Private-party gun sales, regulation, and public safety.

n engl j med 363;6 nejm.org august 5, 2010 508 scrutiny. In the Court’s view, its decision “does not imperil every law regulating firearms,” and quoting Heller, it perceives no threat to “such longstanding regulatory measures as ‘prohibitions on the possession of firearms by felons and the mentally ill,’ ‘laws forbidding the carrying of firearms in sensitive places such as schools and government buildings, or laws imposing conditions and qualifications on the commercial sale of arms.’” Total handgun bans will probably fall — and their effectiveness is uncertain in any event — but otherwise the impact of this sea change in constitutional law may be modest. Still, it will be years, even decades, before that conclusion is clear. And the possibility of more guns in homes, especially handguns, is troubling, as is the lack of guidance the Court’s opinion offered to lower courts. For their part, physicians should remain vigilant and address gun issues, such as access and storage, with patients, especially those who may be suicidal, have survived domestic violence, or live with children. We can only hope that in hindsight, bleak postHeller, post-McDonald forecasts will seem hyperbolic. Otis McDonald has not won yet. A lower court will now decide whether the laws that thwarted him are constitutional. But McDonald is surely a foothold to victory. In all likelihood, he will get his gun. Ironically, that handgun may not be the panacea he seeks. It will not address the root causes of the drugand gang-related crime plaguing his neighborhood. Its promise of safety may be illusory, and it may just increase the risks of homicide, suicide, and accidental injury and death of those who live in or, like his grandchildren, visit his home. It may also create legal problems. If he kills a neighborhood thug in self-defense, the odds that he will be held blameless are slim: in every year from 2004 through 2008, less than 2.5% of handgun-related killings by private citizens were deemed justifiable homicides (see table).4 McDonald has, however, secured a measure of immortality; he will forever be associated with the case that bears his name. That case marks another installment in high-minded constitutional debates. But we should not forget that the collateral damage from firearms, especially handguns, is breathtaking. In the face of staggering statistics about eminently avoidable gun-related harms, perhaps the wisest play for this newfound constitutional right is not to use it at all.