Recognize those words? The Second Amendment to
the Constitution of the United States, what all the fuss is about. In addition
to the confusing use of commas, apparently more generously applied in the 18th
century, we have two key phrases. The final phrase, “shall not be infringed”,
is read by the NRA and other “gun rights” zealots (and it is important to
remember that only a minority of NRA members, and a smaller minority of gun
owners, support this position) to mean essentially “no legislation regulating
guns in any way”. That includes assault rifles, semi-automatic and maybe even
automatic rifles, armor-piercing (“cop killer”) bullets, and any other weapon
or gun modification that creative minds can come up with. Of course, it has
been noted that none of these types of weapons were available at the time of
the Constitution, when firearms were muzzle-loaded muskets, quite different
from current weapons (see graphic).
The NRA take the position that there is
qualitatively no difference, as noted by its President, Wayne LaPierre, after
the December 2012 massacre at Sandy Hook Elementary School: "Absolutes do
exist. We are as ‘absolutist’ as the Founding Fathers and framers of the
Constitution. And we’re proud of it!" Others (including me, in case you
were wondering) would disagree, and say that clearly at some point the
quantitative difference becomes qualitative. This is the only amendment they
are absolutist about; the First Amendment says “Congress shall make no law…
abridging the freedom of speech…”, but it has long been settled that it is not
OK to yell “Fire!” in a crowded theater.
The other obviously important phrase is “A well regulated
Militia”. Again, obviously, this has been the source of much discussion, with
the NRA taking the position that “Militia” just means “everyone” (kind of a
stretch), and (as far as I can tell) “well regulated” means, um, not regulated
at all. Is this cherry picking the words one wants? Maybe, but I can’t imagine
how it is possible to ignore completely the words “well regulated”. But does it
matter? Yes, when we live in a country where
The
36,252 deaths from firearms in the United States in 2015 exceeded the number
of deaths from motor vehicle traffic crashes that year (36,161). That same
year, the US Centers for Disease Control and Prevention reported that 5 people
died from terrorism. Since 1968, more individuals in the United States have
died from gun violence than in battle during all the wars the country has
fought since its inception.
-Bauchner et al., Death by Gun Violence—A Public Health
Crisis, JAMA, October 9, 2017[1]
Those are staggering numbers, and
certainly justify the assertion that it is a “public health crisis”.
The authors also note that “60.7% of the gun deaths in 2015 in the United States
were suicides,” a fact often ignored. That is a majority. A
large majority. If it were an election, 60.7% would be considered a landslide.
But with guns it is a mudslide of death. I have written before about suicide (e.g,
Suicide:
What can we say? December 13, 2013, Suicide
in doctors and others: remembering and preventing it if we can September 14, 2014, Prevention
and the “Trap of Meaning” July 29, 2009) and its
impact on myself and my family, with my son’s successful suicide-by-gun at the
age of 24. My son, to my knowledge, had never used a gun before his final act.
He lived in a state and city with strict gun control laws (some of which,
sadly, have been eliminated by the courts). He was nonetheless able to go to
another state, buy a carbine (terrific choice! No permit needed, even in those
days, like a handgun would require, but short enough to reach the trigger with
the barrel in his mouth!), and use it. It would be easier now, in that state
and many others.
My son was apparently very committed to
this act, and was successful despite some obstacles. But for many, many people
it is the availability of guns that make a spur-of-the-moment decision lethal.
I have noted before that nearly 95% of suicide attempts by gun are lethal while
less than 5% by drug overdose are. My clinical experience is that many suicide
survivors do not repeat their attempts (though many do). The successful suicide
rate for young adult males in low gun control states is several times higher
than in high gun control states. And on and on.
But the epidemic of suicide and murder
and mass murders resulting from the easy availability of guns has not changed
the legal landscape. After the Las Vegas massacre, there was a small ray of
hope that maybe one of the most egregious products the white terrorist Stephen Paddock
used, the “bump stocks” that effectively convert semi-automatic to automatic
rifles, might be limited; even the NRA voiced some possible support. But never
underestimate the cowardice and lack of moral fiber of the Congress; Speaker
of the House Paul Ryan has suggested that this be done by regulation rather
than legislation. This is absolutely because
it will not require any congressperson to actually vote for it and thus be
targeted by the zealots in the next election. Hopefully, not literally targeted
by guns, but do not forget Gabby Giffords and Steve Scalise!
Dr. Bauchner, who is the editor-in-chief
of JAMA, also joined the editors of
several of the other most prestigious US medical journals, New England Journal of Medicine, Annals of Internal Medicine, and PLOS Medicine in an editorial that
appeared in all their journals (this link is the the NEJM), ‘Firearm-Related
Injury and Death — A U.S. Health Care Crisis in Need of Health Care
Professionals’.[2] Again, this emphasizes the fact that guns are a public health
epidemic in the US, and that there is little likelihood of anything being done
at the federal level to stem its carnage. It recognizes that there is a
variable response at the state level, with some states going as far as trying
to legally prohibit physicians from asking about guns in the home (Florida;
since struck
down by the courts) while others have had
stronger regulations. Many legislatures have also acted to prevent the cities
in their states from acting independently to regulate guns in any way. One of
the most insane was the state of Arizona suing to prevent the city of Tucson
from destroying guns seized from criminals. The legislature mandated that they
be sold – thus keeping them on the
streets – and the
Arizona Supreme Court upheld this, saying state
law trumped local ordinances!
Given this situation, the joint editorial
suggests that there are many things that physicians can and should do, including
(quoted):
·
Educate yourself. Read the
background materials and proposals for sensible firearm legislation from health
care professional organizations. Make a phone call and write a letter to your
local, state, and federal legislators to tell them how you feel about gun
control. Now. Don’t wait. And do it again at regular intervals. Attend public
meetings with these officials and speak up loudly as a health care
professional. Demand answers, commitments, and follow-up. Go to rallies. Join,
volunteer for, or donate to organizations fighting for sensible firearm
legislation. Ask candidates for public office where they stand and vote for
those with stances that mitigate firearm-related injury.
·
Meet with the leaders at your own institutions to discuss how to leverage your organization’s influence with
local, state, and federal governments. Don’t let concerns for perceived
political consequences get in the way of advocating for the well-being of your
patients and the public. Let your community know where your institution stands
and what you are doing. Tell the press.
·
Educate yourself about gun safety. Ask your patients if there are guns at home. How are they
stored? Are there children or others at risk for harming themselves or others?
Direct them to resources to decrease the risk for firearm injury, just as you
already do for other health risks. Ask if your patients believe having guns at
home makes them safer, despite evidence that they increase the risk for
homicide, suicide, and accidents. [this
is what the Florida law would have made illegal]
·
Don’t be silent.
The first (JAMA) editorial says:
Guns
kill people….the key to reducing firearm deaths in the United States is to
understand and reduce exposure to the cause, just like in any epidemic, and in
this case that is guns.
The fact is that while physicians have
influence and moral authority, so do other health professionals, and, in fact, so
do all of us. So the advice must pertain to all of us.
Don’t be silent.
[1]
Bauchner H, Rivara FP, Bonow RO, Death by gun violence—a public health crisis, JAMA online Oct 9, 2017,
doi:10.100/jama.2017.16446
[2]
Taichman DB, Bauchner H, Drazen JM, Laine C, Peipert L, Firearm-Related Injury
and Death — A U.S. Health Care Crisis in Need of Health Care Professionals’, October
9, 2017DOI: 10.1056/NEJMe1713355
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