Monday, April 29, 2013

Bioethics and guns, home and abroad

Bioethics workers, particularly in the United States, rarely talk about guns and gun-related violence. The issue is perhaps too baldly political: in the US, discussions generally center on the 2nd Amendment right to keep and bear arms, and to what extent can government create policies infringing or limiting that right. Somehow the public and personal health risks of gun possession get lost in the shuffle, or at least bioethicists in the main seem less morally worried about guns than they are about the dilemmas generated by life-saving technologies. Nevertheless, when guns are around, poor health outcomes occur that wouldn't happen otherwise: children who accidentally shoot themselves or others when they come across a gun in the home; adults who reach for a deadly weapon in the heat of a dispute, or those who injure and kill in the commission of a crime. Some discussions on the bioethics of guns exist, but they are few and far between.

The most recent American massacres have drawn bioethicists indirectly into the fray. Gunmen responsible for the attacks in Aurora and Newton seem to have been mentally unstable, leading to questions about the adequacy of the procedures required to get guns and gun licenses in the first place. More specifically, physicians are increasingly being requested to help law enforcement in assessing a person/patient's competence to carry or safely use a concealed weapon. The more technical issues are how such competence is to be determined and how physicians are to be trained to reliably make such determinations. A larger issue is whether giving a green light to concealed weapon possession is -- as a matter of professional ethics -- the sort of thing physicians should be involved in. Guns put holes in human bodies where they are not meant to be, after all. Predictably, the legal questions loom large: will a physician be held liable if a person/patient deemed competent decides to unconceal his/her weapon and go on a rampage?

The American debate typically presupposes the intrinsic goodness of guns for ordinary citizens. An attempt last week to occupy the bioethical high ground on guns comes from a source not normally associated with pacifism: Pakistan. The Karachi Bioethics Group (KBG) is calling for the 'deweaponization' of Pakistani society, observing that gun-related deaths in the country have tripled in the last two decades. (An interesting account of the genesis of the KBG can be found here in the book Observing Bioethics by Fox and Swazey.) The KBG states simply that licenses and provision of guns should only be permitted for the armed forces and the police. No talk of hunting, target practice for pleasure, or fantasies of heroic self-defence. Healthy position on deadly weapons or acquiescence to the power of an authoritarian state? In any case, here we have a bioethics group not shy about taking overtly political positions.

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