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  • BIOETHICS FORUM ESSAY

Calling on Doctors to Take the Lead in Fighting for Gun Control

The National Rifle Association recently condemned doctors who are against gun violence, telling us to stay in our lane. Reducing preventable deaths is the main lane for doctors.

And despite thinking that doctors would not be targeted because we are here to help, we are not immune. The tragic shooting at Mercy Hospital in Chicago on November 19 that left an emergency physician among the victims brought home to physicians how vulnerable we are to acts of violence.

The Centers for Disease Control and Prevention recently released a report on firearm homicides and suicides. In an understated way, it said that “firearm homicides and suicides represent a continuing public health concern in the United States.” In 2015 and 2016, the U.S. experienced 27,394 homicides, including 3,224 among youths ages 10 to 19, from guns. In the same period there were 44,955 firearm suicides, including 2,118 among 10-to-19-year-olds.

We are so much worse than any other Western democracy that comparisons are almost meaningless. As I point out in my new book, Prescription for Bankruptcy, people can attempt suicide by many means, but none is nearly as “successful” as suicide by gun. Most people who attempt to kill themselves by cutting their wrists or taking an overdose survive, and repeat attempts are rare. The lethality rate when the means used is a firearm is close to 100%.

Last May, CNN reviewed data on school shootings around the world. While this study was less than truly scientific because it relied on media reports and, thus, might have missed shootings in which no one died, what it found was sad enough. From January 1, 2009 through May 21, 2018, there were 288 shootings with fatalities at U.S. schools, including grade schools and colleges and universities. This was 57 times as many as in the rest of the G7 nations combined. There were two school shootings each in France and Canada, one in Germany and none in Japan, Italy, or the United Kingdom.

A study in Health Affairs last January looked at the death rates among children and teenagers in 19 countries in the Organization for Economic Cooperation and Development. Teens in the U.S. were 82 times more likely to die at the hand of a gunman than were their peers in the other 15 countries.

We are well aware of what happens after each mass slaughter of innocent children. Politicians mouth platitudes and offer their prayers and comfort to the victims and their families. They then hop back in the pockets of the NRA and do nothing to prevent the next shooting.

We can lower firearm fatalities without infringing on the legitimate use of firearms by hunters. Massachusetts has one of the toughest gun laws in the nation and the lowest death rate from firearms. If every state in the country had a similar law and death rate from guns, tens of thousands of American lives could be saved.

To own a gun in Massachusetts, you must obtain a permit from your local police department. This requires paperwork, an interview and a background check. In addition, the local police chief may use discretion if he or she knows something about you that does not show up in your criminal record. Only after you get this permit can you go to a gun store and purchase a firearm. All firearms are registered, and if you get yours from a relative or private seller, that person must verify that you have a permit. Certain weapons, such as automatic weapons and sawed-off shotguns, are illegal. Firearms must be stored in a safe or with a trigger guard. While 97% of permit requests are granted, it is assumed that many people do not bother requesting one knowing the process.

A clear majority of Americans want better gun control. Allowing hunters and others with a legitimate need to own rifles or shotguns after background checks would respect their rights while protecting our right to live. We must stand up to the NRA and tell our elected officials they will not be re-elected if they do not grow spines.

Physicians, dedicated to preserving lives, must take a lead, acting both as individuals and working through their organizations in fighting for common sense gun laws and making it clear that this is as high a priority as fighting the opioid epidemic to avoid senseless preventable deaths.

Edward Hoffer, MD, is a recently retired Massachusetts internist and cardiologist who works part time at the Massachusetts General Hospital on diagnostic decision support.

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Published on: December 19, 2018
Published in: Activism, Bioethics

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One comment on “Calling on Doctors to Take the Lead in Fighting for Gun Control

  1. Dan Gabriels, M.D. on

    Edward Hoffer writes, “Reducing preventable deaths is the main lane for doctors.” It’s not, and it’s not for at least two reasons, which I’ll remark presently. Deaths which humans might have any influence over, occur as a result of the circumstances and choices of human activity. The former, inclusive of those varieties of casuation which we’ve come to understand, define risks of death through a host of mechanisms. Alternatives are often chosen because they involve favorable exchanges between those alternative-bundles of risks. The first reason “preventable deaths” is not “our” lane, is that physicians are not expert at all those mechanisms of causation which determine which alternative choices are better bundles of risk.

    Are American lives being lost in Afghanistan fewer than would be being lost by relinquishing control of the region to the Taliban? Do physicians know, because they’re physicians? There’s an active debate in NYS whether its strict liability scaffolding law produces fewer worker deaths or more. Do physicians have a place of authority in speaking to this question because they are experts about which of the deaths at issue are preventable? Public budgets, and non-budgetary public policies, influence how many and which lives are at what risks. Providing for bicycle lanes on city streets—will this increase or decrease bicyclist deaths? Do physicians know?

    “We can lower firearm fatalities without infringing on the legitimate use of firearms by hunters.” This appears to be the only legitimate use of firearms which Edward Hoffer’s influence over “the lane” identifies to consider. He makes no mention of the self-defense function which must be recognized as central in any reality-based discussion of firearms policies, or understanding of the related mechanisms of exchanges-in-lives which are active in the world. Anecdotally, of the three people I’ve known who were murdered, one could have saved herself if she’d had a firearm. Of the three people I’ve known who’ve had family murdered, all three deaths might have been prevented by the victims’ possession of a firearm.

    A Johns Hopkins originating study in the May 2016 issue of The BMJ, argued that more than 250,000 deaths per year are due to medical error in the U.S.. Someone might say that this was a reason to act with urgency to end medical care. But that conclusion wouldn’t be accounting what lives would be lost by ending American medical care—and it would be a similarly uninformed and simplistically blunt agenda to suppress all firearm ownership except for the “legitimate use” of hunting. Our being physicians doesn’t produce expertise here, while such a magnitude of iatrogenic deaths is very definitely in our lane, our responsibility, and would have to be a higher priority for our physician-as-physician energies and activity. And with the Hoffer-noted opiod crisis killing tens of thousands that could credibly be laid at the feet of living-memory physician prescribing practices, physicians-as-physicians should not necessarily be seeking to draw attention to ourselves as seers.

    The second reason “preventable deaths” is not “our” lane, is that “preventable” obscures preceding valuative judgments. All MVA deaths could be prevented by eliminating motorized vehicles, but physicians as physicians aren’t advocating such. We could also prevent all astronaut deaths by ending the exploration of space, and I’ve personally been eyeing those rock climbing youths with more than a little wish they wouldn’t do that. But I have no expertise and no place to make all valuative choices for others. “[T]he doctor’s prime and basic function is not so much the prevention of death (which is not in his power) but the preservation of life capacities for the realization of a reasonable, realistic life plan. . . the doctor must see himself as the servant, not of life in the abstract, but of the life plans of his patients.” Charles Fried, Medical Experimentation: Personal Integrity and Social Policy.

    I haven’t looked at the CNN or Health Affairs data but I’m both not overwhelmed and also skeptical, respectively. Similar American tragic exceptionalism had been reported for mass shootings, and is certainly purveyed by media outlets, but work that didn’t limit itself to data reported in ENGLISH found quite different—reversed—conclusions: “. . . the US makes up less than 1.43% of the mass public shooters, 2.11% of their murders, and 2.88% of their attacks. All these are much less than the US’s 4.6% share of the world population.” (“How a Botched Study Fooled the World About the U.S. Share of Mass Public Shootings: U.S. Rate is Lower than Global Average,” John R. Lott, Jr.). As regards the 32 deaths/year in schools which CNN is cited as reporting, this is not quite three times the 12 children still strangled each year by curtain cords (as of 2015). Is there anything like a third of the hue and cry about curtain cords by physicians as physicians, as Hoffer’s remarking of school shootings seems directed to motivate, regarding firearms policies?

    Physicians certainly have a specific role and voice, as drawing attention to and bearing witness to the experiences and losses of the humanity which physicians encounter, which most people don’t, or don’t in significant quantity. Some will also strive to do bedrock-sound research that results in relevant expertise and specific recommendations. And by all means speak to “the lane” as citizens with carefully informed perspectives. But physicians as physicians shouldn’t arrogate to themselves a global expertise which they do not have, or speak from a presumed valuative hegemony which does not exist.

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