Gun violence: Care ethicists making the invisible visible

Ann Gallagher, David Augustin Hodge, Sr

Many readers will be aware of the devastation caused by gun violence in the United States. In recent months, you would, most likely, have heard of massacres in Las Vegas (58 dead) and in a Texas church (26 dead). These are, however, the tip of this catastrophic iceberg. One overview of the statistics highlights the following: everyday, in America, an average of 93 people are killed with guns; every year, there are about 12,000 gun homicides; for every person killed with a gun, two others are injured; on an average day, seven children and teenagers are killed with guns; every month, an average of 50 women are killed by a partner with a gun; Black men are 14 times more likely to be shot and killed by guns than white men; and the gun homicide rate in America is 25 times more than the average of other developed countries.1

The current gun situation in America is an issue that needs to be understood and responded to by care ethicists. It is an issue whereby some groups are less visible and less valued than others. It is our view that this is contributed to by a lack of empathy. This is an issue that ethicists need to care about as it impacts negatively on marginalized groups and communities and on caregivers who have to respond to the suffering of victims of gun violence and their families. It is noteworthy that the American Nurses Association has “taken a stand”2 on this issue and the American Medical Association has declared gun violence “a public health crisis.”3

Conversations we have had with Americans reveal a wide range of views. We have talked with people who take their right to bear arms seriously and who argue that they need a gun, particularly in rural areas, for self-protection and to keep the number of deer and coyotes down. Others are appalled at the liberal legislation relating to gun control. A colleague sent us a link to a news item reporting that the State of Wisconsin had lowered the age limit for a hunting gun license. The headline ran “Babies issued gun licenses after minimum shooting age eliminated by Wisconsin law.”4 In response to this report, our colleague said she was “not proud to be American.”

The authors of this editorial come at this topic with different experiences. One of us, a white female ethicist, worked as a nurse during the Northern Irish conflict and witnessed the anguish caused by shootings. The other, a black male philosopher and theologian, has personally witnessed the senseless death of a young black male.

It is our view that the lens of intersectionality may help illuminate some of the complexity of disparities relating to the reporting of gun deaths and injuries. The African-American academic, Kimberlè Crenshaw,5,6 for example, shows how black women are invisible in the reporting of gun crime. This invisibility inhibits ethical sensitivity and an empathic response—and this is unethical. Any trend or aspiration that vies for the invisibility of other humans cannot be an ethical one. Additionally, the dilemma is more widespread than just gun control and can be affixed to a broader context that are identified as social determinants of health.

Dr David Satcher,7 past director of the Centers for Disease Control and Prevention (CDC) and former Surgeon General of the United States, gives a rather straightforward definition that demonstrates the complexity of gun control and intersectionality: “Social determinants of health have been identified as the conditions in which people are born, grow, learn, work, age and die, and the impact those conditions have on health outcomes.” If we take Satcher’s view seriously, we must conclude that gun control is a health issue requiring a public health ethics response that is grounded in a normative theory of empathy and care ethics.

Gun lobbyists are fond of curt mantras like “Guns don’t kill people—people kill people!,”8 and there are good reasons to believe that this reductionist logic needs quieting. But let’s accept this premise and conclusion for a moment. Let us agree that people kill people with guns, because they do. Wouldn’t it be a strong induction to argue that removal of guns would curtail the killing of other people? Curt refrains like “Guns don’t kill people—people kill people!” smack of apathy rather than empathy.

We would characterize the ethical problem as follows: there seems to be a greater immediacy for what is visible (near and dear) than what is invisible (far and away). For example, a child drowning in front of us is more immediate than a starving child we merely hear about or witness on a television program. The largest portion of people who are dying from gunshot wounds (GSWs) are black and from poorer populations in inner cities that we merely hear about. They are quite invisible to the masses. They are neither fundamentalist gun lobbyists nor National Rifle Association of America members, but they are humans—just with a radically different social context.

In our introduction, we mentioned the sensationalized, headline-worthy, gun crime deaths where (mostly white) people were killed in Las Vegas (58 dead) and in a Texas church (26 dead). There was, understandably, a national and international empathic response. But there are far higher numbers to be found in the city of Chicago alone. At the time of this writing (11 December 2017) in Chicago, so far this year, there were 2833 people shot and wounded, 594 shot and killed, and 65 shot and wounded this month alone, the overwhelming majority being young black men. These deaths and injuries do not make national or international headlines. These victims of gun violence remain invisible.

Perhaps, if these real lives-now-lost were made visible to defenders of the curt mantra, their normal human empathy would extend itself in caring ways.9 Normal human empathy directs us toward caring for others—making the invisible visible, which is a noble and ethical aspiration. Until all humans are made visible to each other, excess deaths by avoidable social determinants is a form of moral blindness with devastating consequences that will continue to prevail.

The authors thank Michael Slote of the University of Miami for very helpful comments and also thank Craig Gannon and other colleagues who commented on a blog post on this theme (see

1. Everytown. Gun violence by the numbers, Scholar
2. Urges nurses to help stop gun violence. The American Nurses Association, 25 December 2016, Google Scholar
3. Gun violence “a public health crisis.” American Medical Association, 14 June 2016, Google Scholar
4. Sanders, L. Babies issued gun licenses after minimum shooting age eliminated by Wisconsin law. Newsweek, 29 November 2017, Google Scholar
5. Crenshaw, K. Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Univ Chic Leg Forum 1989(1): 139167, Google Scholar
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7. Satcher, D. Tuskegee legacy: the role of social determinants of health. In: Katz, RV, Warren, RC (eds) The search for the legacy of the USPHS syphilis study at Tuskegee. New York: Lexington Books, 2011, p. 41. Google Scholar
8. Shamas, M. “It’s time to retire the ‘guns don’t kill people—people kill people’ argument. Guns do kill people.” HUFFPOST, 13 October 2017, Google Scholar
9. Slote, M. The ethics of care and empathy, Ch. 2. New York: Routledge, 2007. Google Scholar

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