SECOND AMENDMENT AND HEALTH: WHAT DID OUR FOUNDERS INTEND?

As a physician concerned with health issues, I am impelled to examine the original conditions underlying our country’s current allowance of the widespread presence of firearms. Hopefully, this may provide better insight into our present dilemma.

After a lively debate in 1789, the final version of the second amendment to the U.S. Constitution read: “A well regulated militia being necessary to the security of a free state, the right of the people to keep and bear arms shall not be infringed”   Its meaning has provoked more controversy in our own time than when it was originally adopted.

After the American Revolution, there was great concern about states’ rights; five states had even called for prohibition of a permanent standing federal army because of the perceived threat posed by a professional army under federal control. Thus the prevailing intent was to allay the fear that would have limited states’ rights. The armed forces that won the American Revolution actually consisted of a Continental Army that was formed by a conglomeration of state and regional militia units together with regular French armed forces. Allowing for a powerful U.S. federal force at that time was all too reminiscent of the recently defeated tyrannical forces of England

In United States v. Miller (1939), the Supreme Court seemed to have supported this collective concept by ruling that the federal government and the states could limit any weapon types not having a “reasonable relationship to the preservation or efficiency of a well regulated militia.”   By contrast, the more recent Supreme Court decision (Heller v. District of Columbia, 2008) found the right to bear arms an inherent and nearly unlimited individual right, which was clearly at odds with the founders’ original intentions that referred to a right of collective defense in the form of militias. Most scholars believe this right was to apply when the sanctions of society were breached by the violence of oppression, clearly a collective endeavor.

Now that our federal government controls a strong national defense force, bearing of arms is no longer a state or local responsibility, and the individual “right” to bear arms is, in reality, not really a right but a privilege to be granted individuals with permission of local jurisdictions, within broad and reasonable limits provided by the federal government. In reality, local militias are now passé, and individuals have no need to claim rights that were formerly accorded to defend against militant groups—be they Indians, foreign forces, or our own federal forces.

When the second amendment was introduced, the standard firearm was a musket that, under the most favorable conditions, could fire a single shot every 15 seconds for at least 4 minutes before usually slowing down because of fouling in the barrel—a method clearly inadequate for mowing down large numbers of unarmed people in packed assemblages. It thus seems clear that our founders—were they made aware of the devastating potential of modern rapid firing weapons such as assault rifles (AK 47) and their ilk—would have urged sensible limitations to this so-called individual “right” to bear arms. Obviously, the constitution requires constant reinterpretation in response to changing circumstances, as evidenced by abolition of slavery, school desegregation, and others too numerous to list.

More sensible control of firearms is a desire shared by the majority of our population that includes gun owners themselves. Thus all individuals should carefully monitor the preferences of our candidates for public office and vote accordingly, a vote that should also take into account the individual proclivities most likely to select future Supreme Court justices willing to reassess the control of firearms in a modern context.

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FIREARM VIOLENCE IN THE UNITED STATES: A MEDICAL OPINION

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   Most people don’t realize that over 30,000 people are purposely shot to death each year in the U.S. Moreover, rates of firearm-related violent crimes continue to climb, having increased by 26% since 2008. To gain perspective on these numbers, firearm deaths have now reached a yearly rate that equals that of automobile fatalities. What we can do to stem such violence is urgent but hampered severely by the rabid supporters of the second amendment and, of course, the gun lobby. Some clarification recently has been shed on this problem by a study appearing in the prestigious medical journal, the AMA sponsored Archives of Internal Medicine. These authors explored the question whether more restrictive firearm laws in a given state are associated with fewer shooting deaths. To answer this question, using sophisticated statistical methods, they measured the association between the rate of shooting deaths in a state-by-state rating (divided into quarters) of strength of legislation designed to limit sale and use of firearms. Their results were very illuminating: Those states with the fewest firearm regulations, as exemplified by Utah and Louisiana (0-2 laws), suffered the highest rate of firearm fatalities, which included both homicides and suicides. The states with the strictest pattern of regulation, as exemplified by Hawaii and Massachusetts (9-24 laws) experienced the lowest fatality rates. Indiana, my home State, fell into the second lowest category for regulation and, as expected, fell into the second highest incidence of firearm deaths.

    These authors freely admitted that finding an association between two factors—gun laws and mortality—does not prove that these two are causally related. But it sure raises important thoughts about what we as a society can do about this problem. Further research is obviously needed, but it is quite likely that more restrictive gun laws can save lives.

The experience in Australia adds strong support to this argument: In response to a mass shooting of 20 people by an assault weapon in 1996, the state enacted a comprehensive set of firearm law reforms. Among others, the regulations included a ban on civilian ownership of semiautomatic long guns and pump action shotguns. Financed by a small tax levy on all workers, this law was combined with a buyback program of those guns already in circulation. This included a prohibition of mail or internet gun sales with required registration of all firearms continuing to be legally held. Since then, there have been no mass shootings and an accelerated decline in total gun-related deaths.   

    Another study appearing in a major medical journal has added even more weight to these conclusions. In a study that included 27 different countries around the world, researchers found that there was a strong correlation between gun ownership rates and firearm-related deaths. Those countries with the highest rates of gun ownership, e.g. the U.S.A. (88.8 per 100 inhabitants) suffered the highest firearm-related deaths, whereas those with the lowest rates of such possession, i.e., Japan and the U.K. (0.6 and 6.2 per 100) enjoyed the lowest rate of such deaths. Interestingly these same researchers found a poor correlation between mental illness and firearm deaths. 

    Another proposed remedy, i.e. more aggressive attempts to identify, treat and constrain the huge numbers of those who are mentally ill, is an exercise doomed to failure.

Moreover, the limited relationship between mental illness and firearm deaths, as noted above, implies that trying to find and treat those suffering from mental illness would do little to reduce the number of gun-related fatalities. Hall and Friedman provided further confirmation of this concept (Mayo Clinic journal, November, 2013), by concluding that proper identification the small proportion of the mentally ill individuals capable of homicide prior to an actual act of violence is extremely difficult, if not impossible.

     Widespread arming of teachers and/or police officers is equally ridiculous, especially since it would increase chances for erroneous shootings in the absence of any expected benefits.

    With such limited options available, what are we left with? Although we need not scrap the second amendment, those who hold legislative power should seriously consider stronger laws restricting guns, while, at the same time, sponsoring and performing more comprehensive research on this urgent problem. If we value life, we cannot afford to wait!      

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