Custodians of the Game: Ethical Considerations for Football Governing Bodies in Regulating Concussion Management

Abstract

Concussion in professional football is a topic that has generated a significant amount of interest for many years, partly due in recent times to the filing of the class-action litigation and the uncapped compensation injury fund and settlement involving 4,500 retired professional players and the National Football League (NFL). The proceedings claimed that the NFL, as the governing body of American football, failed in its duty to protect players' health during their professional playing careers by exposing players to risks of repetitive concussions and actively concealing links to potential long-term consequences. The NFL litigation sharpened the focus on the fundamental regulatory, governance and ethical considerations for football governing bodies, as self-regulated organisations, when governing the delicate balance between the dynamics of contact and collision sports, entertainment and player-health considerations. It also raised questions about public accountability and responsibilities to all levels of the sport through a framework of public health ethics. The NFL litigation and Congressional hearings have led to changes within the NFL and its regulatory and governance responses. A case study of the NFL responses to concussion in the sport of American football can provide insight into concussion regulation. Australian football governing bodies can align their regulatory and governance responses to concussion within their sports with the aim to avoid similar accusations, and circumvent a more coercive form of intervention.

Balance Regularity Among Former High School Football Players With or Without a History of Concussion

“…A merican football has come under great scrutiny 1 due to research 2À4 revealing a possible link between concussion history or head-trauma exposure and later-life impairments, such as an elevated risk of clinically diagnosed depression, mild cognitive impairment, earlier onset of Alzheimer disease, and the heavily debated chronic traumatic encephalopathy. Authors of this growing body of literature have indicated that athletes who sustain a concussion may have subclinical changes (ie, not severe enough to present in observable symptoms) occurring in the brain that are not evident until later in life.…”

The Impact of the Concussion Crisis on Safeguarding in Sport

“…The two sides of the concussion crisis debate remain polarized between those who insist that greater restrictions on individual liberty are justified by the need to protect participants (especially children) from harm, and those who believe the value of sports participation (especially physical and mental health benefits) outweigh the potential risks (Quarrie et al, 2017 ). Consequently, the regulation of concussion in sport remains a “wicked problem”; complex, difficult to define and continuously evolving (Greenhow and East, 2015 ). These tensions are likely to fuel continuous incremental safeguarding adaptations, but more radical reforms will require three main reconsiderations.…”

“…The response of the NFL was to repeatedly cast doubt and uncertainty over the reliability of scientific evidence and the causal connection between playing the game and player harm (Goldberg, 2013 ). Congress viewed the NFL as having fallen “short of community and government expectations” and failing “to regulate its sport for and in the best interests of the players and the public” (Greenhow and East, 2015 , p. 75, 76). In 2015, a class action lawsuit concluded when the NFL agreed to establish a $1bn player compensation fund.…”

Two Sports, Two Systems, One Goal: A Comparative Study of Concussion Policies and Practices of the Australian Football League and Hockey Canada

“…From a governance and regulatory perspective, Malcolm explains that biomedical science alone is “insufficient” to address the problem (Malcolm, 2019 ). Malcolm ( 2019 ), citing Greenhow and East ( 2015 ), notes that sport-related concussion is a “wicked” problem; one that is “complex, difficult to define, evolving and has many interdependencies and many stakeholders” (p. 70).…”