Epidemiology and Reality

Funny thing that Steve should leave his comment on my previous post because I was just planning to say something along the lines of the question he raises. Steve proposes, "To my way of thinking, irrespective of the legitimacy of the analysis, any conclusion to restrict the right of a law abiding, sane person to obtain a concealed carry permit can and should be legitimately discarded. The individual right to be discreetly armed trumps the analysis."

This is a clear example of a very common ethical problem in public health. If I can show, to whatever degree of certainty you want to stipulate, that a regulation of some kind -- such as actual existing laws requiring that motorcycle riders wear helmets or drivers wear seat belts, banning smoking in public places, banning marijuana altogether, or as in the case at issue banning law abiding citizens from carrying concealed firearms -- will reduce injuries and deaths, is that sufficient justification for doing it? The "nanny state" is substituting its judgment for our individual choice, and the loss of liberty is a fundamental cost that overrides whatever statistical benefit to the population as a whole one might expect.

In fact, the question is never that simple and the proposition is constructed on a false dichotomy. Individuals, in exercising their own liberty, inevitably run up against the liberty of others. Just because you own a gun doesn't mean you can use it to rob, rape or kidnap people. The state deprives you of your liberty to take those actions in order to protect the liberty of the rest of us. When that guy in the Indianapolis Planet Hollywood dropped his gun on the floor and it shot two other patrons, he deprived them of their liberty to freely enjoy a public place and to enjoy the use of their own wrist and hip, respectively. So there are competing liberty interests here, it cuts two ways.

When a motorcycle rider suffers a brain injury, the state may wind up having to take care of his dependents, and may even end up spending tens of millions of dollars over his lifetime for his institutional care. That means collecting taxes from everybody else, which obviously impinges on our liberty. The state has a legitimate interest in preventing that, on behalf of all of us.

There are additional complexities. Tobacco is addictive, so are tobacco addicts really exercising their liberty by smoking? Many, if not most of them, will tell you that they do not want to smoke but cannot help themselves. Perhaps legal restrictions that encourage them to stop are actually enhancing their autonomy.

The point is not that letting people carry concealed handguns is wrong, or that making them wear motorcycle helmets is right. The point is, these decisions are always a matter of degree, there are no absolutes. Many libertarians make the mistake of assuming that only government can take away our freedom, but that is just obviously wrong. So can other individuals, and private organizations. None of us is ever really "free" anyway, all of our choices are constrained by circumstance. Even the most committed libertarian ought to be able to see that there is a legitimate role for government in arranging those circumstances to make people feel as free as possible. Without such government action, we will all be at the mercy of the most ruthless, or the most irresponsible, of our fellow citizens.

Update: One of the definitions of "liberal" (from Dictionary.com) is "favorable to or in accord with concepts of maximum individual freedom possible, esp. as guaranteed by law and secured by governmental protection of civil liberties." This neatly sums up the difference between liberalism and libertarianism: liberals recognize the need for government action to protect liberty, whereas libertarians think that liberty just happens.