The Guns of Never One (with apologies to Alistair MacLean)

This will probably be my last posting on guns for a while.  I hope...

I love hearing gun nuts (and specifically the NRA) argue that the problem with gun violence is not related to high prevalence, unsafe storage, lack of background checks for gun show and internet sales, etc., but an issue of keeping “mentally ill” people from obtaining guns.  While fighting vigorously against any national registry of gun ownership, he advocates for creation of “an active national database of the mentally ill”.  For some reason, alas, he has neglected to publish the criteria that would constitute the admission ticket to this elect group, nor does he seem to contemplate several other issues:

1. Isn’t creating a national registry of the “mentally ill” a far greater intrusion on liberty and the right to privacy than a registry of gun owners?  The latter is a voluntary choice.
2. Since mental illnesses are defined and redefined essentially by consensus, inclusion on such a list has a substantial degree of arbitrariness, both in condition definition and assessment.  Furthermore, since symptoms wax and wane, many people cross back and forth across the magic lines we draw for diagnosis on a regular basis.
3. We have very poor predictive ability for homicide and suicide among persons with serious medical disorders (see, for example, this article).
4. Many people who commit violence with guns would not meet criteria for any list of diagnoses that the NRA and its allies would agree to.
5. In contrast, felons have already been convicted of criminal behavior.

In my practice in community health centers and public hospitals, I have had patients who have been victims of gun violence and patients whose families have been affected by gun violence.  A couple of years ago, I was told that one of my patients had died.  He certainly had mental illness, and was seeing a counselor and taking medications.  He had grown up as a victim of violence and had a violent youth.  He was struggling to keep his life together and, especially, to keep his teenage son from following in his footsteps.  But, as it turns out, he had an estranged ex-girlfriend I had never heard about who had a no-contact order on him.  One day, he found her in a store, shot and killed her, went back to his room, and committed suicide.  Would I have wanted him to have a gun?  No.  Would I have expected him to use a gun on someone?  No.

If the NRA trusts the nation’s medical providers to make the determination of who can safely be allowed to own a firearm, practitioners of evidence-based medicine can help:

1. As above, we have no good way of predicting who will commit a gun-related crime or suicide.
2. However, owning a firearm, or having one in the house, substantially increases the risk of gun-related suicide, homicide, and injury.

The answer seems pretty obvious.  In fact, I am willing to take on the burden of being “The Decider” for the entire nation. 

Q:  Should _____ (fill in name) be allowed to own a gun?

A:  No.

Repeat as necessary.

(P.S.  In fact, I am perfectly happy to allow responsible ownership, storage, and use of hunting rifles; in Alaska, for example, many people really are subsistence hunters, and we have to do something to control deer populations with their natural predators eliminated.  But do we need more 5 year olds being given "first shotguns" and then killing 2 year olds???)