Sports Medicine: Just the Facts

CHAPTER 2 • ETHICAL CONSIDERATIONS IN SPORTS MEDICINE 5

ethical standards. Sports themselves are considered to

reflect values generally considered to be important to

society: character building, health promotion, and the

pursuit of competitive excellence and enjoyment.

• Ethical considerations in the area of sports medicine
  are similar to those in medicine in general, including
  the basic principles and rules.


• Beneficence, the principle of performing acts or
  making recommendations only potentially beneficial
  to an athlete, is the trump principle.


• Nonmaleficence, the principle of prohibiting recommen-
  dations or actions detrimental to an athlete’s short- and
  long-term health, is considered with every action taken
  in the trainer’s room when tending to an injured athlete.


• Confidentiality informed consent and truthfulness are
  absolutely essential for the ethical management of any
  sports related medical decision.

THE SPORTS PHYSICIAN’S
RESPONSIBILITIES

• An athlete’s autonomy, his or her interests and desires,
  and the third principle of medical ethics must always
  be taken into consideration in any decision made by a
  sports physician. Such decisions should always be
  made in the athlete’s best interest.


• Whether the decision involves a diagnostic test or the
  athlete’s eligibility, its end result is the maintenance of
  good health with the least risk to the athlete.


• Conflict between physician and athlete should always
  be minimal or absent.


• While autonomy is respected, most athletes can and
  should rely on their sports physician to lead them in
  the decision making process.


• It is quickly recognized by the sports physician that
  one solution rarely fits all with the same problem. The
  same set of circumstances can lead to a different sug-
  gested solution by the same sports physician.


• Exactness and infallibility, while desirable, are not traits
  of even the finest sports physicians (Maron, 1994).


• The sports physician’s primary duty is to make the
  best effort to maintain or restore health and functional
  ability (Howe, 1988).


• The athlete’s welfare must guide all efforts.
  •To be a good sports physician, he or she must have a
  genuine appreciation for the importance of athletics in
  his or her client’s life. The precepts of Dr. O’Donoghue
  for sports physicians are timeless: accept athletics, avoid
  expediency, adopt the best methods, act promptly, and
  try to achieve perfection (O’ Donoghue, 1984).


• The injured athlete must know the diagnosis, under-
  stand its implications, and participate in all therapeu-
  tic decisions.
  
  
  • Despite the athlete’s wishes, the sports physician
    cannot do less than seek the best possible outcome.
  
  
  • All sports medicine physicians gain knowledge and
    better judgment with experience, soon recognizing
    many recommendations or forms of therapy have
    risks as well as benefits.
  
  
  • Harm can come to the athlete-patient from unneces-
    sary or excessive restriction as well as from failure to
    restrict activity when appropriate.
  
  
  • The sports physician does not operate in a vacuum. To
    make sports oriented medical decisions, one must be
    well versed in current recommendations for eligibility
    and continued participation and not depend on his or
    her own limited personal experience or unscientific
    reasoning (Mitten, 1999).
  
  
  • Recognizing the wide range of opinions and individ-
    ual fallibility, athlete-patients can assert their right to
    another opinion.
  
  
  • Continuing education of the sports physician aids in the
    development of a suitable level of skill and knowledge
    and their maintenance (26th Bethesda Conference,
    1994).
  
  
  • While sports physicians will be able to treat most
    referrals, they must be aware of their own level of
    competence. They must know when and where to
    refer for specialized consultation or therapy. It is
    essential to know their colleague’s ability, personality,
    and empathy for athletes in order to make competent
    referrals (Rizve and Thompson, 2002).
  
  
  • The referred patient should not be abandoned. The
    consultant may gain insight from the referring physi-
    cian. This affords the athlete continuing support from
    his or her primary sports physician.
  
  
  • There is no obligation to accept without question the
    recommendations of consultants, especially if incon-
    gruent with the referring physician’s knowledge of the
    patient.
  
  
  • All the above lead to trust established between athlete
    and physician, allowing for more comfortable resolu-
    tion of the decision making process.
  
  
  
  

POTENTIAL FOR DIVIDED LOYALTIES

• While rare in high school and uncommon in college
  sports, there is major distrust between professional
  athletes and team physicians (George, 2002).


• Athletes may feel that there are too many instances
  when the quality of their treatment is often secondary
  to the doctor’s obligation to team owners and coaches.
  •A salaried position can interfere with the traditional
  doctor–patient relationship.
  •To many the role of the salaried physician leads to a
  conflict of interest. Such a conflict exists when the