This 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.

Ann 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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