Gun control has become an intense political topic within the state due to a recent mass shooting at a middle school in the state’s capitol. The governor has asked the Secretary of the Department of Human Services (DHS) — your boss — for her support on a proposed bill to regulate and restrict firearm ownership. Under the bill, DHS would be responsible for maintaining a new registry. The secretary has some reservations about supporting the bill and asks you, as the agency’s Office of Health Information Technology, for your advice. The facts are as follows.
In the aftermath of the shooting, the governor partnered with state law enforcement agencies and several legislators representing the middle school’s district to draft a bill entitled the Firearm Owner Identification (FOID) Mental Health Reporting System,1 which would require qualified clinicians and other healthcare professionals to report patients who they determine to be:
A “clear and present danger” in that they communicate a serious threat against a reasonably identifiable third person or themselves or otherwise demonstrate threatening physical or verbal behavior;
“Intellectually disabled,” meaning that the individual’s intellectual functioning and adaptive behavior are “significantly subaverage” as a result of a disability which manifested before the age of 18; or
“Developmentally disabled,” meaning conditions that result in impairments similar to those caused by, and require services similar to those required by, intellectual disabilities, and which manifest before the age of 18 and are expected to continue indefinitely.
Data in the FOID Mental Health Reporting System would be cross-referenced with state and local police data and used to restrict people with a qualifying condition from obtaining a “Firearm Owner Identification Card” allowing them to legally possess firearms. The new reporting requirements would apply to clinical psychologists, clinical social workers, licensed clinical professional counselors, physicians, psychiatrists, registered nurses, and marriage and family therapists practicing at public or private mental health or developmental disability facilities. If an aforementioned provider determines that a person has a qualifying condition (i.e., a person presets a clear and present danger, is intellectually disabled, or is developmentally disabled as described in the law), then the provider is required to report that person’s name, address, date of birth, gender, race, physical description, and the determination made through an online system to be administered by DHS within the time frame established in the law. No official diagnosis is required; all the provider needs to do is click the box in the online reporting system to indicate which of the three qualifying conditions the subject is determined to have according to her professional judgment.
To encourage reporting and protect providers the proposed bill has provisions that maintain the confidentiality of the reporting provider’s identity, and protect providers and their employers from criminal, civil, or professional liability for reporting or failing to report, except for willful or wanton misconduct. To guarantee proper use of the registry, the bill stipulates the registry’s use is restricted to that necessary to determine a person’s eligibility to possess a firearm.
The proposal has sparked public debate and divisions in the state capital. The Coalition for Firearm Reporting, a coalition of concerned citizens from across the state, is lobbying forcefully in favor of the bill. The group’s media campaign has focused on reports of the deadly school shooting and other gun-related tragedies involving people with mental disabilities that have occurred in other states. They contend that current events warrant the passage of the law, and that law enforcement needs all the help it can get in curbing gun violence; mandated reporting would allow officials to take preventative measures by denying lawful access to those who they believe pose a threat to themselves and the public at large. Reporting would further allow law enforcement to investigate gun owners and revoke FOID cards as necessary. The Alliance to End Disability Discrimination, a disability advocacy group, has argued equally vociferously (if not as publicly) against the bill. The group argues that the proposed requirements deny disabled persons their constitutional rights and unjustifiably stigmatize them; the bill is premised on the notion that there is a correlation or causal relationship between disability and gun violence. They see the inclusion of the intellectually and developmentally disabled as an attempt to appease and shift attention away from the powerful pro-gun lobby and argue that the law effectively scapegoats the disability community. Moreover, they argue that the disabled may have a greater need for self-defense and that the law will frustrate the efforts of law-abiding citizens to protect themselves.
The governor and the State’s Attorney’s Office have supported the bill publicly. They see the new reporting requirements as a common sense reform with proper oversight. The number of gun-related deaths has been rising in the state and the governor would like to sign the bill into law before next year’s gubernatorial election. The Department of Public Health director has expressed strong opposition to the bill but has done so behind closed doors so as not to publicly break ranks. In his opinion, the inclusion of intellectually and developmentally disabled persons is arbitrary and dangerous. He believes that if passed the law would have one or both of the following results: people will be discouraged from seeking much-needed medical treatment, and/or otherwise, law-abiding citizens will obtain firearms through other means and impede law enforcement’s ability to track gun ownership. As her policy think tank, the secretary has turned to your team for counsel.
Draft a position paper supporting or rejecting the bill. In doing so you should consider the following:
How do you go about determining the correct course of action in this emotionally charged debate? What tools or information did you require to reach a decision?
Does the proposed rule create an ethical conflict between the DHS and the population that it serves? Between those living with disabilities and society? Examine the proposed rule from the competing perspectives of the patient, provider, the secretary of the Department of Human Services, and the public as you think about what action you would advise the secretary to take.
What are the ethical issues involved in this scenario? What ethical principles might guide you as you advise the health director in making this extraordinarily difficult decision? How do you weigh the competing values, interests, and ethical principles in making your decision?
[1] The legislation for this case is based on the Illinois Firearm Owners Identification Card Act, 430 IL Compiled Stat. 65, as amended by The Firearm Concealed Carry Act, Illinois Public Act 98-0063.
Refernece: Neuburger. B, and Swirsky, ES. (2017). Informatics and Public Health. In L.B. Harmon and F. Cornelius (eds.) Ethical Health Informatics: Challenges and Opportunities, 3rd ed. Boston: Jones and Bartlett: pp. 233-27
