Tuesday, July 1, 2008

Firearm Fatalities: Glass Half Full?

In the wake of the news that the Second Amendment contains enforceable rights, I noticed an article that helpfully pointed out that less than half of the firearms deaths in the United States are intentional killings.

This wasn't actually the thrust of the article; the idea in the article seemed to be that suicides are such an important public health issue that as a matter of policy weapons offering high-success suicide methods should be banned. (I note that the advocated policy wasn't supported with any legal argument.) I'm not sure how the accidental nature of the killings helps us reach the conclusion urged by the folks to whom the linked "news" article is sympathetic. Fewer than half of automotive deaths in the United States are intentional killings, and substance abuse remains epidemic. And here, perhaps, is a parallel worth following.

When I first became acquainted in the 1980s with automotive fatality statistics, the United States consistently lost more people on the highways each year than were killed wearing U.S. uniforms over the entire duration of the war conducted to save Vietnam from antidemocratic totalitarians. The number was staggering to me, particularly since folks didn't seem to care. Yet, persistent public health campaigns to educate people on the hazards of inebriated motoring, to reprogram attitudes about driving under the influence, and to increase surveillance for violators who could be caught before they created terrible damage ... it all seems to have paid off. Despite having more motorists, more automobiles, and worse traffic and faster cars we seem to have educated people that they need to wear seat belts so their safety features can protect them, and we've reduced fatalities from something like 55,000 a year to something like 35,000 per year.

If the scourge of firearms is a mental health problem, and the reason they should be eliminated is that when they are involved in suicide attempts the suicides become completed rather than fizzle as mere attempts, maybe we should be looking at a deeper public health problem. Perhaps we should be thinking about how to prevent suicide attempts, how to conduct effective surveillance to identify depression before it results in terrible consequences, how to prevent poor mental health in the first place.

We've done quite a bit in the last century to control infectious disease as a cause of morbidity and mortality. Perhaps we should think about the quality-adjusted life-years we could save by preventing long-running misery that culminates in violence -- whether self-directed or not.

I am reminded of folks who blame law suits on lawyers. People have been suing one another for centuries, long before law was a licensed profession. People are in court in large part because we've become civilized enough that we seldom duel in the streets any more, and are willing to be satisfied with the verdict of a jury of our peers, or at least a settlement made under the threat of same. If we outlawed law suits, imagine what might substitute for justice.

Be careful what you wish to disappear. On the other hand, folks with a serious interest in implementing lawful firearms bans in the United States might want to re-visit the procedures described in Article V of the United States Constitution, which seem to offer the way forward for that perspective at this point.

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