Sudden cardiac death: mandatory exclusion of athletes at risk is a step too far

Anderson, Lynley; Exeter, Daniel J.; Bowyer, Lynne

doi:10.1136/bjsports-2011-090260

Cited by 7 publications

(5 citation statements)

References 14 publications

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“…In human sport, testing for genetic predisposition to disease that limits performance is undertaken on the grounds of harm protection. Examples include testing for genetic predisposition to Achilles tendon and anterior cruciate ligament injury (Posthumus et al 2010); to sudden cardiac arrest (Anderson, Exeter, and Bowyer 2012;Tiziano et al 2016); and to exertional rhabdomyolosis associated with sickle cell anaemia (Taranto et al 2018). Such testing is ethically complicated, since tensions exist between the desire to protect athletes from injury and the protection of athletes' autonomy; privacy and their right to informed consent.…”

Section: Ethical Arguments Surrounding Genetic Testing For Performancmentioning

confidence: 99%

“…Such testing is ethically complicated, since tensions exist between the desire to protect athletes from injury and the protection of athletes' autonomy; privacy and their right to informed consent. Whilst some have argued in favour of mandatory testing programmes 7 (Ferrari et al 2015), others argue that non-voluntary testing is unjustifiably paternalistic (Anderson, Exeter, and Bowyer 2012;Savulescu 2005). Such arguments are complicated by the fact that there is no absolute link between genetic predisposition to disease or injury and the actual risk of harm in an individual (Magavern et al 2017;McNamee et al 2009).…”

Section: Ethical Arguments Surrounding Genetic Testing For Performancmentioning

confidence: 99%

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Ethics, Genetic Technologies and Equine Sports: The Prospect of Regulation of a Modified Therapeutic Use Exemption Policy

Campbell

McNamee

2020

Sport, Ethics and Philosophy

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This article critically reviews the current availability and selected use of genetic technologies for horses, before undertaking an ethical evaluation of current practice and regulatory positions in comparative relation to debates surrounding genetic testing, preimplantation genetic testing and gene editing in humans. We argue that genetic testing for hereditary disorders is not only justified but should be encouraged on welfare grounds and that genetic testing for performance traits is ethically permissible based on a restricted imperative to genetically edit horses and horse embryos to reduce genetic predisposition to disease and injury. Given the current state of the science, where the effects of gene editing on health and welfare are currently undetermined, space is created for an analytical distinction between equine gene editing for 'treatment' and for 'enhancement'. Gene editing is only justified for purposes of correcting/preventing disease and injury. Current regulation is challenged by apparently conflicting welfare-based ethical imperatives with respect to welfare-based gene editing. We propose modifications to the blanket bans on gene editing with a case-by-case assessment of applications to permit gene editing, based on best welfare interests underwritten by the aim of facilitating fair sport that adapt WADAs International Standard for Therapeutic Use Exemptions, adding an important reporting element. We reject the use of gene editing to obtain currently prohibited competitive advantages. In order to safeguard the welfare of human and equine athletes, we argue that regulatory institutions should urgently collaborate to develop cross-sport international regulations for the use of gene editing, including obligatory reporting of data about the health and welfare of genetically edited horses.

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Section: Ethical Arguments Surrounding Genetic Testing For Performancmentioning

confidence: 99%

Section: Ethical Arguments Surrounding Genetic Testing For Performancmentioning

confidence: 99%

Ethics, Genetic Technologies and Equine Sports: The Prospect of Regulation of a Modified Therapeutic Use Exemption Policy

Campbell

McNamee

2020

Sport, Ethics and Philosophy

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“…It is also recognized that some individuals might decide not to follow such advice and attempt to continue to participate irrespective of the personal risk communicated to them. 41,42 In this setting, an array of legal, financial, and ethical issues might emerge as a consequence of a physician's advice to restrict further opportunity for sport participation. 43…”

Section: Options Dialoguementioning

confidence: 99%

Canadian Cardiovascular Society/Canadian Heart Rhythm Society Joint Position Statement on the Cardiovascular Screening of Competitive Athletes

Johri

Poirier

Dorian

et al. 2019

Canadian Journal of Cardiology

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Sudden cardiac death (SCD), especially in a young seemingly healthy individual, is a tragic and highly publicized event, which is often followed by a strong emotional reaction from the public and medical community." Although rare, SCD in the young is devastating to families and communities, underpinning our society's desire to avoid any R ESUM E La mort subite d'origine cardiaque (MSOC), en particulier chez une personne jeune et qui semblait être en bonne sant e, est un ev enement tragique et hautement m ediatis e qui engendre souvent de la part du public ou du milieu m edical un « appel à l'action ». La MSOC chez les jeunes, si elle est rare, n'en a pas moins des cons equences The Canadian Cardiovascular Society (CCS) Guidelines Committee identified the need for a Position Statement addressing cardiovascular (CV) screening of competitive athletes with particular attention to the 12-lead electrocardiogram (ECG). Currently, European and American recommendations exist, however the lack of a national position has led to tremendous variation of practice in Canada. 1 This statement provides appropriate, evidence-based recommendations for Canadian sporting organizations and institutions with a focus on the role of routine ECG screening in preventing sudden cardiac death (SCD). Methods and Terminology The CCS Guidelines Committee appointed co-chairs, and a primary and secondary panel to develop this document. The primary panel established its scope, identified topics, reviewed literature, prepared and voted on the recommendations on the

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“…Sex segregation in sport necessarily entails the public dissemination of medical information that would otherwise be considered privileged and subject to patient-confidentiality [32]. c) Concerns have been expressed that cardiac screening, even when voluntary, may represent a "coercive offer" and so contravene the notion of informed consent [33]. However, policies which entail both mandatory testing and the enforced cessation of competitive sport (for some who test positive) are also problematic from a confidentiality point of view.…”

Section: Contextual Factors Influencing Confidentiality In Sports Medmentioning

confidence: 99%

Confidentiality in Sports Medicine

Malcolm

2016

Clinics in Sports Medicine

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Key Points:While ethical principles identify ideal practice, ethics are always operationalized in a social context and understanding that context is necessary for facilitating best practice.Sports clinicians work in a context which, if not unique, is distinct from many other areas of medical practice.The maintenance of confidentiality is shaped by the multiple obligations, physical environment, and practice and policy context of sports medicine.Empirical research shows that there is considerable diversity of practice in relation to maintaining patient-confidentiality in sports medicine.A variety of policy recommendations have been made that could enable greater conformity to medical ethical best practice. SynopsisThis article synthesizes existing literature to provide a comprehensive summary of the ethical issues related to patient confidentiality in sport. It consists of four parts. The first outlines the medical ethical principle of confidentiality and identifies cross-cultural ethico-legal variations which shape its implementation. The second explores four factors specific to the context of sport which shape the application of patient confidentiality, namely: clinicians multiple obligations, physical environment and practice and policy context. The third reviews research detailing real life experiences of maintaining patient confidentiality in sport, and the fourth summarizes the many policy recommendations that have been made for enabling and enhancing compliance with this ethical principle. It is argued that the context of sport exacerbates pressures on clinicians to break patient confidentiality, breaches therefore occur relatively regularly, and interventions are required to enhance ethical compliance in sports medicine.

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Sudden cardiac death: mandatory exclusion of athletes at risk is a step too far

Cited by 7 publications

References 14 publications

Ethics, Genetic Technologies and Equine Sports: The Prospect of Regulation of a Modified Therapeutic Use Exemption Policy

Ethics, Genetic Technologies and Equine Sports: The Prospect of Regulation of a Modified Therapeutic Use Exemption Policy

Canadian Cardiovascular Society/Canadian Heart Rhythm Society Joint Position Statement on the Cardiovascular Screening of Competitive Athletes

Confidentiality in Sports Medicine

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