ACP, others issue call to action on firearms injuries, deaths

Last week, after back-to-back mass shootings in El Paso, Texas, and Dayton, Ohio, ACP and six other organizations issued a policy paper offering recommendations to reduce firearm-related injury and death in the United States. The paper was published Aug. 7 by Annals of Internal Medicine.

ACP joined with the American Academy of Family Physicians, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Psychiatric Association, and American Public Health Association to recommend the following steps.

• Comprehensive criminal background checks for all firearm purchases, including sales by gun dealers, sales at gun shows, private sales, and transfers between individuals with limited exceptions, should be required.
• Research into the causes and consequences of firearm violence and unintentional injuries and deaths to help identify, test, and implement strategies to reduce these unnecessary injuries and deaths is urgently needed.
• Federal laws prohibiting domestic abusers from accessing firearms currently apply only to spouses and not dating partners. This loophole in the background check system must be closed. Offenders who have been found guilty of a crime of violence against a family member or intimate partner, including dating partners, cohabitants, stalkers, and those who victimize a family member other than a partner or child, should be reported to the National Instant Criminal Background Check System and be prohibited from purchasing or possessing firearms.
• Storing firearms safely and securely is essential to reducing the risk of unintentional or intentional injuries or deaths from firearms, particularly in homes with children, adolescents, people with dementia, people with substance use disorders, and the small subset of people with serious mental illnesses that are associated with greater risk of harming themselves and others.
• Most people who have a mental illness or substance use disorder are not violent; however, screening, access, and treatment for mental health disorders play a critical role in reducing self-harm and interpersonal violence. ACP and the other organizations who developed the recommendations support improved access to mental health care and caution against broadly including all individuals with a mental health or substance use disorder in a category of individuals prohibited from purchasing firearms.
• Extreme risk protection order (ERPO) laws, which allow families and law enforcement to petition a judge to temporarily remove firearms from individuals at imminent risk of using them to harm themselves or others, should be enacted in a manner consistent with due process.
• Physicians can and must be able to advise their patients on issues that affect their health, including counseling at-risk patients about mitigating the risks associated with firearms in the home and firearm safety.
• A common-sense approach to reducing casualties in mass shooting situations must effectively address high-capacity magazines and firearms with features designed to increase their rapid and extended killing capacity.

“The medical profession has an obligation to advocate for changes to reduce the burden of firearm-related injuries and death on our patients, their families, our communities, our colleagues, and our society,” the paper concluded. “Our organizations are committed to working with all stakeholders to identify reasonable, evidence-based solutions to stem firearm-related injury and death and will continue to speak out on the need to address the public health threat of firearms.”

A related Ideas and Opinions piece published by Annals of Internal Medicine on Aug. 13 compared the political response to mass gun violence in the United States and New Zealand. After a mass shooting in March 2019 in Christchurch that killed 51 people, New Zealand acted quickly to ban most semiautomatic firearms, some shotguns, and large-capacity magazines, as well as to restrict exemptions from firearm prohibitions. The country also plans to institute a buy-back program for prohibited weapons this year and imposed tougher penalties on people who illegally possess prohibited firearms and parts.

In contrast, after the murder of 26 people, including 20 children, at Sandy Hook Elementary School in Newtown, Conn., in 2012, an assault weapons ban and an amendment to improve background checks for gun sales failed to pass in the U.S. Senate. In addition, the Trump administration and Congress have since reversed an executive order by the Obama administration that made it more difficult for persons with mental illness to buy firearms, and in February 2019, the Violence Against Women Act, which restricts domestic violence offenders from buying firearms, expired. It has not yet been reauthorized by the Senate.

Both the U.S. and New Zealand have high rates of gun ownership, but U.S. culture views it as a right protected by the constitution while New Zealand considers it a privilege, the authors said. Also, the National Rifle Association is one of the most influential lobbies in the United States, whereas in New Zealand, the influence of the gun lobby is small. Firearm fatalities are rare in New Zealand, with an annual average number of firearm deaths of 56 from 2001 to 2014, versus an estimated 35,000 firearm fatalities annually in the United States. The two countries' firearm suicide rates are 1.1 per 100,000 in New Zealand and 6.9 per 100,000 in the U.S.

“Comparison of these countries in terms of their views on gun ownership and the roles firearms have in suicide and death highlights the reality of 2 very different gun cultures, which have determined their respective countries' responses to tragedy,” the authors wrote. “The stark contrast between these cultures can affect our understanding of how to address gun violence.”