‘A free people ought not only to be armed, but disciplined; to which end a uniform and well-digested plan is requisite; and their safety and interest require that they should promote such manufactories as tend to render them independent of others for essential, particularly military, supplies.’ — George Washington (1732-1799)

Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA

Pam and I are visiting friends at their lake house on the Sam Rayburn Reservoir in Texas. As we were traveling, we were shocked at the slaughter of 19 children and two teachers at an elementary school in Uvalde, TX, on May 24. This hit particularly close to home, as our middle daughter is a second-grade teacher in Maryland.

More than 30 mass shooting events have occurred just over two weeks later in the United States. A mass shooting event is defined by gun violence incidence where at least four people are injured or killed, not including the attacker. Data from the national Centers for Disease Control and Prevention (CDC) demonstrates that the leading cause of death in children and adolescents is now firearms, having surpassed auto accidents in 2020. Firearm-related death in the United States represents a healthcare emergency. All providers must now factor this into their patient care plans.

Sadly, the appalling lack of sensible gun-control legislation at the federal level has been an issue I have addressed before in this column. As the mass shooting incidents come and go, our legislative bodies apparently can only offer “thoughts and prayers” to the families of the slain. While other established democracies worldwide appear to be able to establish gun control laws to curb gun violence, America remains paralyzed while firearm-related violence grows. At issue, or at least the excuse that is most often used, is the erosion of civil rights that gun control legislation might represent, as it supposedly weakens Second Amendment rights established in the Constitution. Since most of the readers of this column and I have sworn to protect and defend the Constitution, this argument finds some purchase with me, personally. From this perspective, I decided to investigate the Second Amendment a little closer, from the perspective of our Founding Fathers.

The quote I used from George Washington came from his First Annual Message to Congress on the State of the Union. I often see this quote used by pundits to defend the fundamental relationship between Americans and their guns. The statement is often misrepresented, because only the first few words are used: “A free people ought not only to be armed but disciplined.” The semicolon and the inconvenient language that follows are usually left out. Why? Because Washington’s words reveal that the Founding Fathers were not necessarily interested in every American’s right to own a gun; they were clearly interested in the participation of white, able-bodied men in the local militia. The Federalist Paper No. 29, penned by Alexander Hamilton, and the Second Amendment proposed by James Madison were not focused on a citizen’s right to own a weapon but instead on the need for citizens to own a gun and other military supplies to sustain them as active members in a “well-regulated militia.”

The organized armies of 18th century Europe had been the prime mechanism of force used by monarchs of the time to control their populations and maintain their stranglehold on power. Our Founding Fathers hazarded the journey to the New World to escape this control. They were keen on not subjecting themselves or the country to an overreaching monarch or central government again. Their answer to government overreach and gun control was a “well-regulated militia.” The absolute right to “keep and bear arms” was only within the context of one’s participation in the community militia. Ownership of a firearm (again, limited typically to white landowners and merchants) would require training and disciplined control through the military command structure of the local militia. The Founding Fathers certainly did not want everyone (Indians, nonwhites, non-citizens, enemies and criminals) to have weapons—only the militia that served as both the local and national defense force. This perspective, taken from the written words of the Founding Fathers, seems inconsistent with the rhetoric of the pro-gun lobby today.

The Founding Fathers were also greatly influenced, as we are today, by the level of technology of their time. A highly trained and experienced militiaman of the era could fire three aimed musket shots a minute. Therefore, effective fire required lines of soldiers, all firing at once at a reasonably close target. Our constitutional framers could not have imagined that war technology would lead to the development of assault weapons that would afford a single individual the firepower of an entire militia. They did not have to worry about weapon technology, though, because their intent, as they clearly indicated in their written statement on the topic, assumed weapon ownership would be under the regulatory direction of the militia. I think Robin Williams sums up my argument best with his statement, “The Second Amendment says we have the right to bear arms, not to bear artillery.”

As a career Army officer, I am familiar with automatic assault weapons and pistols designed for war. As a medical officer, I am even more acquainted with the tremendous damage these war weapons inflict on the human body. I have trained with these weapons as part of my job preparing for war under military regulations. These weapons are designed for combat and use by professional soldiers and should not be in the hands of an amateur with no formal training or regulation. I recognize that this statement is exceedingly controversial. Still, the actual language of the Second Amendment and the history behind this “right” supports my position. I am pretty sure the 19 Uvalde children would agree with me. But, of course, their votes will never be counted.

I am a gun owner myself. Most of my weapons are hunting rifles, though I do own some pistols. I believe I should have the right to own these weapons in a highly regulated environment for hunting and home defense. I imagine that most responsible gun owners in this country would not have any issue with bans on implements of war (assault rifles, extended magazines, bump stocks, etc.). It makes no sense that I require a license and insurance to operate a motor vehicle, but I could go buy an assault weapon today on a whim with my credit card. Indeed, increased law enforcement and mental health services would help, but only within the context of solid gun regulation.

As federal healthcare providers, we must insert ourselves into this national conversation. The lack of gun regulation in this country is literally killing our patients. Our Founding Fathers never intended for American citizens to own guns without those weapons being ‘well regulated.’ Federal research dollars need to be invested into gun violence research to inform future regulations in this space. It is time for our legislators to finally address this complex problem. If they are unable, it is time for the majority of Americans who desire better gun control legislation to find those politicians who will.