Our Unregulated Militia Is Killing Our Children.

Special interest  or public health issue?
I cannot conceive that any health professional would consider the incidence of death and injury from firearms as other than a public health issue. Surely the absolute numbers of people killed or injured (in excess of 100,000 per year); whether self-induced or by others; by accident or on purpose places the matter squarely before us on a regular basis no matter where we live. This uninterrupted endemic parade of victims is punctuated by epidemic outbreaks in crowded places like schools or workplaces.  There are carriers of this disease in all 50 states. No cure has emerged for this essentially American pandemic. The most recent outbreak which stimulated me to write this article occurred last month in Florida at the Marjory Stoneman Douglas High School in Parkland where 17 students were killed by another student, and 17 others wounded by an AR-15 military machine gun– a.k.a. assault rifle. The damage caused by this gun unnerves even hardened professionals.

Unlike most other epidemics of disease, reliable information about how to prevent non-military people from death-by-bullet is scarce because of a bizarre broad governmental prohibition to even study the matter. The self-censorship is deafening in a recent 476-page report from the U.S. Department of Health and Human Services.  It is titled, “Health, United States, 2016” but the words “gun” or “firearm” are not to be found in it. Disturbingly, it remains unclear that any meaningful national attempts to control this epidemic will be made or even that individual states will be permitted to do so.   Undeterred, advocacy groups are increasingly demanding that immediate and definitive action be taken to protect themselves and the rest of us.

Our young adults step forward.
Last Monday evening, I unexpectedly met a group of students from St. Francis High School here in Louisville who had come out for a program of Kentucky to the World to hear Nobel Laureate and scientist Phillip Sharp talk about the value of education for individuals and our communities. In chatting with the students, I learned that they were planning to participate in the National School Walkout to protest against gun violence and to demand gun control. I was touched by their commitment, and as a father of former students of St. Francis how could I not stand with them?

Thus it was that at 10 AM on March 14, that the majority, if not all of the St. Francis’s students turned out in front of their school and with signs, speeches, and responsive chants demanded their elected representatives to cease with the BS and to do something.  I was moved!  I am realistically pessimistic that anything significant will happen soon, but it is clear to me how the students will judge who to vote for when they are able. I was immensely proud of them.

An inadequate justification.
Much as the pharmaceutical industry controls what Congress and the FDA does, the lobby of gun manufacturers and enthusiasts has captured the legislative and regulatory process. To justify doing nothing to abet our epidemic of gun violence; proponents of unrestrained access to firearms  (of any type, in any place, and at any time) point to the Constitution of the United States – specifically its second amendment.  That amendment to the original Constitution declares that for “a well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear Arms shall not be infringed.” Of course, this is the same Constitution that endorsed the enslavement of non-whites; mandated that those “held to service or labor in one state” must be returned by another should they escape; withheld the vote from females; and instituted an indirect method of voting for senators and presidents more characteristic of a House of Lords than a fully representative government. Given that the Constitution was considered by its authors to be a living document, some of these  directives were voided, clarified, or augmented by additional amendments. One of these was the Second Amendment referenced above. Another was the 18th amendment which prohibited the manufacture, sale, or transportation of intoxicating liquors. As clear evidence that the Constitution is not engraved into stone, the 18th amendment was largely repealed by the 21st. Suffice it to say that other fundamental changes have been made to the Constitution of the United States. The most recent was the 27th which was finally ratified in 1992 and relates to the compensation of Senators and Representatives. Efforts to change the Constitution are ongoing, such the recent effort to make same-sex marriage unconstitutional.

In preparing this article, I re-read our Constitution with reference to guns and militia in mind. Thus, the Constitution authorizes Congress to “organize, arm, and discipline the militia.”  The President is declared Commander-in-Chief of the militias of the several states.  The militia can be called forth “to execute laws of the Union and suppress insurrections…” However, it is clear to me that the “militia” being referred to in the Constitution has more in common with the National Guard units of our present states than it does with the kinds of militias of subversive or anti-government groups that blow up federal buildings. I read nothing into our Constitution that would endorse carrying machine guns into movie theaters.  I see abundant proof that the Constitution can be reinterpreted or rewritten.

Risk vs. Benefit.
I have been a practicing physician and teacher of physicians for almost 50 years. Intrinsic to these professions is a balancing act that weighs the potential benefits against the risks of everything we recommend or do. Nothing we do in medicine is completely free of risk– not even the central act of taking a history and doing a physical examination. Seeking to deal with this balance in medical practice defines the core of one of our oldest ethical standards– “to do no harm.” How to gather the evidence necessary to appropriately weigh risk against benefit, and then how to convey this to our patients, is central to medical teaching.  I assert that it is impossible to practice medicine without doing harm or exposing to risk, but we can continuously seek to learn more and do better!

I at least profess to have an open mind!  Perhaps there are some societal benefits to unrestrained ownership and availability of firearms of any type. Perhaps at some time or in some place an armed teacher will get the drop on some shooter that will prevent or limit school casualties.  Predictably however, sometimes the teacher will inevitably miss, shoot the wrong person, or be shot in turn by the shooter or other rescuers. It is inevitable that some student or family member will gain access to the teacher’s gun and injure themselves or others either by accident or on purpose. Because of the legislative prohibition of research into gun violence, we do not have a lot of data available to help us balance potential benefits against these obvious risks and others not so obvious or unknown.

We deserve informed consent.
I knew that when I recommended a powerful medicine like methotrexate (a traditional cancer chemotherapy drug) to my patients with bad rheumatoid arthritis, that there was a definite risk that something untoward might happen because of the drug.  When I negotiated with my patient about whether or not to go forward, I would tell them what I knew about possible adverse reactions to the treatment; what could be done to ameliorate such; and the potential risk from their ongoing inflammatory arthritis. This process is called obtaining informed consent.  Assuming that our elected officials serve only with our collective consent, I ask now of every elected official to help us understand what we constituents are getting and what we are giving up when they vote for or against every effort at gun control. Please be clear and tell us in the comments section below why you think the benefits of private handgun ownership and unlimited concealed-carry is worth it. Why does a right of nonmilitary ownership of machine guns outweigh the firearm carnage we have been living with?  Convince me and others that we are wrong in seeking major change. You need to do this, because a reasonable person might assume you have been bought-off by the NRA and the firearm manufacturers behind that organization and that your reelection is more important than preventable deaths.  Don’t tell us that some people need guns to protect them from the Government.   These self-designated “militias” include some of the same people who are killing us!   I want to hear something more than that the Constitution instructs us that our allowing our epidemic of gun violence to continue without effort to eliminate it is a trade-off worth making.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
14 March 2018



8 thoughts on “Our Unregulated Militia Is Killing Our Children.”

  1. School shooting in the planning stage or not?
    I could not find a school shooting today– and that is good– but there are false alarms and poorly conceived pranks that keep people on edge. Ten students at Memorial High school in Eau Claire, WI were discovered in a group chat where there was talk of a mass shooting on March 26. Four of the students were taken into custody for apparently more overt threats. All the facts are not known to me, but even if was stupid braggadocio, people are on edge and are aware that the unthinkable can happen. Copy-cat crime and killings are not abstract things.

    Unarmed black man shot again.
    Being always on edge almost certainly had some bearing on a police shooting of an unarmed 22 year-old black man in Sacramento. By account, he had been found breaking into cars and was chased into a dark backyard. Body cameras showed that the police fired some 20 times at Stephon Clark who was holding a cell phone. In our gun-overloaded country, who can say that the officers did not fear for their lives, but 20 shots does seem excessive. The man was allowed to lie unaided. If neither the police or citizens were all so fully armed, the thinking might have been very different. Not all countries arm all their police. If a person has a tool, it is likely to be used, be it criminal or police officer. The problem is guns, is it not?

  2. Another School Shooting Today.
    With today’s shooting of the day, we are back in a school. At Great Mills High School in Maryland, a male student shot and critically injured a 16-year-old girl. In this case, an armed school resource officer responded immediately and fired at the shooter. The shooter died, presumably shot by the officer. A 14-year-old boy who was also in the hallway shooting gallery was hit, but as of this writing is in stable condition. As I write this, it has not been made clear who shot the boy.

    Much is and will be made that in this case a good guy with a gun prevented further tragedy. Of course it remains possible the good guy augmented the tragedy. I’m unaware of evidence yet that shooter planned to harm anyone other than the girl with whom he is said to have had a previous relationship. His next target might even have been himself. How can one possibly know how this would have played out without the intervention. The school resource officer cannot be blamed. He did what he thought he had to do – what he was supposed to do.

    Wouldn’t it be nice if this didn’t happen again? Does anybody think it will not?

    Addendum, March 27: As it happens, the killer shot both the girl and the boy with one bullet before shooting himself. The officer fired a shot but only hit the gun of the killer.

  3. Shooting of the Day, and Comment about Mental Illness Checks.
    The first new shooting of yesterday that popped up on Google was that of a 13 year-old boy who was shot in a drive-by in New Orleans. Doing the count on the day after means all the details are not known. It is thought that some local dispute was acting out. The lesson here is that not all shootings of children happens in schools, indeed those comprise the minority. Last May here in in Louisville, 7-year-old Dequante William Lamar Hobbs, Jr. was shot and killed at his kitchen table by a stray bullet aimed at someone else in the street. His photo showed a cheerful young fellow who by all accounts had a bright future ahead of him. I wept at the news of the loss, and wept again when I learned he wanted to be a doctor. It occurs to me now that I stood with our students last week and am writing this series in large part because of the tragedy of that specific loss. It and so many of the others cannot be justified in any conceivable way.

    Who is mentally ill? How do we possibly decide and keep track?
    The first two pages of Google returns still dealt with the school shooting in Parkland Florida. It turns out that responsible authorities had such serious concerns about shooter Nikolas Cruz that they wanted him committed involuntarily as early as 2016. Nothing happened. Seems to me that this dereliction rivals that of the armed officer who stayed in the alley outside the school as the shooting took its toll. Much is being made of the possibility that if Cruz had a record of mental illness such that he would not have been able to purchase his AR-15. This assumes that any records would have been available and been checked. Focussing on checking for previous mental illness as a way of preventing gun violence is a straw man that diverts us from any effective remedy. First off, mental health records are the most carefully protected of all such records– even in the era of computerized medical records. Changing that will require a major shift in privacy law that the public will not likely support. Secondly, failure of checks for criminal activity or gun problems at the time of purchase just doesn’t work– in part because of NRA lobbying against effective screening and sheer impracticality at the point of purchase or private trade. Thirdly, who makes the decision about whether someone is mentally ill or not? This would have to be done before every gun purchase. Would you allow some third party to make a judgement about your mental status that would effectively become public without your permission? What do we do about all the millions of people who already own guns? Lastly but not least, even if someone is thought sane before purchase, mental status changes and guns are ubiquitous. No! Guns kill people: used by accident or on purpose; with before-thought or impulsively; by those who are chronically or temporary mentally ill or depressed; or aimed by the angry sane people who do most of the killing. It is the handguns and assault rifles that have to go first. We can debate about who deserves the right to hunt animals or shoot targets later.

    Addendum March 22.
    Today, 16 year-old Jaelynn Willey who was shot in the head by 17 year-old Austin Wyatt Rollins was taken off of life support. The 14 year-old boy who was shot in the leg is doing OK. As of this time, it is still not know whose bullet hit the boy or the shooter.

  4. Shooting of the Day, March 18.
    Actually, this school shooting happened 4 days ago but it is so on-point that I use it anyway. At Seaside High School in Northern California, an armed teacher who is also a reserve police officer fired his semi-automatic handgun by “accident” as he was demonstrating how to use a gun safely. (Showing off? How can something so predictable be called an accident?) He was reportedly about to use the gun to demonstrate how to disarm someone and had had allowed students to handle the gun and pose for photos with it previously. This guy was supposed to be “trained!”

    At least one student was hit by some ricochet fragments. Two others had minor injuries. The father of the boy who came home with bullet fragments in his neck gun was the first to notify the real police. To make things even worse, it is against the law in California to have guns in school. Bizarrely, there are some who are pressing for him to be allowed to keep his job. Would you trust his judgement ever again? This is what happens when gun-fever interfaces with the real world. Who is willing to tell us that having things like this happen– and which will happen again– are worth tolerating so we can have a well-regulated militia?

  5. Shooting of the Day.
    I just took the first google return for “Shooting March 17, 2018.” It tells of a shooting at a Ventura California mall where a man killed his divorced wife with a handgun and then botched the job of killing himself. The pair’s two children were elsewhere and not harmed (physically). Is the answer to train and arm all the elderly mall-walkers to protect shoppers? I don’t think so. The only solution that makes any sense to me (as it made successful sense to Australians) is to confiscate all handguns and assault weapons. I suspect concerns of violent insurrection and lobbying $$$ will keep that solution from any serious airing, but what does that say about our country?

  6. Do we need a National Nurse Walkout too?
    Even as I had been preparing yesterday’s followup comment to my March 14 article, a disgruntled employee at a University of Alabama teaching hospital in Birmingham opened up with a gun killing a nurse and injuring another before shooting himself dead. I have no other details, Metal detectors were said not to have preventedt he tragedy.

    Arming teachers and otherwise “hardening” schools is hardly a solution to the real problem– even if those things worked. To the list of teachers, must we now add add nurses and doctors to the list of individuals trained to kill? Indeed, universal carry is one of the goals of the NRA and like-minded enthusiasts who believe all the good people should be armed at all times in all places. Nonsense! Even if we had a way to separate the good from the bad, the problem is that there are too many guns already in hand in every private or public venue. Angry, deranged, depressed, or even unhappy people will use whatever tools they have available.

    I have not yet heard from anyone attempting to justify why shootings in schools, hospitals, churches, and all the other manifestation of gun-violence are something we have to live with for our own good.

    Peter Hasselbacher

  7. Why is this acceptable?
    Even as I wrote yesterday’s article, there was another fatal school shooting. At Huffman High School in Birmingham, AL, a well-thought-of and promising future nursing student, Courtlin Arrington, was shot dead by another student who brought a gun to school. Metal detectors (that were not turned on) and three “school resource officers” who may or not have been armed were apparently no deterrent. I do not know whether the killing was an accident or intentional, but the end result for Ms. Arrington is the same.

    Someone tell me how this senseless death is an acceptable result of allowing private ownership of handguns? Elected officials who make the rules and can change things, lets hear from you too. Since I suspect few if any of the latter read the KHPI Blog, I am considering sending legislators a letter directly asking for their justifications. Other readers can help me by doing the same and forwarding any replies to me. I would publish responses or indicate who chose not to reply. If private ownership of handguns is so essential to our nation, public officials should have no difficulty making their case– but I doubt that many if any responses would be acceptable if even rational.

    Peter Hasselbacher

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