Team physicians face the ethical problem of determining when it is appropriate
to compromise an athlete’s long-term health for short-term performance.
Informed consent is at the heart of this problem. A physician must be sure that
the athlete understands the long-term consequences of the recommended
medical treatment or lack of treatment. Physicians who do not tell patients the
risks of treatments that allow an athlete to compete when it is medically
contraindicated face substantial malpractice liability. If there is evidence that
the coach encouraged the physician to withhold information about the risks of
treatment, the physician may face punitive damages for fraud.
An equally difficult problem is the degree to which players exercise the free
choice that is necessary for an informed consent. There is pressure to maintain
team performance, irrespective of the risk to the individual. Players who will
not take risks for the team do not last long in the starting lineup. It is arguable
whether consent given out of the fear of ending one’s career is coerced.
Conversely, physicians are limited in their right to impose their values on
patients. The decision to risk disability by continuing play is the reasoned
choice of some athletes.
Athletes in highly competitive, commercialized sports such as football are under
constant pressure to play when injured and to submit to risky surgery rather
than prolonged convalescence. The risks posed by these actions are much the
same for all athletes. The benefits, however, are vastly different, depending on
the athlete’s status. A veteran professional football player is protected by a
pension system and extensive knowledge of the consequences of various
injuries. Such a player is paid very well to accept the risk of permanent injury.
Moving back in the athletic hierarchy to college teams, players have little
protection if their injuries are permanently disabling. The college athlete faces
the pressure to play but with limited benefit as compared with the risk. This is
a special problem for athletes who are able to attend college only because of
athletics. If they aggravate an injury and are unable to play, few will stay in
college as regular students even if they can continue their scholarship. Since
the probability of a given college athlete’s entering professional athletics is
small, it is difficult to justify the risk of aggravating an injury to play an extra
few games in a season.