by Craig Klugman, Ph.D.
Where is the vibrant bioethics literature on gun control and firearm violence? In 1997, bioethicist Leigh Turner asked why bioethics “neglect[s] issues of public health, preventive medicine and social medicine…{such as] gun control and firearm-related violence.” In 2012, Art Caplan wrote that “We need to treat violence as a public health issue” and in 2015 that “guns are a medical issue.” John Kaplan in an Albany Medical College blog in 2013 was amazed by “how little bioethicists are saying about the need for gun control.” In 2017, Jenny Nguyen in Medium offered a deontological examination of the issue: “I consider violence to be an issue that should be addressed using bioethics.” In 2018, Jones et. al in the AMA Journal of Ethics wrote that physicians have a role in reducing gun violence. In recent days, psychiatrist-bioethicist Jonathan Metzl has spoken on MSNBC about the Parkland shooting as a mental health specialist, not as a bioethicist. PubMed search of “bioethics” plus (“gun,” “firearm,” violence,” or “control”) yielded 8 results. Eight peer-reviewed bioethics articles and a handful of blog posts.
Sadly, over the five years of this blog, I have written almost annually about the challenges of guns and the preventable deaths they cause (2012, 2014, 2016a, 2016b). After Parkland, I began sharing on social media about the problem with guns. Predictably I received a great deal of pushback. Much of the rhetoric offered disproven “alternative facts”. Others stated that there really aren’t so many mass shootings because more than 3 people have to die for it to be “mass” and that suicides do not count because “other people aren’t harmed.” Thus for the purposes of this discussion, a “gun” is any weapon (firearm, sidearm, pistol, rifle, semi-automatic) that shoots a bullet. A “shooting” is a discharge from a firearm whether it is a suicide, homicide, accident, or other. Yes, this is a broad stroke.
To hear the rhetoric from supporters, the Second Amendment is sacred. By sacred, they mean cannot be abridged or restricted in any way. Consider that Justice Thomas disagreed with the Supreme Court’s decision to not hear a challenge to California’s 10-day waiting period for purchasing firearms (leaving the waiting period as law). In his dissent he said the decision moves the Second into a “disfavored right.” The stance is interesting because no rights under the Constitution are absolute, they are all prima facie. Famously, the right to speech is limited: You cannot speak words that will harm others. You cannot yell fire in a crowded theater. There are restrictions on distributing obscene materials, publishing material in a school newspaper that the administration forbids, advocating for illegal drug use at school events, or burning your draft card. But somehow, a waiting period for purchasing a gun is seen as an attack on the Second.
What makes Thomas’s comments even more insulting (to our intelligence and sense of decency) is that it comes days after the Parkland shooting. The only thing more distasteful is that a candidate for political office in Kansas is giving away AR 15s (the gun that has been involved with most US mass shootings in recent year) as part of his campaign.
In the first 6 weeks of 2018, there have been 18 discharges of firearms in and around schools (including accidental firings, bullets hitting schools, suicide attempts, and shots fired both during and outside of schools hours). According to the CDC, the number of deaths by firearms (all causes) is 33,594 people which is 10.5 people per 100,000. For perspective, motor vehicle deaths are responsible for 33,736 deaths or 10.6 deaths per 100,000 population. In 21 states, deaths by firearm are higher than death by motor vehicle. Not surprisingly, states with looser gun laws (specifically, shall-issue laws) have higher rates of gun deaths.
In comparison to other countries around the world, the rate of gun deaths in the US is startling. According to United Nations data, the U.S. has 29.7 per 1 million population homicides by firearm. The next closest is Switzerland with 7.7. Of course, the US has the highest rate of gun ownership in the world, followed secondly by Switzerland. We have all heard the arguments as to why there are so many gun-related deaths in the U.S.: The culture, mental illness, freedom, media (TV, movies, and video games), etc. However, the studies of such variables do not support the claims of responsibility. For example, violent video games and movies are distributed worldwide, but we don’t see real life shootings in other countries, even English speaking ones. Other countries value freedom and other countries have unmet needs for people with mental illness. If mental health was a concern, as politicians state, then why did the U.S. government make it easier for people with mental illness to purchase guns in 2017? Other countries have a history of a gun culture (in Israel most adults serve in the military, Canada was founded as a similar frontier nation). When you comb through the data, the one variable that sets the U.S. apart from its peers is that firearms are more widely available and more easily accessible: More guns equal more gun related deaths.
However, this research is limited. In 1997, Congress passed the Dickey Amendment that prohibits the CDC from studying firearm violence which has decreased studies into the extent of the problem, the causes of the problem, and testing potential solutions. The AMA has called gun violence a public health crisis. The American Public Health Association has advocated taking a public health approach to firearms violence: “define a problem, conduct research to identify risk and protective factors, and use the knowledge about risk and protective factors to develop preventive interventions.”
I strongly believe in gun control and even wonder in the modern era whether the Second Amendment should be repealed. After all, it was created in part to ensure that a person could defend themselves if the government should invade their home. The idea of the early militias was a citizen army that could be deployed in the battlefield and to be sure that the British would not enter homes and cease their weapons. The U.S. has a professional army now. Also, if the government showed up at someone’s door, it is unlikely that a shotgun, handgun, or even AR 15 would prevent a military armed with tanks and missiles from accessing your home. The idea that the Second meant that individuals had a right to own, store, and carry guns was only created in 2008 when the Supreme Court confirmed the Second Amendment to individuals from militias. Our more modern idea, that this Amendment cannot be abridged actually comes not from the writing of the Constitution or even the founding of the Republic, but rather from slavery: “Southern men thus carried weapons both ‘as a protection against the slaves’ and also to be prepared for “quarrels between freemen.”
Bioethics is supposed to be the great facilitator of moral discourse on issues of health in the modern era. After all, we came into being as activists to bring autonomy into medical decision-making, to bring to light wrongs in human subjects research, and to help people make difficult health care decisions, usually difficult because of the existence of a new technology. Bioethics has taken a public role, applying ethical analysis and discussion on issues in the public arena in such areas as human subjects research, stem cells, cloning, neuroscience, Ebola, secondary findings, genome sequencing, synthetic biology, abortion and much more. Our expertise is in facilitating difficult conversations and moral deliberations. We can provide strong ethical analysis, engage in debate and conversation, weigh arguments, and help create consensus. These are valuable tools in the hospital and they are valuable tools in the public.
While bioethics has been criticized for shying away from issues of public health and social justice, the discourse on firearms is near silent. It is time for that silence to end.