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Journal Article

Citation

Webster DW, Gostin LO. J. Am. Med. Assoc. JAMA 2022; 328(12): 1187-1188.

Copyright

(Copyright © 2022, American Medical Association)

DOI

10.1001/jama.2022.14073

PMID

36166019

Abstract

On June 25, 2022, President Joe Biden signed the Bipartisan Safer Communities Act, which enhances background checks for individuals younger than 21 years seeking to purchase a firearm, incentivizes states' implementation of extreme risk protection orders (ERPOs), and expands access to mental health services. Two days earlier, the Supreme Court declared a broad right to carry firearms in public, which will be far more consequential for gun violence.

The Supreme Court's ruling coincided with a historic rise in firearms violence, including a mass elementary school shooting in Uvalde, Texas; a racist attack in Buffalo, New York; and a mass shooting during an Independence Day parade in suburban Chicago that resulted in a least 6 deaths and wounding of at least 30 other people. In 2020, the US reached an unprecedented total of more than 45 000 firearms deaths.1 Mass shootings (4 or more injuries or deaths) now occur more than once every day.2 The US firearms death rate is 25 times higher than in other high-income countries.3 In this Viewpoint, we discuss the recent Supreme Court decision and offer a public health strategy for firearms safety laws.

The Bruen Decision

In New York State Rifle & Pistol Association v Bruen, the Supreme Court struck down a 109-year-old New York law requiring "proper cause" (a special need for self-defense) for obtaining a license to carry a concealed weapon in public. Seven additional states, and many localities, have "proper cause" concealed carry laws. Justice Clarence Thomas, writing for a 6-3 majority, held that New York's proper-cause requirement violates the Fourteenth Amendment by preventing law-abiding citizens with ordinary self-defense needs from exercising their Second Amendment right to possess firearms in public for self-defense.4

The Second Amendment reads, "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." In District of Columbia v Heller (2008) and McDonald v Chicago (2010), the Supreme Court effectively disregarded the militia clause, finding an individual right to bear arms for self-defense. Following Heller and McDonald, lower courts balanced the right to bear arms with states' reasonable public safety needs. Instead, the Supreme Court in Bruen ruled courts must apply a single test: whether laws are "consistent with the Nation's historical tradition of firearm regulation." The Second Amendment "surely elevates above all other interests the right of law-abiding, responsible citizens to use arms" for self-defense.4

Justice Antonin Scalia's ruling in Heller in 2008 explicitly permitted a wide range of firearm regulations: "nothing in [the] opinion should be taken to cast doubt on longstanding prohibitions on the possession of firearms by felons and the mentally ill, or laws forbidding the carrying of firearms in sensitive places." He suggested that firearms storage regulations were permissible, as well as bans on "dangerous and unusual weapons," such as "M-16 rifles and the like." The Supreme Court in Bruen reiterated states' longstanding ability to "forbid the carrying of firearms in sensitive places." It remains unclear which places are sufficiently "sensitive" to permit restricting firearms. Beyond that, it is uncertain which evidence-based firearm safety laws would meet Bruen's strict historical test.

Civilian Concealed Carry Laws

According to the Supreme Court, modern firearms regulations should be judged by standards at the time the Second Amendment was adopted in 1791. Supreme Court justices do not have expertise to conduct historical analyses, and the Founding Fathers could not have foreseen high-powered firearms or the historic rise in fatal shootings. Concealed carry laws do have deep historical traditions, with Kentucky first enacting a ban in 1813. It was not until the late 1980s that states began to adopt laws allowing most legal owners to obtain a license to carry concealed guns in public. "Right to carry" laws, supporters argued, would deter violent attacks. Most recent studies have found that right to carry laws often were associated with increased violent crime.5 Until Bruen, courts have found concealed carry laws to be on solid legal footing,6 but now any discretionary licensing requirements will be vulnerable.

Public Health Strategies

Evidenced-based public health strategies could significantly reduce firearms violence, mass shootings, suicides, and unintended weapons discharge. Judicial orders can reduce firearms access for potentially dangerous individuals, such as through domestic violence restraining orders (DVROs) and ERPOs. DVROs are associated with reductions in intimate partner homicides, but their effectiveness is contingent on whether laws cover dating partners and explicitly require firearm surrender.7 Raising the minimum age to purchase firearms to 21 years would reduce access by adolescents who have elevated rates of violence. Safe storage regulations are associated with reductions in youth suicides, youth-perpetrated homicides, weapon-related violence in schools, and unintentional shootings.

Background checks can reduce firearm access by persons with a record of dangerous behavior most effectively when applied to sales between unlicensed parties, such as 2 private parties. The Bipartisan Safer Communities Act requires anyone selling firearms for profit--a widespread practice among unlicensed sellers--to obtain a license.

Laws that require a license or permit to purchase handguns are associated with reductions in guns being diverted for use in crime, homicides, suicides, fatal mass shootings, and law enforcement officers shot in the line of duty. Prior court rulings have found these laws to be constitutional...


Language: en

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