Ethics in Sports Medicine

Abstract

Physicians have struggled with the medical ramifications of athletic competition since ancient Greece, where rational medicine and organized athletics originated. Historically, the relationship between sport and medicine was adversarial because of conflicts between health and sport. However, modern sports medicine has emerged with the goal of improving performance and preventing injury, and the concept of the "team physician" has become an integral part of athletic culture. With this distinction come unique ethical challenges because the customary ethical norms for most forms of clinical practice, such as confidentiality and patient autonomy, cannot be translated easily into sports medicine. The particular areas of medical ethics that present unique challenges in sports medicine are informed consent, third parties, advertising, confidentiality, drug use, and innovative technology. Unfortunately, there is no widely accepted code of sports medicine ethics that adequately addresses these issues.

Confidentiality in Sports Medicine

“…Despite this the literature has frequently identified the difficulties of simply transplanting medical ethical conventions into sports medicine [2]. While some explain this by locating sports medicine as a form of occupational medicine [11], it should be noted that even the Faculty of Occupational Medicine views patient confidentiality as a primary ethical issue [12], and that most ethical codes for sports medicine explicitly state that they add detail to, rather than replace, more widely recognized medical ethical principles [13,14].…”

“…informing them of another players' infectious disease) this would not necessarily extend to a more individual issue, such as an athletes' alcohol misuse [2]. The use of the term "physician covering the team" rather than "team physician" has been proposed to clarify the obligations the role should entail [4].…”

Dazed and Confused: Sports Medicine, Conflicts of Interest, and Concussion Management

“…In the context of modern professional sport and the emergence of the "team doctor" (Polsky 1998), the doctor-patient relationship has been described as a triad of doctor-patient-team (Dunn et al 2007). The obligations that sports doctors have to third parties (often they may be paid by those third parties) may create tensions in the clinical decision making process.…”

Ethical issues in return-to-sport decisions

“…Sufficient and appropriate information should be given to an athlete to facilitate informed decision-making. 6,8,9 The healthcare professional should therefore confirm that an athlete understands the risks and benefits associated with return-to-sport decisions, and must also appreciate the extent of external pressures on an athlete that may influence decision-making. In addition, athletes must be educated regarding the importance of reporting injuries, to ensure effective management and to facilitate an efficient and safe return to sport.…”

“…4 Healthcare professionals working with sports teams have a fundamental responsibility to promote the health and well-being of athletes. 6,8,9 However, return-to-sport decisions may often challenge the clinical decision-making processes of healthcare professionals and judgements regarding the best interests of an individual athlete. It is necessary to appreciate the various influences and pressures that exist in recreational and professional sporting environments.…”