This is an educational program on gun deaths. It may be shared.

1. ―HAPPINESS IS A WARM GUN‖
BIOETHICS AND GUN POLICY
Steve Miles, MD
Center for Bioethics, University of Minnesota
Producer George Martin showed me the cover of a gun
magazine saying ― 'Happiness Is a Warm Gun.’ I just
thought it was a fantastic, insane thing to say. A warm gun
means you just shot something.‖ ---John Lennon.
b. October 9, 1940
d. December 8, 1980, 10:50 PM– Shot in the back at close
range with 4 hollow-point bullets from a
Charter Arms Undercover .38 Special at 10:50 PM.

2. Gun Violence: A Public Health Approach
THE LINK BETWEEN MEDICAL ETHICS AND GUN POLICY

3. WHAT IS A PUBLIC HEALTH APPROACH TO GUN VIOLENCE?
• Research who, when, and where of gun related 1996, NRA successfully
injuries, considering the gun user, the gun, and the lobbies to instruct CDC:
setting. "None of the funds made
• Identify factors associated with greater or lesser risk of available ... may be used to
injury or death. advocate or promote gun
• Risk factors are not ―causes‖ (bad railings do not control.‖
cause a person to fall from a deck). 2013, NRA successfully
• A risk factor does not mean that a person will always lobbies to bar Bureau of
experience morbidity. Alcohol, Tobacco, Firearms
• Prevention decreases risk; it is not always
and Explosives from using
successful. firearms data to make
conclusions about gun
• Apply lessons from other public health campaigns (e.g.
crimes.
motor vehicles, tobacco, etc.)
• Develop and evaluate morbidity prevention strategies
• Adopt successful prevention strategies.
J Pub Hlth Pol 2001; 22:381-402.

4. MORE HOUSEHOLDS WITH GUNS:
MORE GUN DEATHS.
―The only way to stop a bad guy
with a gun is with a good guy with
a gun,‖
NRA Executive Vice President
Wayne LaPierre.
JAMA Intern Med. 2013;doi:10.1001/jamainternmed.2013.1286

5. GUN DEATHS
• 31,000 deaths per year.
606 • 75,000 Emergency Room visits per year.
11,078 Homicides
Suicides
19,400 Accidents

6. Deaths
39,000 606
total
suicides
11,078 Homicides
Suicides
19,400 Accidents
SUICIDE

7. SUICIDE BY GUN: OLDER, MALE
Suicide is the seventh top cause of death for men
and fifteenth for women in the United States.
Firearm Suffocation
Poison Other
25000
20000
15000
10000
5000
0
Women Men
Charlton Heston, NRA President

8. SUICIDE AFTER GUN PURCHASE:
• Suicide is leading cause
of death of the buyer 400
during first year after 350
handgun purchase. 300
• N Engl J Med 1999; 250
341:1583-9. Death / 100,000
p-yrs 200
• Background checks that 150
delay the acquisition of
100
a gun in some studies
50
decrease death by Baseline Suicide Risk
suicide. 0
1 2 3 4 5 6 7 8 9 10
Months after Purchase

9. HIGHER RISK OF SUICIDE IN GUN OWNING HOUSEHOLD NOT
EXPLAINED BY MORE MENTAL ILLNESS IN THE HOUSEHOLDS.
• People in homes with guns are no
more likely to have recent
anxiety, mood
disorders, substance dependence
or abuse, suicidal ideation or
suicide planning.
• Having made a suicide attempt
over the previous year was the
only mental health factor more
common among people who lived
in a home without firearms.
Injury Prevention. 15(3):183-7, 2009 Jun. Household survey of 9282 adults. Multivariate logistic regression
analyses controlled for age, sex, race/ethnicity, educational attainment and poverty.

10. TEEN SUICIDE: ACCESS AND IMPULSE
Southgate — A crowd of
• Handguns used in most teen suicides. 300 students, parents
• Teen gun suicide attempts are 80-90% lethal. and staff members
• Youth Suicide by Firearms Task Force. gathered Thursday
http://www.pbs.org/thesilentepidemic/riskfactors/guns.html night for a vigil honoring
an eighth-grader who
• 80% of 14-19 year olds’ suicides take place at home. shot himself to death.
• A home with a handgun is almost ten times more Police said he took the
likely to have a teen suicide. Most guns owned by gun from a family
parents. member's home.
• Suicide & Life-Threatening Behavior. 40(6):609-11, 2010 Dec. The firearm, a .40
caliber Glock
• Children who commit gun suicide have fewer risk handgun, was legally
factors for suicide, such as expressing suicidal registered.
thoughts. Gun suicides appear more impulsive than
suicide by other means.
• Suicide and Life Threatening Behavior. 2004; 34:36-43.

11. WHEN GUNS LEAVE HOUSEHOLDS:
FEWER PEOPLE, ESPECIALLY TEENS, SUICIDE.
• When there were one or
more guns in the home, the
risk of suicide among women
increased five times.
• For each 10% decline in the
percentage of households
containing children and
firearms, firearm suicide by
children <19 dropped 8.3%.
• Inj Prev. 2006 June; 12(3): 178–182.
Multivariate population study, US.
• See also: J Trauma 2007;62:1029-35.
NB: Studies suggest that handguns are a greater risk than long
guns and that guns stored unlocked are a greater risk than guns
stored locked.

12. BOTTOM LINE: SUICIDE
• Suicide is the most common lethal
event with a gun.
• The biggest risk factor for suicide by
gun is having one available in the
house.

13. Deaths
606
11,078
Homicides
Suicides
Accidents
19,400
HOMICIDE

14. Homicide trends and weapon used.
18000
16000
14000
12000 Other
10000 Blunt Obj
8000 Knife
6000 Other gun
4000 Handgun
2000
0
Bureau of Justice
Homicide weapon
http://bjs.gov/content/pub/pdf/htius.pdf

15. ASSOCIATION BETWEEN HOUSEHOLD GUN-
OWNERSHIP AND HOMICIDE RATES.
States with higher levels of household gun ownership had higher rates of firearm and
overall homicide. There is no association between gun prevalence and non-firearm
homicide.
Soc Sci & Med 2007 64;656 – 64., Multivariate analysis for rates of aggravated assault, robbery, unemployment, urbanization, alcohol consumption, and
resource deprivation (e.g., poverty), genders and all age groups.

16. GUNS AND INTIMATE MURDER
Bureau of Justice
http://bjs.gov/content/pub/pdf/htius.pdf

17. GUNS AND INTIMATE MURDER
• Gun owners 8 times more likely to threaten their partners with a
gun than non-gun owners.
• threatening to shoot them
• threatening to shoot a pet or person the victim cares about,
• cleaning, holding or loading a gun during an argument, and
• shooting a gun during an argument.
• J Am Med Women Assn, 2005; 60:62-8. 8,000+ men in a certified batterer
intervention program in MA, 1999-2003. See also Evaluation Review. 2006;
30:283-95.

18. GUNS AND INTIMATE MURDER
• A gun in the home makes it three times more Deaths
1,100
likely a person will be murdered by a family 606
member or intimate partner.
Homicides
• Gun intimate assaults are 12 times more likely 11,078
Suicides
to result in death than non-firearm associated 19,400
Accidents
assaults.
• http://www.silentwitness.net/sub/violences.htm

19. BOTTOM LINE: HOMICIDE
• Homicide is the second most common
lethal event with a gun.
• Guns in the house is highly correlated with
the risk they will be used for homicide.
• Guns in the house are the most powerful
predictor of domestic intimate violence
becoming a homicide.

20. Deaths
14,675 wounded but
survive (1/5 under 19
years old). NCIPC 606
11,078
Homicides
Suicides
Accidents
19,400
GUN ACCIDENTS

21. GUN ACCIDENTS
• Fatal gun accidents are 1% of all lethal home accidents (poisonings
43%, falls 34%, burns 9%).
• BUT: 14,675 wounded but survive (1/5 under 19 years old). NCIPC
• BUT: Preventable
• Accidental lethal shootings 8 times more common in the four states
with the most guns compared to the four states with the fewest guns
• Acc Anal Prev 2001;33: 477-84.
• Adults with a gun in the home have a 4 fold higher risk of dying of an
accidental gunshot.
• Acc Anal Prev 35(2003)711-716

22. Deaths
606
180 1
190 9
0
11,078 Homicides
Suicides
19,400
350
Accidents
1
160 6
0
1
130 9
0
Children (<14 Years) Deaths per year
CHILDREN

23. 18
16.3 RELATIVE RISK OF GUN
16 HOMICIDE, SUICIDE AND LETHAL
14 ACCIDENT FOR 5 TO 14 YEAR OLDS
IN HIGH AND LOW GUN STATES
12
10
High Gun
8 Low Gun
6.7
Non Gun
Ratio of High Gun Sts to Low
6
Gun Sts for Non-Gun deaths
4 3.3
2 High Gun States are
1 1 1
1 LA, AL, MS, ARK, WV
0
Homicide Suicide Accident Low Gun States are
HI, MA, RI, NY, DEL
J Trauma 2002; 52:267-75.

24. RELATIVE RISK OF GUN DEATHS FOR CHILDREN
• For 5 to 14 year olds, the U.S. unintentional gun death rate is 11 times higher
than the combined rates of 22 other high-income developed countries.
• J Trauma 2011;70:238-43.
• In 2011, 2,886 children 0-19 were treated in an emergency room for an
unintentional gunshot injury. NCIPC
• For 0 to 4 year olds, gun deaths are 17 times more common in high gun states
than low gun states.
• For 5 to 14 year olds, gun deaths are 14 more common in high gun states
than low gun states.
• Acc Anal Prevent 2001;33: 477-84

25. GUN LOCKS:
Toddler shot in St. Paul
UNDERUSED as kids play with
handgun
Less than half of
home guns are
secured.
PRICELESS
CHEAP

26. BOTTOM LINE: CHILD DEATHS BY GUNS
• Guns in the home are the most
powerful predictor of lethal gun
accidents, suicides, and homicides of
children.

27. Kokapo— rara avis
GUNS PREVENT VICTIMIZATION

28. MAJOR PAPER CITED BY ANTI GUN CONTROL
PREVENTS CRIMES.
Kleck, Gertz. J Crim Law Criminology 1995;86.150-87.
• 222 of the 4799 (which in turn was 20% of the total sample
respondingreported having at least one Defensive Gun
Use (DGU) in the past 5 years.
• After correcting for oversampling in some regions, this
drops to 66 personal DGUs in the preceding
year, indicating that 1.326 percent of adults nationwide
had experienced at least one DGU.
• When multiplied by 1.478, the number of DGUs Our survey was ―free of the taint of
reported per DGU claimant and by the adult being conducted by, and on behalf
population, an estimate of 2.55 million DGUs per year of, employees of the federal
was arrived at. government, and it was completely
anonymous.‖

29. FROM 2.55 MILLION DEFENSIVE GUN USES PER
YEAR TO…. Cato Institute. Tough Targets. 2012.
8 years of news clippings.
• 277 news reports where the
intended victim disarmed
criminal.
• 25 where an armed rape
attack victim got the upper
hand.
• 65 where an armed carjack
victim prevailed.
• 11 out of 4,699 where a
Bureau of Justice criminal took a gun away
http://bjs.gov/content/pub/pdf/htius.pdf from a defender.

30. BOTTOM LINE: GUNS FOR SELF
PROTECTION FROM HARM.
• An armed citizen is vastly more likely
to commit homicide or to suffer harm to
him/her-self or those in his/her
household than he/she is to benefit
from gun protection.

31. THE DOCTOR’S OFFICE

32. AMERICAN ACADEMY OF PEDIATRICS (PARAPHRASED)
• Pediatricians should counsel parents
about the dangers of allowing children
and adolescents to have access to guns
inside and outside the home.
• Pediatricians should ask about the
presence and availability of firearms
…and urge parents who possess guns
to prevent access to these guns by
children.
• Health professionals should counsel parents of all adolescents to
remove guns from the home or restrict access to them. This advice
should be reiterated and reinforced for patients with mood
disorders, substance abuse problems (including alcohol), or a history
of suicide attempts.

33. ―The Affordable Care Act does not prohibit or
otherwise regulate communication between
doctors and patients, including about firearms.‖
• –White House
―Doctors are being ordered, instructed to talk to
patients and get information from them about
gun ownership, where they are in their
house, who has access to them, where the
ammunition is kept. Doctors are now "permitted‖
to do this. It makes 'em deputies, agents of the
state.‖

34. STRONGER GUN LAWS: FEWER GUN DEATHS
Firearm deaths
Strength of laws

35. MINNESOTA LAWS
Gun Dealers Gun Owners
• No state dealer license. • No permit to purchase or
• Dealers not required to retain records for license to posses, no
guns /ammo sales. fingerprinting.
• No mandatory theft reporting, • No requirement to report
• No ID microstamps on semi-auto handguns. thefts.
• No bar on bulk sales of handguns. • No ban on assault
• No background checks on gunshows or rifles, large clips.
interpersonal sales.
• No disarming of prohibited
• No mandated sale of locks with all
handguns. handgun possessors.

36. http://data.huffingtonpost.com/2013/03/gun-deaths

37. Steven Miles, Miles001@umn.edu
SLIDES AVAILABLE ON REQUEST.