countersigning the application certify that to the best of their knowledge and belief the information given in it is true, that they know of no reason why the applicant should not be permitted to possess a firearm, and that the photographs enclosed with the application bear a current true likeness to the applicant.
The difficulty for the medical profession is that, even with clearly stated limitations to the countersignatory's responsibilities, a doctor's signature is likely to imply more than simply that the facts of the medical record are correct. And as David Cooke, professor of forensic psychology at Glasgow University, stated in his evidence to the Cullen inquiry, it is impossible to predict with certainty who might be unsafe with a gun. Even with a multi-disciplinary team and several hours of direct interaction between doctor and patient, no absolute guarantee of future safety can be given. This is because mental illness can arise rapidly, and even if re-certification took place at yearly intervals (it is currently every five years) this would not necessarily address the problem.
In its existing advice to doctors, the BMA draws a distinction between a doctor acting simply as a person of good standing and a doctor signing an application for a patient. In the second case, doctors are advised not to support firearm applications unless they believe that they have sufficient knowledge about an individual to justify their judgment that the person could safely possess and control a firearm. There will be those both within and outside the profession who feel that, while the system is not perfect, a general practitioner is likely to be in a better position than many others to judge a patient's state of mind and should therefore take part in certification in the interests of public safety. But the BMA believes that doctors will rarely have sufficient information about patients to state with confidence that they can “safely possess and control firearms,” and the annual representatives meeting in June concluded, by a small majority, “that doctors should not endorse gun licence applications.”
In its evidence to the Cullen inquiry, the Federation of Police Surgeons suggested the introduction of a confidential medical questionnaire similar to the one used when applying for a life insurance policy. This would be completed by the patient's own general practitioner. The preliminary screening would then be carried out by an independent doctor specially appointed for this task. Further reports could be obtained with specialist examination if necessary. If the applicant did not cooperate the application would simply be turned down. In its evidence the BMA emphasised that this proposed scheme still suffered from the flaw that medical risk prediction is insufficiently precise to give absolute guarantees about the safety of an individual to carry firearms and this must be made clear to the public to prevent any false reassurance. It does have the advantage of removing direct responsibility for endorsing firearms licences away from the applicant's general practitioner.
The BMA also suggested a helpline similar to the Driver and Vehicle Licensing Agency helpline for doctors who are concerned about a patient's fitness to drive. A doctor concerned about a patient's fitness to carry firearms could ring the firearms helpline and discuss the details with a medical advisor. This advisor could take appropriate action to investigate the case, and if the gun licence holder refused to cooperate the license would automatically be revoked. Disclosure of medical details would be allowed under guidance from the General Medical Council in the public interest.
This week the Home Affairs select committee on control of handguns proposed a change to existing procedures, suggesting that applications for firearm and shotgun licences should contain all relevant medical information and should be signed by a general practitioner. However, applicants should not be asked to undergo psychological screening.1 Many bodies including the BMA have asked parliament to ban the private ownership of handguns, but the final decision rests with Lord Cullen. If he does not recommend a ban, he will need to decide on new licensing procedures. The medical profession will have to face up realistically to any recommendations about its role, urgently reconvene the debate, and formulate a response that aims to safeguard members of the public rather than falsely reassure them.