Guns and family violence: How many tragedies does it take?

On December 1, 2012, NFL linebacker Jovan Belcher shot and killed his girlfriend, Kasandra Perkins. He then drove to Arrowhead Stadium and then shot and killed himself in front of his two coaches and the general manager of his team, the Kansas City Chiefs. On February 14, 2013, South African track star Oscar Pistorius shot and killed his girlfriend Reeva Steenkamp through the bathroom door of his home. Two well-known athletes, two horrifying acts. While we don’t know exactly what went on in the homes of either man, we do know this: they both had easily accessible firearms. If they hadn’t, three people might be alive now.

There is nothing we in the US can do to affect gun use in South Africa. But we do have some idea of what might help here. Two decades ago, a study entitled “Gun ownership as a risk factor for homicide in the home” appeared in the New England Journal of Medicine and made it clear that a gun in the house was more likely to be used against a “loved” one than for protection. Just this week, the New York Timeshad a story that bore out this finding in gruesome detail. Unfortunately, despite this knowledge, despite the many who have died or been injured, nothing has changed.

According to the General Social Survey, a survey that takes the pulse of America on social trends from the University of Chicago, one-third of Americans live in a house with a gun and the Violence Policy Center reminds us that 89.5 percent of murder-suicides involve a firearm [PDF]. People do own guns for other reasons including hunting, target shooting and sport and, yes, even for self-defence. But that’s not what I see: As an emergency physician working in a busy urban emergency room for the past 16 years, I have seen or heard of at least one patient a month who has been shot by their partner.

Fifteen years ago, Dr John May of Chicago developed the acronym GUNS, to give health care workers as a reminder to ask whether a gun is kept in the home. If the answer is yes, doctors are encouraged to determine if important risk factors for suicide, homicide, or unintentional injury are also present. This would include partner violence. The questions are: Is there a Gun in your home? Are you around Users of alcohol or drugs, do you Need to protect yourself and do any of these Situations apply to you? The GUNS mnemonic has been endorsed by the Handgun Epidemic Lowering Program (HELP) and is included in the American Medical Association’s Physician Firearm Safety Guide. Sadly, I have neglected to follow these guidelines myself in recent years, even though in 1999, I wrote a clinical review paper entitled entitled “Firearms and Family Violence” for Emergency Medicine Clinics of North America, a journal for professionals in the field. Questions about gun violence are hard to ask of a vulnerable person – but I, and other health care professionals, must ask these basic questions of their patients who seek help from partner abuse. I am fortunate that I work in Georgia, where I can ask – under Florida law, I would not be permitted to do so.

According to the Bureau of Justice Statistics, the overall rate of intimate partner violence has declined since 1993. The sad truth however, in these same statistics, guns continue to be used more often to commit domestic homicide than any other method. In fact, the CDC reported the percentage of female intimate partner homicide victims killed with firearms (64.1 percent) is greater than the percent of all female homicide victims killed with firearms (47.5 percent), whereas knives account for 17.4 percent of all female homicides and 16.1 percent of female intimate partner homicide victims. We also know that owning a gun will also put you more at risk for killing yourself. Suicide is the second-leading cause of death among Americans 40 years of age or younger. Among Americans of all ages, more than half of all suicides are by guns. Easy access, easy use.

In Jovan Belcher’s case, it became clear that he likely had been abusing Perkins for some time, and so he might have killed her by other means. But the fact is that a nearby gun assured that there would be a deadly outcome. The Second Amendment, so often cited in discussions about gun control, does give Americans the right to bear arms – but does that mean the right to keep them in the home to kill a partner? Certainly that is not what the founding fathers intended. It’s time for health professionals to remember to ask about guns in the home with patients suspected of partner violence. And it’s time for the President and our legislators to stand up to the gun lobby and to create reasonable boundaries on gun ownership.

Sheryl Heron, MD, is an associate professor in emergency medicine at Emory University and a Public Voices fellow with The OpEdProject. She practices at Grady Memorial Hospital in Atlanta, Georgia.