Our article “NFL Player Health Care: Addressing Club Doctors’ Conflicts of Interests and Promoting Player Trust” focused on an inherent structural conflict that faces club doctors in the National Football League. The conflict stems from club doctors’ dual role of providing medical care to players and providing strategic advice to clubs. We recommended assigning these roles to different individuals, with the medical staff members who are responsible for providing player care being chosen and subject to review and termination by a (...) committee of medical experts selected equally by the NFL and the NFL Players Association. Recognizing that the problem of structural conflict of interest is deeply entrenched and that our recommendation is a significant departure from the status quo, we invited comment from a diverse and highly qualified group of experts. There is considerable common ground among the commentators. All but one agreed with us that, despite the best intentions of upstanding professionals, there is a structural conflict of interest in the club doctors’ relationship with players, and the commentaries were generally supportive of our recommendation for change. There are also meaningful disagreements, however. Some commentators think that the proposal is on the right track but does not go far enough to reduce the structural conflict of interest, and one commentary wholly disagrees with our analysis and recommendations. (shrink)

Head injuries are an inherent risk of participating in the major collision sports played in Australia. Protocols introduced by the governing bodies of these sports are ostensibly designed to improve player safety but do not prevent players suffering from repeated concussions. There is evidence that repeated traumatic brain injuries increase the risk of developing a number of long term problems but scientific and popular debates have largely focused on whether there is a causal link between concussion and chronic traumatic encephalopathy. (...) We argue that the governing bodies of collision sports played in Australia have used uncertainty about CTE to justify a “wait and see” approach instead of attempting to prevent repeated head injuries. This stance is difficult to defend when these governing bodies claim to give a high priority to protecting player welfare. (shrink)

Concussion and Mild Traumatic Brain Injury affect millions of people worldwide. mTBI has been called the “signature injury” of the recent conflicts in Iraq and Afghanistan, affecting thousands of active duty service men and women, and veterans. Sport-related concussion represents a significant public health problem, with elite and professional athletes, and millions of youth and amateur athletes worldwide suffering concussions annually. These brain injuries have received scant attention from neuroethicists, and the focus of this special issue is on defining the (...) ethical considerations and developing and elucidating the neuroethical contributions to the discussion about concussion and mTBI. (shrink)

ABSTRACTTeam physicians have a complicated job that involves potentially conflicting obligations to multiple entities. Though responsible for the medical care of the athletes as individuals, they also have obligations to the team that employs them which can include returning athletes to play who are at heightened risk of re-injury. The fact that the athletes and owners have some overlapping interests only complicates this issue. Further, there are strong financial incentives to do what is necessary to obtain and keep a position (...) as a team physician. This article examines dual loyalty and conflict of interest in sports medicine, and argues that there is not now a widely accepted or adequate solution to either. Moving toward a solution will require fairly serious changes in the role of the team physician.Abbreviations: FIMS International Federation of Sports Medicine; NFL National Football League; MVP Most Valuable Player; RGIII Robert Griffin, III. (shrink)

Concussion in professional football is a topic that has generated a significant amount of interest for many years, partly due in recent times to the filing of the class-action litigation and the uncapped compensation injury fund and settlement involving 4,500 retired professional players and the National Football League. The proceedings claimed that the NFL, as the governing body of American football, failed in its duty to protect players’ health during their professional playing careers by exposing players to risks of repetitive (...) concussions and actively concealing links to potential long-term consequences. The NFL litigation sharpened the focus on the fundamental regulatory, governance and ethical considerations for football governing bodies, as self-regulated organisations, when governing the delicate balance between the dynamics of contact and collision sports, entertainment and player-health considerations. It also raised questions about public accountability and responsibilities to all levels of the sport through a framework of public health ethics. The NFL litigation and Congressional hearings have led to changes within the NFL and its regulatory and governance responses. A case study of the NFL responses to concussion in the sport of American football can provide insight into concussion regulation. Australian football governing bodies can align their regulatory and governance responses to concussion within their sports with the aim to avoid similar accusations, and circumvent a more coercive form of intervention. (shrink)

Current discussions about concussion in sport are based on a crucial epistemological question: whether or not we should believe that repetitive mild Traumatic Brain Injury causes Chronic Traumatic Encephalopathy. This epistemological question is essential to understanding the ethics at stake in treating these cases: indeed, certain moral obligations turn on whether or not we believe that mTBI causes CTE. After discussing the main schools of thought, namely the CTE-sceptic position and the CTE-orthodox position, this article examines the concussion debate in (...) sport and asks if its current articulation helps to answer whether or not we should call for responsive, ethical action. (shrink)

In this paper, we explore the issue of the elimination of sports, or elements of sports, that present a high risk of brain injury. In particular, we critically examine two elements of Angelo Corlett’s and Pam Sailors’ arguments for the prohibition of football and Nicholas Dixon’s claim for the reformation of boxing to eliminate blows to the head based on the empirical assumption of an essential or causal connection between brain injuries incurred in football and the development of a degenerative (...) brain disease known as chronic traumatic encephalopathy ; and John Stuart Mill’s rejection of consensual domination. We present four arguments to contest the validity of Corlett, Dixon’s and Sailor’s positions. Specifically, we argue that certain autonomy-based arguments undermine paternalist arguments for reform; the nature of the goods people pursue in their lives might justify their foregoing future autonomy; Mill’s argument against consensual domination draws on ambiguous and arbitrary distinctions; the lack of consensus and empirical evidence regarding CTE arising from brain injuries in sport underdetermines calls for reform. We conclude that these proposals for reforming or eliminating sports with high risks of brain injuries are not well founded. (shrink)