Before I retired, I had the privilege of serving on the Concord Hospital Medical Ethics Committee for many years. This committee is composed of clinical staff, legal scholars, clergy and community members, and it meets regularly throughout the year. Its first responsibility is to consider medical cases that pose ethical dilemmas for staff, families and/or patients and to apply the principles of ethics to recommend solutions. But in addition, it is a forum to broaden our thinking about potential situations that might arise in a medical setting where an ethical approach is crucial.
One educational session some years ago stands out for me, because it raised questions I had never seriously considered up to that point: What are the ethical responsibilities of staff to their patients in the Intensive Care Unit when an active shooter is on campus?
This session took place relatively early in the grinding cavalcade of mass shootings that have plagued our country over the last few decades. You might say I was naïve, but at the time the possibility of a shooting close to home seemed unlikely, and possibility of an incident in a hospital seemed laughably remote. I had a hard time imagining the situation, let alone the solution. Critically ill patients are entrusted to staff who view the care of these patients as their highest responsibility. I recall that my only thought about this question was that the incident must not be allowed to happen in the first place.
Fast forward over the years. The exponential rise in mass shootings in schools and public places (and yes, hospitals) in our country has continued, as access to guns has become ever easier. Yet gun rights advocates argue that any laws which restrict their personal liberty to own and use guns are unconstitutional. So much for their individual rights, but they rarely if ever have an answer to the dangers of the powder keg they have created that threatens our collective liberty to live safely together.
The solutions they propose still seem preposterous to me. “Harden schools.” “Arm teachers and leaders.” “Position armed guards in schools, public buildings, and hospitals.” “Allow concealed and open carry of weapons so a good guy with a gun can deter a bad guy with a gun.” Wait. What?
In New Hampshire, a lawmaker wants to go one step further toward chaos. He wants it to be illegal to restrict the possession or use of guns on public college campuses in our state. The net effect of House Bill 1793 would be that anyone who wishes to carry a gun on campus may do so. Where is that leading us? I shudder to imagine. We will be left with yet more hand-wringing and thoughts and prayers after yet more tragedies. This lawmaker wants to make our futile gestures, which are inevitably after the fact, all the more pointless.
The deputy chief of the Durham police department recently testified that he would never send his daughter, now a high school senior, to the University of New Hampshire if HB 1793 becomes law. He knows that the chance of a “good” outcome when shooters are in the room is exquisitely slim. And at what cost? Why would he want to risk that for his daughter?
He knows what would happen, and we do too. Not only would campus violence escalate, but so would fear flourish, so would mental health suffer, so would open exchange of ideas be stifled and so would that many more suicides succeed.
A university is a special place where students can learn and grow intellectually and socially, and where educators can help guide them into adulthood, not a place where shooters should be invited to succumb to the pressures of the moment and inflict their angst on the people around them.
A hospital is a special place too, where lives are saved more than they are lost. The ICU staff acts daily in life or death situations, but it is a cruel demand that they also be required react in an instant to a threat to their patients’ lives which is also a threat to their own life.
In ethical analyses we apply principles of respecting patient autonomy, ensuring informed consent and joint decision-making, and working toward outcomes which promote the most good while causing the least harm. These are not questions that can be settled on the spur of the moment or at the point of a gun. There is no place for guns in hospitals, and there is no place for guns on university campuses. The only ethical solution in hospitals and on campus is to work toward fewer guns and less access to them, not more. A first and very obvious step in our universities is that HB 1793 cannot become law.
Millie LaFontaine is a retired neurologist who lives in Concord.