After Newtown: Public Health and Bioethics Frameworks for Deliberating Gun Policy

Bioethics-in-the-News-logoThis post is a part of our Bioethics in the News series. For more information, click here.

By Ann Mongoven, PhD

The tragedy of the Newtown massacre has prompted national reconsideration of gun policy. But will it prompt reconsideration of the frameworks for that discussion? Or will continued questions about ambiguous constitutional parameters entrench the discursive cross-fire in which individual rights are pitted against public interest, hobbling meaningful response? By asking different questions, public health and bioethics offer alternative frameworks that could foster pragmatic balancing of individual rights and public interests. These frameworks enable new approaches to reduce gun violence without eliminating responsible gun ownership.

Public Health. The stranglehold of a discourse framed on individual rights, despite lack of clarity of constitutional dictates, prevents gun violence from being addressed as a public health challenge. Certainly that is odd, given the magnitude of the threat gun violence poses the public. Moreover, like other dangers perceived as public health issues, that threat is characterized by traceable patterns of vulnerability and spread. More than 30,000 Americans die annually from gun violence; gun violence ranks second among accidental causes of death only to car accidents; it is the leading cause for those who die in domestic violence; it is one of the highest-ranking causes of death among youth; it is the number-one cause for African-American teens. Indeed, if any disease posed an analogous threat it likely would be identified as the first priority of the public health community.

Yet legislative barriers impede federal public health agencies from analyzing gun violence using public health methods. In a recent editorial in Journal of the American Medical Association, Arthur Kellermann and Frederick Rivara describe the history of those barriers and how they curtailed gun violence research at the Center for Disease Control and National Institutes of Health(1). Post-Newtown Congress should rescind those obstacles to scientific research on gun violence. Meanwhile, public health leaders such as New York Mayor Michael Bloomberg and faculty at the Johns Hopkins School of Public Health Center for Gun Policy Research underscore the relevance of traditional public health questions(2). What is the epidemiology of gun violence? What are its common vectors (what types of individuals, institutions, practices, guns or ammunition)? What are the pathways of spread? What populations are particularly vulnerable? What targeted interventions could shut down those vectors, pathways, and vulnerabilities? Public health professionals assume that advancing public health can require restrictions on individual liberty, but typically they seek the most public health “bang” for the least “buck,” not only in terms of dollars spent but in terms of individual liberty constrained. Thus they pursue evidence-based, targeted interventions rather than broad, ideologically-based approaches.

Not only public health, but also the field of bioethics, offers frameworks for thinking about gun regulation that could move us beyond national paralysis.

Principlism. A commonly employed “principlist” approach to bioethics asks how we can balance diverse ethical principles that are individually cogent but that may press against each other in a tragic moral universe. These principles include respect for individual autonomy, beneficence, non-maleficence, and justice. With gun violence striking down innocent individuals and disproportionately affecting identifiable groups, respect for the autonomy of gun enthusiasts is just one factor among many to be balanced by principlism. Principlist reasoning has developed rigorous strategies to negotiate dilemmas between ethical principles that are in tension. These include proportional analysis of harms and benefits, consideration of least infringing alternatives when one ideal must be limited for the sake of others, and the continued maintenance of partially-implementable aspects of those principles that are deliberately subjugated. All these traditions of reasoning provide deliberative infrastructure for a new approach to gun regulation, conceived as something other than “a zero sum game.”

Cases and Beyond; Patients and Beyond: Multi-Level Ethical Analysis. Bioethics continually questions the relationship between cases, patterns, and policy. The field has a time-honored history of working at the case level, in all its specificity, while also discerning and addressing ethically relevant commonalities among cases. This back-and-forth has enabled policy initiatives that simultaneously respond to patterns while acknowledging the uniqueness of patients, families, and providers (such as living wills and durable powers of attorney). Gun policy discussions need a similar back and forth. While there may be truth to the adage “hard cases make bad law,” we cannot afford to ignore patterns at play from Columbine, to Virginia Tech, to Aurora, to Newtown. Nor can we ignore patterns in the “slow bleed” of cases that remain outside the national limelight while taking a greater aggregate toll, such as the use of handguns in individual suicides. One troubling pattern is the frequency with which guns legally owned by one family member become vehicles for tragic gun violence by another. Bioethics’ historically individualistic moorings have been stretched to recognize that patients come enveloped in diverse webs of family and community. We must recognize that gun-users do, too.  Rhetoric that treats cases as isolated events and gun-owners at atomistic individuals will no longer do.

Virtue Ethics. So-called virtue ethics have become increasingly prominent in bioethics. Virtue ethics ask: “What kind of community (clinic, health care system, etc.) do we wish to be? How can we become that kind of community?” Virtue ethics can change the nature of gun control debates by focusing on the character of communities rather than on  individual rights.  Do we wish to be a community in which there are more guns than people? In which gun violence is a leading cause of death, especially for youth? In which there are no “gun-free” zones? In which our children routinely watch gun murders and suicides enacted in diverse “entertainment” media? If not, how can we cultivate becoming a different kind of community?

We don’t just need a new conversation on gun policy. We need a conversation with new conceptual frameworks. We need frameworks that help us think through gun regulation that successfully balances multiple interests. Public health and bioethics offer several. By pushing us to ask different questions, they may help us arrive at better answers.

References:
1. Kellermann AL, Rivara FP. Silencing the Science on Gun Research. JAMA. 2012;():1-2. doi:10.1001/jama.2012.208207.
2. Johns Hopkins Bloomberg School of Public Health Center for Gun Policy and Research website.

mongoven smallAnn Mongoven, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Pediatrics at Michigan State University.

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3 Responses to After Newtown: Public Health and Bioethics Frameworks for Deliberating Gun Policy

  1. Jake Newcomb says:

    Very interesting restructuring of the conversation. Most likely the barriers to the shift in framework to a public health lens are purely political, however this may soon be changing with the growing tide of public opinion.

  2. Judith Andre says:

    It depends what “purely political” means. Americans think almost exclusively in terms of individual benefits and individual choice. Asked what would most improve global health, students reply: More health care, better life styles. The concept of common goods, intrinsically shared, has faded away. Publicly available clean water, breathable air, the eradication of the polio virus, public education are all common goods, and contribute greatly to better global health. To me a fundamental political task is reintroducing the very notion of a common good, to which public health is dedicated.

  3. Ann Mongoven says:
    Many thanks to Jake Newcomb and Judy Andre for their thoughtful responses. My combined reply is: Professor Andre has hit the nail on the head re a conceptual task at hand that permeates our democratic life– to re-infuse the word “political” with connotations of social discernment and promotion of the common good. But “common good” is complex. Personal freedom and public safety might both be a part of common good, for example. I would still insist bioethics has something special to offer. Endemic to the field is a dual recognition: recognition of major guiding ends (patient or public health welfare), and recognition of moral tensions to be negotiated in promoting those ends. To its credit, bioethics is complexly teleological. In addition to what I will term “the Andre challenge” (renewing commitment to common good), I seek to raise another challenge as well. That is the challenge of critically evaluating the over-arching metaphors that frame our political debates. Too often debates rage within such rhetorical frameworks without ever questioning the framework. The biggest questions I want to raise are: “Why don’t Americans think of gun regulation as a ‘public health’ issue, given the enormity of public health impact? How could our discussions of the issue change if it were addressed as a public health issue?”

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