The occurrence of sport-related concussions (SRCs) has emerged as a significant health concern in professional sports, with millions of concussions occurring worldwide each year. Current return-to-play (RTP) protocols after SRCs involve a multi-disciplinary approach with growing interest in genetic testing technology. Numerous studies have indicated that the gene Apolipoprotein E4 (APOE4) holds promise as a predictive factor for developing diseases after concussions and other traumatic brain injuries. Nevertheless, there is an ongoing and contentious debate surrounding the impact of SRC genetic (...) testing on the RTP decision, encompassing concerns about the potential adverse effects on individual athletes, coaches, and even the whole sport community at large not in a small degree due to incidental findings. Hence, the purpose of this article is to explore the clinical and ethical components of SRCs genetic testing and its potential integration into RTP protocols by utilizing the ACCE framework to assess the validity, utility, and ethical aspects of SRCs. (shrink)

Collision sports pose a high risk of concussion. How to respond to this risk is more ethically complex when considering children and adolescents due to a) incomplete evidence regarding the impact of concussion on developing brains, b) physiological and social vulnerability, and c) the young person’s reliance on proxy decision-makers, usually parents. There is also a lack of clear definitions of (a) collision sport (vs. contact sport) and (b) what constitutes a child or adolescent. We consider whether parents should be (...) free to allow their children/adolescents to play contact or collision sport. The article analyses the harms and benefits of collision sport and methods of determining risk, before outlining our support for the precautionary principle. We then consider whether the ‘best interests’ or ‘right to an open future’ framework ought to be applied to the issue of childhood participation in collision sport. Rather than supporting a ban of child/adolescent participation in collision sport, we argue that permissibility should be decided on a sport-by-sport basis. Moreover, we apply the ‘Accountability of Reasonableness’ framework to ensure that sound ethical values guide and support protections for this vulnerable group in the absence of high-quality evidence. (shrink)

The 6th Consensus Statement on Concussion in Sport is authored by the Concussion in Sport Group (CiSG) and intends to provide evidence-based recommendations on concussion management for the welfare of sports participants. However, the authors of the Consensus Statement have declared many competing links to third-party groups. While the declaration of an author’s competing interests is now a widely accepted practice within academic publishing aimed at greater transparency and research integrity, it is not a measure to remove the potential influence (...) of third-party links. In the case of the Consensus Statement, this leaves uncertainty about how the potential sources of third-party bias declared by individual members of the CiSG may have influenced the CiSG’s interpretation of the existing state of evidence on concussion management and impacted the content of the recommendations contained with the Consensus Statement. Openly declaring third-party links falls short of securing trustworthiness in the Consensus Statement recommendations since it leaves end-users of the Consensus Statement with the task of interpreting the impact(s) of these competing interests with little information to guide them. This is because the authors themselves offer neither explanation nor guidance concerning potential bias arising from the competing interests that they have declared, which impinges upon the ability of readers to evaluate the trustworthiness of the content. The status quo could be improved by excluding researchers who have conflicts of interest. Nevertheless, if authors with competing interests are permitted to be part of the CiSG (as is the status quo), then I propose a novel option for increasing transparency that would require authors of the Consensus Statements to provide a reflexive explanation, not simply a declaration, of their competing interests. (shrink)

Concussions are traumatic brain injuries that can result from a blow to the head or a jolt to the body. Athletes in many sports are exposed to concussion risks. There is a growing concern in sport and society about sport-related concussions (SRC) and an increasing awareness of the importance of proper diagnosis, treatment, and prevention. A traditional, reactive approach emphasizes sound protocols in cases of suspected SRC. A proactive approach involves identifying various causes of SRC and implementing preventive measures. For (...) example, to reduce SRC prevalence in Canadian youth ice hockey, a ban on body checking has been introduced. When a preventive SRC measure implies a change in the main rules of a sport, it impacts its nature and alters how it is played. This can lead to tensions between SRC prevention and sporting concerns. By employing an extended consequentialist framework that includes normative analyses of the values of sport, I will examine the possibilities and limitations of preventive SRC measures in terms of constitutive rule changes. More specifically, I will propose a consequentialist framework to determine the conditions under which athlete exposure to SRC risks in a given sport can be considered unacceptable, acceptable, and even valuable. (shrink)

This article critically examines the development and consensus outputs of the Concussion in Sport Group. We examine the six Consensus Statements between 2001 and 2023 to explore the challenges that the presence of contextual forces pose to the development of effective and ethically justifiable medical guidelines to manage situations involving brain-injured athletes. First, we discuss the implicit and explicit ethical framework and goals underlining the statements. Secondly, drawing on a relational account of athlete choice, we expound on the limitations of (...) the framework, concentrating on those resulting from a simplified understanding of athlete autonomy. Thirdly, we conclude by proposing a series of recommendations to improve concussion management protocols: (1) adopting a broader understanding of autonomy built upon relational accounts, beyond just the healthcare professional-athlete relationship; (2) further minimizing conflicts of interest that increase athletes’ vulnerability and hinder decision-making ability; (3) enhancing healthcare professional training to allow better adjustment of treatment plans to athletes’ contexts; and (4) promoting research on sociocultural elements affecting athletes’ vulnerability and autonomy. (shrink)

The purpose of this article is to explore the intersection between the ancient philosophical concept of àskēsis and contemporary boxing discipline, investigating boxing’s potential as an educational tool for cultivating ethics, personality, and virtues. Drawing on Hadot and Foucault’s theories, the study analyzes the ethopoietic purposes of Stoic spiritual exercises and technologies of the self, examining their relevance to modern boxing practices. By scrutinizing the cultural practices of boxing, the article elucidates how they can judiciously be employed to foster ethical (...) development. By analyzing the parallels between philosophical doctrines and boxing ethics, an attempt is made to emphasize the embodiment of virtues that boxing champions could potentially have. In addition, the author, a former boxer turned coach, reflects on the changes in sporting values within boxing over the past two decades and discusses the practical and moral paradox of the problem of sub-concussions and concussions versus the formative purposes of ethos. While acknowledging the risk of chronic traumatic encephalopathy, the author argues that boxing, if approached consciously, can contribute positively to the development of personality and ethical behavior. (shrink)