'I am in blood Stepp'd in so far...': ethical dilemmas and the sports team doctor.
ABSTRACT There are many ethical dilemmas that are unique to sports medicine because of the unusual clinical environment of caring for players within the context of a team whose primary objective is to win. Many of these ethical issues arise because the traditional relationship between doctor and patient is distorted or absent. The emergence of a doctor-patient-team triad has created a scenario in which the team's priority can conflict with or even replace the doctor's primary obligation to player well-being. As a result, the customary ethical norms that provide guidelines for most forms of clinical practice, such as patient autonomy and confidentiality, are not easily translated in the field of sports medicine. Sports doctors are frequently under intense pressure, whether implicit or explicit, from management, coaches, trainers and agents, to improve performance of the athlete in the short term rather than considering the long-term sequelae of such decisions. A myriad of ethical dilemmas are encountered, and for many of these dilemmas there are no right answers. In this article, a number of ethical principles and how they relate to sports medicine are discussed. To conclude, a list of guidelines has been drawn up to offer some support to doctors facing an ethical quandary, the most important of which is 'do not abdicate your responsibility to the individual player.''I am in blood Stepp'd in so far that, should I wade no more, Returning would be as tedious as to go o'er' -Macbeth: Act III, Scene IV, William Shakespeare.
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ABSTRACT: Professional sports with high rates of concussion have become increasingly concerned about the long-term effects of multiple head injuries. In this context, return-to-play decisions about concussion generate considerable ethical tensions for sports physicians. Team doctors clearly have an obligation to the welfare of their patient (the injured athlete) but they also have an obligation to their employer (the team), whose primary interest is typically success through winning. At times, a team's interest in winning may not accord with the welfare of an injured player, particularly when it comes to decisions about returning to play after injury. Australia's two most popular professional football codes-rugby league and Australian Rules football-have adopted guidelines that prohibit concussed players from continuing to play on the same day. I suggest that conflicts of interest between doctors, patients, and teams may present a substantial obstacle to the proper adherence of concussion guidelines. Concussion management guidelines implemented by a sport's governing body do not necessarily remove or resolve conflicts of interest in the doctor-patient-team triad. The instigation of a concussion exclusion rule appears to add a fourth party to this triad (the National Rugby League or the Australian Football League). In some instances, when conflicts of interest among stakeholders are ignored or insufficiently managed, they may facilitate attempts at circumventing concussion management guidelines to the detriment of player welfare.Journal of Bioethical Inquiry 11/2013; 11(1). DOI:10.1007/s11673-013-9491-2 · 0.71 Impact Factor
- British Journal of Sports Medicine 04/2011; 45(12):948-9. DOI:10.1136/bjsm.2011.083881 · 5.03 Impact Factor
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ABSTRACT: The idea that sex (the male/female binary) is a clear-cut category distinction is well established in our culture. However, people born with ambiguous genitalia or with a mixture of male and female anatomy have always existed, originally known as hermaphrodites and, later on, as intersex. Along the centuries, human cultures have classified sexual differences in different ways, though the dichotomical model of the two sexes has been the most prevalent. The main objective of this paper is to show how different epistemological models or frameworks have a direct impact on the way of thinking about sexual difference and we claim that a new epistemological model based on fuzzy logic can open the scope to understanding sex in a non-dichotomic and fixed way.Fuzzy Information Processing Society (NAFIPS), 2012 Annual Meeting of the North American; 01/2012