Legal and ethical implications in the evaluation and management of sports-related concussion

Abstract

Objective: To examine the ethical and legal issues physicians face when evaluating and managing athletes with sports-related concussions, and to offer guidance to physicians as they navigate these situations.Results: This position paper reviews and compares the components of sports-related concussion laws, including education, removal from play, and clearance for return to play. It highlights the challenges privacy laws present relevant to providing care to concussed athletes and suggests ways to help physicians overcome these obstacles. The report also explores the ethical considerations physicians should bear in mind as they evaluate and manage concussed athletes, addressing them through a framework that includes considerations of professionalism, informed decision-making, patient autonomy, beneficence, nonmaleficence, conflicts of interest, and distributive justice.Conclusions: Physicians caring for concussed athletes have an ethical obligation to ensure that their primary responsibility is to safeguard the current and future physical and mental health of their patients. Physicians have a duty to provide athletes and their parents with information about concussion risk factors, symptoms, and the risks for postconcussion neurologic impairments. Physicians should facilitate informed and shared decision-making among athletes, parents, and medical teams while protecting athletes from potential harm. Additionally, including concussion evaluation and management training in neurology residency programs, as well as developing a national concussion registry, will benefit patients by the development of policies and clinical guidelines that optimize prevention and treatment of concussive head injury. Over the past few years, sports-related concussion has become a major health concern in the United States. The Centers for Disease Control and Prevention (CDC) estimates that 1.6-3.8 million sports-related concussions occur each year.1 Although a majority of these injuries occur while playing football, concussions are also common in other contact sports, like soccer, lacrosse, hockey, rugby, and basketball. [2][3][4][5] Concussions can have devastating effects, such as shortterm impairments in athletes' cognitive and athletic performance. Repetitive concussions, and even subconcussive impacts, have been associated with long-term impairments in neurocognitive functioning, behavioral problems, premature dementia, and chronic traumatic encephalopathy. 5-12Evaluating and managing sports-related concussion raises a variety of distinctive ethical and legal issues for physicians, especially relating to return-to-play decisions. A recent survey conducted by the American Academy of Neurology (AAN) demonstrated that while a majority of neurologists see patients with sportsrelated neurologic concerns, most do not receive formal or informal training regarding concussion. 13 The purpose of this position paper is to explore the ethical and legal issues physicians face when evaluating and managing athletes with sports-related conc...

Mild Traumatic Brain Injury: General Characteristics, Neurodegenerative Consequenses and Modeling

“…У зв'язку з цим були створені освітні програми, які за-безпечують слухачів інформацією про ознаки легкої ЧМТ та заходи, необхідні для поперед-ження або знешкодження її наслідків [19]. Особливо ці програми стосуються спортсме-нів та батьків дітей, які займаються спортом.…”

Trending Issues and Long-Term Effects of Recurrent Concussion in Sport

“…Not only does this correspond with Doherty's (2013) overture for the direction of sport management, but this will further establish the need to remove sole RTP decisions from a team's medical staff or from individual physicians, which have demonstrated judgments to be financially constricted (Kain, 2009). Thus, the nature of team physicians' RTP guidelines is not only variable in general (Matheson et al, 2011;Shultz et al, 2013), but is victim of conflicting financial and ethical interests (Kain, 2009;Kirschen, Tsou, Nelson, Russell, & Larriviere, 2014), evidently leading to, or at least highly feasible of, poor concussion management. Kirschen and colleagues (2014), who further examined the legal and ethical issues pertaining to physicians' RTP decisions, suggested that the research and management of concussion in sport would greatly benefit from a wider implementation standard for baseline cognitive testing, and the evolution of a "national concussion registry."…”

One-Year Concussion Prevalence in Marion County, Florida High School Athletes

“…3 Although some agreement exists, diagnosis and management of concussion are continually evolving as new data become available. 4 The International Conference on Concussion in Sport and an elevated level of media attention 5 in recent years have spurred sports medicine clinicians to standardize diagnosis, management, and reporting guidelines for athletes sustaining traumatic brain injury during athletic competition. 4,[6][7][8] To date, most attention on concussion has been devoted to collision sports such as football to reduce the risk for serious complications such as second-impact syndrome and potential links to other neurologic disorders.…”