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Firearms

Guidance from the Ethics Department
February 2004

• General principles
• Introduction
• Current legal situation
• Medical information
• The role of the countersignatory
• Issues for concern
• Applicants who may present a risk
• The GMC’s guidance on disclosures to protect the patient or others
• Objections to signing firearms certificates
• Suggested further reading

General principles
- There is nothing to prevent doctors from countersigning firearms applications when they are simply acting as a person of good standing, ie where the applicant is not, and never has been, their patient

- Where the applicant is a patient, doctors are advised not to support firearm applications unless they believe that they have sufficient knowledge about an individual to justify a judgement that the individual could safely possess and control such a firearm. Such occasions will probably be rare

- Doctors must make it clear that they are in no position to judge the ‘future dangerousness’ of any applicant

- If doctors have reason to believe that an individual has access to firearms and is currently a danger to him or herself or to society they should encourage the individual to return the licence and surrender the firearms. Doctors should, however, also be prepared to breach confidence and inform the appropriate authorities if necessary. They need to bear in mind that they may need to justify the decision if confidentiality is breached without the individual’s permission.

Introduction
This guidance note has been drawn up in response to enquiries from doctors concerned about being asked to certify the ‘fitness’ of their patients to hold firearms by acting as countersignatories or referees to firearms and shotgun applications. More rarely, the BMA is asked by doctors about notifying the relevant authorities about an individual who legally holds firearms or shotguns but whom they believe is unfit to do so, and advice is also given in this area.

Current legal situation
Application forms for firearms and for shotguns are different. Applicants for both need to provide a number of medical details, including whether they suffer from any ‘medical condition or disability including alcohol and drug related conditions’. They also have to make a declaration as to whether or not they have ever suffered from epilepsy or been treated for ‘depression or any other kind of mental or nervous disorder’.[reference 1] [reference 2]

An application for a firearm requires endorsement from two referees of ‘good standing’. They must have known the applicant personally for two years and be resident in Great Britain. They cannot be members of the applicant’s immediate family. Referees are asked to confirm that the answers to questions 1 to 16 of the form are correct, and to endorse one of the applicant’s photographs to the effect that it bears a current true likeness to the applicant. A referee can be of any background or occupation.

An application for a shotgun, by contrast, requires the endorsement of a single countersignatory in place of the referees. In addition to the general requirements for being a referee, the countersignatory must also be either a Member of Parliament, Justice of the Peace, minister of religion, doctor, lawyer, established civil servant, bank officer or ‘person of similar standing.’ Countersignatories are required to confirm that they know of no reason why the applicant should not be permitted to possess a shot gun and to ‘bear in mind the character, conduct and mental condition of the applicant in so far as they are relevant.’ [reference 3] At the time of writing, in January 2004, the Home Office was considering replacing the system of countersignatories for shotgun licences with a system of referees similar to that for firearm certificates.

Although countersigning shotgun licenses clearly entails greater responsibility, the ethical guidance given here applies to both shotgun and firearms licences.

Medical information
Application forms for both firearm and shot gun certificates require the applicant to give permission for the police to approach the applicant’s general practitioner in order to obtain factual details of the applicant’s medical history. The police only usually request details from the GP where there are genuine doubts about the applicant’s medical history that may have a bearing on the applicant’s suitability to possess firearms. Police do not make such requests routinely, nor do they check the accuracy of the medical information provided in application forms. [reference 4] Where police do require additional information, requests should be limited to specific factual issues, and requests for access to the entire medical record should not normally be agreed to.

Any requests for the release of further information require consent from the applicant. If the applicant does not give consent, the information should not be provided unless the doctor has reason to believe that the applicant may pose a risk to themselves or others if the request for a licence were granted. (See below.)

The role of the countersignatory
The decision as to whether an individual is fit to be entrusted with firearms or shotguns rests in law with the police and, ultimately, the courts. Under the Firearms Act 1968, the onus is therefore on a chief officer of the police, not the countersignatory or referee, to be satisfied that the applicant has a good reason for acquiring a shotgun or firearm and that its acquisition would not be prejudicial to public safety or peace. (As mentioned above, it is the counter-signatory’s role to confirm that he or she has no knowledge that would prohibit the applicant having a licence.) It is also the responsibility of a chief officer to ensure that applications for firearms or shotgun certificates by anyone of ‘intemperate habits or unsound mind’ are refused. As indicated above however, countersignatories, as opposed to referees, need to ‘bear in mind the character, conduct and mental condition of the applicant in so far as they are relevant to these matters.’ [reference 5]

Home Office guidance on the role of referees and countersignatories
According to Home Office guidelines for the police, [reference 6] the role of the countersignatory or referee is to provide information and opinions that the police can take into account when making a judgement. Neither are expected to offer an ‘expert’ opinion, regardless of their backgrounds. In particular, doctors acting as referees or countersignatories should do so on a personal basis rather than as medical professionals, and they should not therefore be expected to offer any medical opinion as to the applicant’s mental state or likely future behaviour. It is open to the police to contact the referee or countersignatory to discuss the information provided on the reference form or any other matter relating to the application.

In its previous guidance on firearms, the BMA expressed concern that doctors were being asked to make predictions about an applicant’s ‘future dangerousness’. The BMA believes that doctors are not in a position to make such a judgement. The guidance from the Home Office therefore makes it clear that doctors are not and should not be called upon to offer such an opinion.

Issues for concern
Although the BMA welcomes the Home Office guidance relating to countersignatories and referees, it still has some concerns about the weight placed on their endorsement. Although the guidance suggests that countersignatories and referees are not called upon to offer a medical opinion, the Association is concerned that excessive emphasis may still be given to an endorsement by a doctor, because of the specialist nature of his or her expertise. Doctors who have contacted the BMA have pointed out that they very rarely have sufficient knowledge of the mental stability of an individual to certify that he or she has not suffered from any mental disorder, nor will they be able to give a meaningful medical opinion on more general issues such as the ‘character, conduct and mental condition’ of the applicant.

As previously indicated, the doctor is only one of a number of people ‘of good standing’ or ‘good character’ who can be asked to countersign a firearms or shotgun certificate. When the doctor is simply acting in this capacity, that is where the applicant is not a patient, then the Association believes that there is nothing to prevent doctors from endorsing the application, as long as this is made clear. Where the applicant is a patient, however, the Association believes that doctors are not seen by the public as solely persons of good standing but are still considered to be making a medical assessment and therefore have a greater responsibility. In these circumstances, the Association advises doctors not to issue certificates unless they have a sufficiently detailed knowledge of the patient’s mental and physical health to be confident that the individual can safely possess and control firearms or without endangering themselves, their families or the public. The BMA expects that very few doctors will be this confident about their knowledge of a patient.

Applicants who may present a risk
In the majority of cases, individuals obtain firearms or shotgun certificates with the assistance of people of good standing, and no problems arise. In exceptional circumstances, however, a doctor may have good reason to believe that an individual either applying for a firearms certificate, or already in possession of one, may represent a danger either to themselves or to others. In these circumstances doctors should strongly encourage the applicant to reconsider or revoke their application. If the applicant refuses, the doctor should consider breaching confidentiality and telling a senior police officer – usually the Chief constable of the County or the Commissioner of the Metropolitan Police – of their concerns. Consent should initially be sought from the applicant for contacting the police, but if it is not possible to obtain consent, the doctor should consider making his or her concerns known without consent wherever feasible. It is good practice to discuss the reasons for this with the applicant beforehand. The GMC’s guidelines on consent in these circumstances is:

Disclosures to protect the patient or others
Disclosure of personal information without consent may be justified where failure to do so may expose the patient or others to risk of death or serious harm. Where third parties are exposed to a risk so serious that it outweighs the patient’s privacy interest, you should seek consent to disclosure where practicable. If it is not practicable, you should disclose information promptly to an appropriate person or authority. You should generally inform the patient before disclosing the information. (General Medical Council. 'Confidentiality: protecting and providing information'. London: GMC, 2000: para 36.)

Doctors should bear in mind that, as in other situations where a doctor may consider breaching confidentiality, doctors may be called upon to justify their decision either before a court or the GMC.

Objections to signing firearms certificates
The BMA has received inquiries in the past from doctors who do not wish, on grounds of conscience, to sign firearms certificates. Doctors are under no obligation to sign these certificates and the BMA would support any doctor who refuses such a request.

Suggested further reading
British Medical Association. Medical ethics today: the BMA’s handbook of medical ethics and law. London: BMA, 2004: 193, 578-9.

References
1. The law relating to certification for firearms and shotguns in England and Wales is contained in the Firearms Act 1968 and the Firearms Rules 1998s3-10. In Scotland the law is contained in the Firearms (Scotland) Rules 1989 s3-10 (SI 1989 No. 889). In Northern Ireland, certification for firearms and shotguns is contained in the Firearms (Northern Ireland) Order 1981 part 3 (as amended)

2. Firearms Act 1969 to 1997. Firearms forms 101 & 103.

3. Firearms Act 1969 to 1997. Firearms form103: part D.

4. Home Office. Firearms law: guidance to the police 2002. Norwich: HMSO, 2002: 47.

5. Firearms Act 1969 to 1997. Firearms forms 103: notes to part D.

6. Home Office. Firearms law: guidance to the police 2002. Norwich: HMSO, 2002.