Public Policy Malpractice?

The New York Times editorial this week, Missouri: The Shoot Me State, laments that the new Missouri gun legislation “has drawn no great national attention, but it certainly provides further evidence that gun safety cannot be left to state lawmakers beholden to the gun lobby.”

Should legislators and policymakers be held accountable for adverse consequences of their policy decisions when there is good evidence that harmful outcomes will result? What if legislators make wanton decisions that ignore policy evidence and have the effect of causing loss of life?

In other walks of professional life we hold leadership accountable for such decisions. Automobile executives face civil and criminal penalties if they show disregard for evidence of safety problems amongst consumers. Airline executives face enormous accountability for the safety of their companies.

Gun policy is inextricably linked to the safety and quality of life in our communities. There are consequences – including life and death – of different gun policies. There is a substantial body of evidence about the effects of alternative state gun policies.

For example, Professor Daniel Webster’s analyses of state policies provide extensive and dramatic evidence of the consequences of state policy changes, taking a variety of other factors into account. As just one illustration, his analysis of Missouri’s 2007 permit-to-purchase policy, eliminating the need for background checks to purchase guns, attributes a net increase of 14-25 percent in homicides depending on data sources, which translates into an additional 49-68 persons per year dying as a result of this legislation.[1]

Such policy evaluation studies invite all types of methodological and ideological responses, especially in the emotional environment of gun policy. Stipulating that these responses are to be expected and legitimate, it still remains the case that gun policies can and do have empirical associations with higher and lower rates of crime, injury, and homicides. However, the statistical consequences of these policy changes do not appear to enter the political and policy calculus of these legislative votes.

So what if a policy change leads to a net increase of 50 deaths in a state? What if this is knowable, both before and after the fact? Should we hold our policy makers to account for their role in implementing such adverse policies? Is there a claim, analogous to policy malpractice, that should be advanced for policymakers who ignore solid evidence and enact harmful legislation?

There is currently much academic and civic interest in the idea of evidence-based public policy. So far, however, the influence and uptake of evidence in most legislative arenas is extremely limited. Perhaps we need more formal mechanisms, like the policy equivalent of an environmental impact statement, to stimulate formal discussion of policy consequences. Perhaps we need report cards or other forms of evaluation, which account for the deviations in our policymaking from sound facts, evidence, and analysis.

More broadly, we should consider whether there comes an ethical or professional responsibility to act in the best interests of constituents, especially in cases where the evidence is strong, and the potential human consequences are so significant.

Presidential candidates are increasingly scrutinized by formal fact checkers. Governors and legislators also need new kinds of policy accountability so that we know when malpractice is occurring – creating new policies that actually harm the public – and so we can call it out for what it is.

[1] Webster DW, Crifasi CK, Vernick JS.,  Effects of the repeal of Missouri’s handgun purchaser licensing law on homicides.  Journal of Urban Health 2014;91:293-302. Erratum: Journal of Urban Health 2014; 91:598-601.