When the Supreme Court makes a ruling, legal reasoning on the subject of that ruling does not stop. Lower courts begin to interpret and apply the precedent, and to shape what that ruling really means. District of Columbia v Heller is no exception. Courts have ruled on 2nd Amendment issues several times in the years since. These rulings are fleshing out a lot of the vague areas of law that the Heller decision did not address.

In both the Heller and McDonald (a case that extended the Heller ruling to the states) opinions there were several regulations mentioned as specifically allowable. A review of post-Heller legal cases found that more than 80% were decided in favor of the challenged gun regulation on the basis of a specific inclusion in the Heller opinion.

Illustration by darktaco at RGB Stock Photos.

Illustration by darktaco at RGB Stock Photos.

Since Heller, this list of “presumptively lawful” regulations has been referred to in cases validating prohibitions on gun sales to users of controlled substances, prohibitions on gun possession by domestic abusers and laws providing for other forms of gun control. However, the list of allowable regulations enumerated in Heller was not intended to be exhaustive, and several courts have had to rule on laws that were not on the list of “presumptively lawful” regulations.

One ruling on these types of regulations occurred as a result to a challenge to New York gun laws prohibiting possession of “assault weapons” (defined by the law in New York in a manner stricter than the norm), expanding background checks and limiting the magazine capacities to a maximum of seven rounds. The court found that the assault weapon ban was reasonably connected to the cause of public safety. It did, however, strike down the capacity limit.

Another ruling in favor of gun regulations occurred as a result of a new challenge to Washington DC’s stringent gun control laws, revised after the Heller decision. This challenge was brought forth by the same man who originally challenged the laws, and has become popularly known as Heller II. In Heller II, the district court ruled that the District’s strict licensing requirements for firearm ownership did not violate the Second Amendment.

There is no clear test for determining the constitutionality of gun control laws. Judges use several tests to determine if a law is unconstitutional, and the one that applies the highest standard is known as “strict scrutiny.” While some courts have applied this test, no gun control laws have been overturned under “strict scrutiny” since Heller.  Instead, courts using this test have allowed for the laws to exist due to public interest as well as “specific tailoring” to classes of people at higher risk for violent behavior.

Judges have used many different tests and forms of logic in determining their rulings post Heller. Without specific guidance from the Supreme Court, it is likely that the nature and limits of Second Amendment rights will continue to be a confusing question for the Federal courts. However, the overall picture painted by the judiciary thus far is that gun control laws in America are almost always constitutional. Many gun rights activists celebrated the decision in Heller, thinking that it might lead to a wave of gun control laws being overturned. Instead, it appears that the decision simply provided a rather high limit on how far gun regulations can go.

More than 7,000 children and teens are injured or killed by firearms every year. Given the steady stream of tragic news stories about children finding unlocked guns, you would think it makes sense for pediatricians to ask parents whether they keep their guns locked up. But doing that requires pediatricians to ask whether the parents have any guns in the first place.

In Florida, that’s against the law. At least since June 2011, when Rick Scott signed into law the Florida Privacy of Firearm Owners Act.Screen shot 2014-07-29 at 12.29.54 AM

You might think such a law would violate the First Amendment by restricting physicians’ right to free speech. Or, at least that’s what a bunch of physicians thought. Along with several Florida doctors, the state chapters of the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Physicians sued the state of Florida for a law they claimed violated their right to free speech (which appears to include their right to pass along data in professional policy statements such as this one on firearms).

However, in a 2-1 ruling (pdf) today, a federal appeals court upheld the Florida law, arguing that a doctor’s questions about firearms violated a patient’s right to privacy. “The act simply codifies that good medical care does not require inquiry or record-keeping regarding firearms when unnecessary to a patient’s care,” the majority opinion stated.

But what is the Florida Legislature doing deciding what’s necessary or unnecessary to a patient’s care? The problem is, good medical care always requires taking into consideration ways to reduce the risk of injury or death. When we choose our doctors, we let them ask us questions about private family issues in exchange for their help managing our family’s health. There is no reason asking about firearms should be any different than asking parents whether they keep their household chemicals and medications out of children’s reach.

Professional medical associations in the U.S. agree that firearm violence represents a major public health problem in the U.S. Given that the U.S. has the highest rate of gun ownership and of firearm deaths and injuries in the developed world, it’s pretty hard to argue that point. Physicians are the stewards who help address public health issues. Arguing that a doctor’s questions about a family’s ownership of firearms violates the family’s right to privacy is akin to arguing that asking about the presence of lead paint – a standard well-child screening question – is a violation of their privacy. Why is it the doctor’s business whether a family has lead paint in their home? Because it presents a risk to children. So do firearms, so why are they any different?

The AAP thinks firearms in the home should be treated at least as seriously as lead paint. In a statement released today following the decision, James M. Perrin, MD, FAAP, the president of the AAP, said the following: “State legislatures should not stop physicians from practicing good medicine. This law has a chilling effect on life-saving conversations that take place in the physician’s office. More than 4,000 children are killed by guns every year. Parents who own firearms must keep them locked, with the ammunition locked away separately. In this case, a simple conversation can prevent a tragedy. The evidence is overwhelming – young children simply cannot be taught to overcome their curiosity about guns, and to suggest otherwise is, frankly, the height of irresponsibility.”

The president of the Florida chapter of the AAP, Mobeen Rathore, MD, FAAP, issued a similar statement: “We strongly disagree with the 11th Circuit’s decision. It is an egregious violation of the First Amendment rights of pediatricians and threatens our ability to provide our patients and their families with scientific, unbiased information. This dangerous decision gives state legislatures free license to restrict physicians from asking important questions about health and safety that are vital to providing the best medical care to patients.”

Ten other states have laws similar to Florida’s introduced in their legislatures. The plaintiffs have said they will appeal the case to the 11th circuit court.

“Bystanders got to Loughner and subdued him only after he emptied one 31-round magazine and was trying to load another.”

—Larry Burns, Federal District Judge who sentenced Jared Loughner to seven consecutive life terms plus 140 years for his shooting rampage in Tucson.

Magazines2w

Twenty-two states have no laws requiring adults to keep guns out of the hands of unattended small children.

Map illustrating states with CAP laws and states with no CAP laws

Map illustrating states with CAP laws and states with no CAP laws

These infographics attempt to illuminate the complexities of ammunition, in the interest of informed debate about possible new legislation and regulations.

Bullet_SizesINFO4s

The policy proposals that President Obama announced on Wednesday (organized by category here) outlined a wide-ranging agenda, including twenty-three items that could be implemented through executive action and twelve recommendations for action from Congress.* The items are a mixed bag, ranging from immediately actionable ideas to proposals that may never make it through Congress. Some are vague (launching a national dialogue about mental illness) while others are very specific (confirming a director for the ATF).  In the coming weeks, PAGV will explore, seek input on, and respond in detail to the specific items. Here we outline a few of our immediate reactions as parents and concerned citizens.

  1. This is an important first step. It is gratifying to see the President both take direct action on a number of important gun-related matters, and publicly initiate the conversation about what needs to change to address the ongoing epidemic of gun violence in the United States.
  2. We strongly agree with the need for a comprehensive legislative and executive agenda, one that attempts to solve gun violence by addressing gun access, gun safety, school safety, societal factors, and mental illness.  Reducing the threat of violence to our children will clearly require such a broad-based, comprehensive effort. Any flaws in individual proposals do not invalidate the entire effort.
  3. There will be something for everyone to like, and for everyone to hate, in the proposals.  Given the current political climate, this may be inevitable.  Due to the absence of thorough research into the causes and effects of gun violence, there is little agreement about its remedies, beyond a desire to see it end.  To some, allocating $10,000,000 to research the connection between video games and violence seems like the worst kind of pandering to the NRA’s “it’s-everything-but-the-guns” narrative. To others, requiring background checks on all gun sales seems like the first step in a government takeover.
  4. Some of the proposals concur in fundamental ways with recent policy proposals from Parents Against Gun Violence. One of the executive orders, for example, directed the Centers for Disease Control to initiate research into the health effects of gun access (PAGV Policy Plank #2, Empower Researchers), while a proposal to Congress urges legislators to allocate $30,000,000 for schools to develop emergency-response plans (Policy Plank #5, Protect Schools).
  5. While President Obama implemented a number of executive actions, the biggest proposed changes will all require legislative action. All of the major funding allocations (with the exception of $20 million to encourage states to share background data) also have to go through Congress. In the coming weeks, concerned parents and citizens need to make sure that our voices and perspectives are heard in the legislative debates.

* Note that Obama actually signed only three executive orders (technically “presidential memorandums“) on Wednesday.  The 23 “executive actions” named in the Obama proposal describe general policy priorities that would not require Congressional approval for implementation. However, many of the proposed “executive actions” come far from implemented (or implementable) public policy at this point.

logo2Parents Against Gun Violence was founded by a nationwide coalition of mothers and fathers hours after the Newtown, CT killings.  In the weeks that followed, our members were busy collecting and studying scientific, peer-reviewed research on the causes of gun violence and gun accidents, and strategizing about how to reduce both.

At the same time, we have engaged in intensive dialogue with concerned citizens from across the political spectrum.  Through this process of research and dialogue, we have developed a set of five policy planks that we believe can gain support across the political spectrum, and that provide a comprehensive approach to reducing gun violence. We encourage all concerned citizens to contact their representatives, senators and any other elected officials as well to advocate for these policy proposals. If you would like to sign the petition promoting this platform, click on the Change.org petition here.

As parents, we urge lawmakers and the President to consider the following:

Policy Plank 1.) Empower law enforcement

a.) Approve Andrew Traver, President Obama’s nominee for Director of the Bureau of Alcohol, Tobacco Firearms and Explosives.  Without a leader, the Bureau is hampered in its ability to enforce its congressionally mandated responsibilities, such as investigating and prosecuting straw purchasers who buy guns for criminals. More »

In the next several weeks we will see new gun legislation proposed in both the House of Representatives (sponsored by Rep. Diana DeGette and others) and the Senate (sponsored by Sen. Dianne Feinstein and others). Both bills will call for restrictions on the sale of high capacity magazines.

For the thousands of Americans who die each year by gun suicide and gun accidents, these bills will have little effect—one bullet is enough to kill. There is ample evidence, however, to suggest that an effective ban on high-capacity magazines will reduce the number of deaths in gun homicides, especially in mass shooting scenarios.

This graph reveals the correlation between magazine capacity and number of casualties during mass shootings in recent history.

This graph reveals the correlation between magazine capacity and number of casualties during mass shootings in recent history.

A seven-year-long study of gunshot victims observed an increasing incidence of gunshot victims who had been shot multiple times. The proportion of gunshot victims with two or more gunshot wounds grew from 26% in the early 80s to 43% by 1990[1]. Over the same span of years, semiautomatic handguns like the Beretta 92 and Glock 17 were replacing the .38 and .357 caliber revolvers that had been the most popular handguns in the United States in the preceding decade. The ammunition capacity in a fully-loaded handgun rose from typically six rounds to typically 15 rounds, and shooters exploited that advantage, shooting their victims multiple times and increasing the likelihood of fatal injury.

Parents Against Gun Violence researchers have identified 37 mass shooting incidents (excluding robberies and armed confrontations) involving more than 6 victims in the United States since 1945. In 35 of 37, the perpetrators carried semiautomatic weapons. In 33 of 37, the perpetrators carried magazines with a capacity greater than 10 rounds. In the recent mass shootings in Tucson, Aurora, and Newtown, the perpetrators sought out inordinately large magazines, including the 100-round drum magazine James Holmes used to shoot 70 people in a movie theater. These mass murderers clearly believe that a higher-capacity magazine will equate to more fatalities.

Opponents of the high-capacity magazine ban will point out that smaller capacity magazines can be rapidly exchanged, and will argue that such a ban will not slow or hinder a mass shooter. Online videos show expert shooters removing an empty magazine and replacing it with a fully loaded magazine with dazzling speed. Let’s remember, though, that these videos are impressive precisely because the reloading skills depicted are remarkably rare—it takes years of practice to achieve such proficiency, and the perpetrators of most mass shootings are young men with limited experience. There are cowboy trick shooters who can operate a single-action revolver or lever-action rifle with astonishing speed—but Annie Oakley doesn’t fit the profile of a mass shooter. We’re not seeking laws to stop Wild Bill; we’re seeking laws to stop Jared Loughner. More »

We’ve been covering a lot of medical association news related to the Newtown shooting and gun-related legislation, but that’s because we’re very focused on looking at what research can tell us about reducing firearm injury, and medical associations are closely involved with much of this research.

Just as the American Psychiatric Association issued their remarks last week, the American Academy of Pediatrics sent their own letter, which you can download here, to President Barack Obama and Congressional leaders on December 19.

The organization had published a report on firearm-related injuries affecting children in their journal Pediatrics in October, in which they wrote “The American Academy of Pediatrics continues to support a number of specific measures to reduce the destructive effects of guns in the lives of children and adolescents, including the regulation of the manufacture, sale, purchase, ownership, and use of firearms; a ban on semiautomatic assault weapons; and the strongest possible regulations of handguns for civilian use.”

Unsurprisingly, in their letter to political leaders, they were just as direct regarding policy proposals related to gun control, mental health and children’s exposure to violence:

•    ”New federal firearms legislation that bans assault weapon sales and the sales of high capacity magazines, strengthens mandatory waiting periods and background checks for all gun purchases and promotes strict gun safety policies is a necessary first step.
•    Next, the federal government must take action to improve access to services that meet the mental health and developmental needs of infants, children and adolescents, and ensures that children and families exposed to violence have access to a medical home and other community supports.
•    Finally, we must engage in a national dialogue designed to reduce children’s detrimental exposure to violence in their communities, environments and entertainment.”

We’ll be revisiting the full account of their policy report on firearms for a later blog post, but we also wanted to mention another article with similar recommendations. “Weapons of Mass Destruction,” published in the Archives of Internal Medicine, which is published by the American Medical Association, also offered commentary related to firearm regulation. More »

As our organization has been working to uncover research related to firearm injury, we stumbled on to an article published last week in one of the world’s most prestigious medical journals that goes a long way to explain why we’ve found our task so difficult. In short, pro-gun members of Congress successfully gutted any funding into firearm injury prevention starting in 1996 and continuing through today.

Illustration by Svilen Milev

Illustration by Svilen Milev

The article, published December 21 in JAMA (the Journal of the American Medical Association), describes how the Centers for Disease Control and Prevention was silenced in the late 1990s when the CDC lost $2.6 million for research into firearm injury — and that was after Congress members failed to completely eliminate the National Center for Injury Prevention and Control as they had tried to do first.

It was no coincidence that the $2.6 million removed from the CDC’s budget in 1996 happened to be the direct amount previously budgeted for firearm injury prevention research. Though that precise amount was added back into the budget as the bill moved forward, it was “earmarked for traumatic brain injury.” The final bill even included the language “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”

Such expansive language basically shut down any firearm research at the CDC, lest such research be considered something that advocated for gun control and thereby cost them their careers. And it didn’t stop there. Two years after a 2009 study funded by the National Institute on Alcohol Abuse and Alcoholism looked at the association between risk of firearm assault and carrying a firearm, Congress expanded the funding restriction to all agencies at the Department of Health and Human Services, including the National Institutes of Health.

The article is worth a thorough read to learn just how successfully pro-gun members of Congress and the gun lobby have managed to completely shut down well-funded scientific research into prevention of injury and death related to guns. It’s true that violent crime and gun-related crime has been on a continual decline in the U.S. over the past two decades. But any crime is too much, and it’s reasonable to expect we might have made even more progress had our top public health researchers and health-related government agencies been allowed the opportunity to research how.