―HAPPINESS IS A WARM GUN‖BIOETHICS AND GUN POLICY Steve Miles, MD Center for Bioethics, University of Minnesota Producer George Martin showed me the cover of a gun magazine saying ― Happiness Is a Warm Gun.’ I just thought it was a fantastic, insane thing to say. A warm gun means you just shot something.‖ ---John Lennon. b. October 9, 1940 d. December 8, 1980, 10:50 PM– Shot in the back at close range with 4 hollow-point bullets from a Charter Arms Undercover .38 Special at 10:50 PM.
Gun Violence: A Public Health ApproachTHE LINK BETWEEN MEDICAL ETHICS AND GUN POLICY
WHAT IS A PUBLIC HEALTH APPROACH TO GUN VIOLENCE?• Research who, when, and where of gun related 1996, NRA successfully injuries, considering the gun user, the gun, and the lobbies to instruct CDC: setting. "None of the funds made• Identify factors associated with greater or lesser risk of available ... may be used to injury or death. advocate or promote gun • Risk factors are not ―causes‖ (bad railings do not control.‖ cause a person to fall from a deck). 2013, NRA successfully • A risk factor does not mean that a person will always lobbies to bar Bureau of experience morbidity. Alcohol, Tobacco, Firearms • Prevention decreases risk; it is not always and Explosives from using successful. firearms data to make conclusions about gun• Apply lessons from other public health campaigns (e.g. crimes. motor vehicles, tobacco, etc.)• Develop and evaluate morbidity prevention strategies• Adopt successful prevention strategies. J Pub Hlth Pol 2001; 22:381-402.
MORE HOUSEHOLDS WITH GUNS: MORE GUN DEATHS. ―The only way to stop a bad guy with a gun is with a good guy with a gun,‖ NRA Executive Vice President Wayne LaPierre.JAMA Intern Med. 2013;doi:10.1001/jamainternmed.2013.1286
SUICIDE BY GUN: OLDER, MALE Suicide is the seventh top cause of death for men and fifteenth for women in the United States. Firearm Suffocation Poison Other25000200001500010000 5000 0 Women Men Charlton Heston, NRA President
SUICIDE AFTER GUN PURCHASE:• Suicide is leading cause of death of the buyer 400 during first year after 350 handgun purchase. 300 • N Engl J Med 1999; 250 341:1583-9. Death / 100,000 p-yrs 200• Background checks that 150 delay the acquisition of 100 a gun in some studies 50 decrease death by Baseline Suicide Risk suicide. 0 1 2 3 4 5 6 7 8 9 10 Months after Purchase
HIGHER RISK OF SUICIDE IN GUN OWNING HOUSEHOLD NOTEXPLAINED BY MORE MENTAL ILLNESS IN THE HOUSEHOLDS.• People in homes with guns are no more likely to have recent anxiety, mood disorders, substance dependence or abuse, suicidal ideation or suicide planning.• Having made a suicide attempt over the previous year was the only mental health factor more common among people who lived in a home without firearms. Injury Prevention. 15(3):183-7, 2009 Jun. Household survey of 9282 adults. Multivariate logistic regression analyses controlled for age, sex, race/ethnicity, educational attainment and poverty.
TEEN SUICIDE: ACCESS AND IMPULSE Southgate — A crowd of• Handguns used in most teen suicides. 300 students, parents• Teen gun suicide attempts are 80-90% lethal. and staff members • Youth Suicide by Firearms Task Force. gathered Thursday http://www.pbs.org/thesilentepidemic/riskfactors/guns.html night for a vigil honoring an eighth-grader who• 80% of 14-19 year olds’ suicides take place at home. shot himself to death.• A home with a handgun is almost ten times more Police said he took the likely to have a teen suicide. Most guns owned by gun from a family parents. members home. • Suicide & Life-Threatening Behavior. 40(6):609-11, 2010 Dec. The firearm, a .40 caliber Glock• Children who commit gun suicide have fewer risk handgun, was legally factors for suicide, such as expressing suicidal registered. thoughts. Gun suicides appear more impulsive than suicide by other means. • Suicide and Life Threatening Behavior. 2004; 34:36-43.
WHEN GUNS LEAVE HOUSEHOLDS: FEWER PEOPLE, ESPECIALLY TEENS, SUICIDE.• When there were one or more guns in the home, the risk of suicide among women increased five times.• For each 10% decline in the percentage of households containing children and firearms, firearm suicide by children <19 dropped 8.3%. • Inj Prev. 2006 June; 12(3): 178–182. Multivariate population study, US. • See also: J Trauma 2007;62:1029-35. NB: Studies suggest that handguns are a greater risk than long guns and that guns stored unlocked are a greater risk than guns stored locked.
BOTTOM LINE: SUICIDE• Suicide is the most common lethal event with a gun.• The biggest risk factor for suicide by gun is having one available in the house.
Homicide trends and weapon used. 18000 16000 14000 12000 Other 10000 Blunt Obj 8000 Knife 6000 Other gun 4000 Handgun 2000 0Bureau of Justice Homicide weaponhttp://bjs.gov/content/pub/pdf/htius.pdf
ASSOCIATION BETWEEN HOUSEHOLD GUN- OWNERSHIP AND HOMICIDE RATES. States with higher levels of household gun ownership had higher rates of firearm and overall homicide. There is no association between gun prevalence and non-firearm homicide.Soc Sci & Med 2007 64;656 – 64., Multivariate analysis for rates of aggravated assault, robbery, unemployment, urbanization, alcohol consumption, andresource deprivation (e.g., poverty), genders and all age groups.
GUNS AND INTIMATE MURDERBureau of Justicehttp://bjs.gov/content/pub/pdf/htius.pdf
GUNS AND INTIMATE MURDER• Gun owners 8 times more likely to threaten their partners with a gun than non-gun owners. • threatening to shoot them • threatening to shoot a pet or person the victim cares about, • cleaning, holding or loading a gun during an argument, and • shooting a gun during an argument. • J Am Med Women Assn, 2005; 60:62-8. 8,000+ men in a certified batterer intervention program in MA, 1999-2003. See also Evaluation Review. 2006; 30:283-95.
GUNS AND INTIMATE MURDER• A gun in the home makes it three times more Deaths 1,100 likely a person will be murdered by a family 606 member or intimate partner. Homicides• Gun intimate assaults are 12 times more likely 11,078 Suicides to result in death than non-firearm associated 19,400 Accidents assaults. • http://www.silentwitness.net/sub/violences.htm
BOTTOM LINE: HOMICIDE• Homicide is the second most common lethal event with a gun.• Guns in the house is highly correlated with the risk they will be used for homicide.• Guns in the house are the most powerful predictor of domestic intimate violence becoming a homicide.
Deaths 14,675 wounded but survive (1/5 under 19 years old). NCIPC 606 11,078 Homicides Suicides Accidents 19,400GUN ACCIDENTS
GUN ACCIDENTS• Fatal gun accidents are 1% of all lethal home accidents (poisonings 43%, falls 34%, burns 9%).• BUT: 14,675 wounded but survive (1/5 under 19 years old). NCIPC• BUT: Preventable • Accidental lethal shootings 8 times more common in the four states with the most guns compared to the four states with the fewest guns • Acc Anal Prev 2001;33: 477-84. • Adults with a gun in the home have a 4 fold higher risk of dying of an accidental gunshot. • Acc Anal Prev 35(2003)711-716
18 16.3 RELATIVE RISK OF GUN16 HOMICIDE, SUICIDE AND LETHAL14 ACCIDENT FOR 5 TO 14 YEAR OLDS IN HIGH AND LOW GUN STATES1210 High Gun 8 Low Gun 6.7 Non Gun Ratio of High Gun Sts to Low 6 Gun Sts for Non-Gun deaths 4 3.3 2 High Gun States are 1 1 11 LA, AL, MS, ARK, WV 0 Homicide Suicide Accident Low Gun States are HI, MA, RI, NY, DEL J Trauma 2002; 52:267-75.
RELATIVE RISK OF GUN DEATHS FOR CHILDREN• For 5 to 14 year olds, the U.S. unintentional gun death rate is 11 times higher than the combined rates of 22 other high-income developed countries. • J Trauma 2011;70:238-43.• In 2011, 2,886 children 0-19 were treated in an emergency room for an unintentional gunshot injury. NCIPC• For 0 to 4 year olds, gun deaths are 17 times more common in high gun states than low gun states.• For 5 to 14 year olds, gun deaths are 14 more common in high gun states than low gun states. • Acc Anal Prevent 2001;33: 477-84
GUN LOCKS: Toddler shot in St. Paul UNDERUSED as kids play with handgun Less than half of home guns are secured. PRICELESS CHEAP
BOTTOM LINE: CHILD DEATHS BY GUNS• Guns in the home are the most powerful predictor of lethal gun accidents, suicides, and homicides of children.
MAJOR PAPER CITED BY ANTI GUN CONTROL PREVENTS CRIMES.Kleck, Gertz. J Crim Law Criminology 1995;86.150-87.• 222 of the 4799 (which in turn was 20% of the total sample respondingreported having at least one Defensive Gun Use (DGU) in the past 5 years.• After correcting for oversampling in some regions, this drops to 66 personal DGUs in the preceding year, indicating that 1.326 percent of adults nationwide had experienced at least one DGU.• When multiplied by 1.478, the number of DGUs Our survey was ―free of the taint of reported per DGU claimant and by the adult being conducted by, and on behalf population, an estimate of 2.55 million DGUs per year of, employees of the federal was arrived at. government, and it was completely anonymous.‖
FROM 2.55 MILLION DEFENSIVE GUN USES PERYEAR TO…. Cato Institute. Tough Targets. 2012. 8 years of news clippings. • 277 news reports where the intended victim disarmed criminal. • 25 where an armed rape attack victim got the upper hand. • 65 where an armed carjack victim prevailed. • 11 out of 4,699 where a Bureau of Justice criminal took a gun away http://bjs.gov/content/pub/pdf/htius.pdf from a defender.
BOTTOM LINE: GUNS FOR SELFPROTECTION FROM HARM.• An armed citizen is vastly more likely to commit homicide or to suffer harm to him/her-self or those in his/her household than he/she is to benefit from gun protection.
AMERICAN ACADEMY OF PEDIATRICS (PARAPHRASED)• Pediatricians should counsel parents about the dangers of allowing children and adolescents to have access to guns inside and outside the home.• Pediatricians should ask about the presence and availability of firearms …and urge parents who possess guns to prevent access to these guns by children.• Health professionals should counsel parents of all adolescents to remove guns from the home or restrict access to them. This advice should be reiterated and reinforced for patients with mood disorders, substance abuse problems (including alcohol), or a history of suicide attempts.
―The Affordable Care Act does not prohibit or otherwise regulate communication between doctors and patients, including about firearms.‖ • –White House―Doctors are being ordered, instructed to talk topatients and get information from them aboutgun ownership, where they are in theirhouse, who has access to them, where theammunition is kept. Doctors are now "permitted‖to do this. It makes em deputies, agents of thestate.‖
MINNESOTA LAWS Gun Dealers Gun Owners• No state dealer license. • No permit to purchase or• Dealers not required to retain records for license to posses, no guns /ammo sales. fingerprinting.• No mandatory theft reporting, • No requirement to report• No ID microstamps on semi-auto handguns. thefts.• No bar on bulk sales of handguns. • No ban on assault• No background checks on gunshows or rifles, large clips. interpersonal sales. • No disarming of prohibited• No mandated sale of locks with all handguns. handgun possessors.