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.