THE PLAYER, THE DOCTOR, THE BUSINESS:
MEDICAL ETHICS IN PROFESSIONAL FOOTBALL
MAJ Ryan Labio, Capt Marc Orcutt, MAJ Bob Plotts
Faculty: Dr. Karin Zucker, Dr. Scott Kruse
Army - Baylor Graduate Program in Health and Business Administration
Bryan Christie Design; Purdue University
“The same ethical principles that apply to the practice of medicine shall apply to sport medicine...Never impose your authority in a way that impinges on the individual right of
the athlete to make his/her own decision.” The International Federation of Sports Medicine's (FIMS) code of ethics (1994).
“It is the responsibility of the sports medicine physician to determine whether the injured athletes should continue training or participate in competition” (FIMS 2009).
BACKGROUND
2009
Team Physician Considerations
Professional football, a billion dollar industry, is widely
recognized as the most popular and successful sport in
America. Recent traumatic brain injury (TBI) research
has prompted increased scrutiny of the health risks of
football. Advances in neuro-imaging capabilities have
raised new ethical considerations involving return-toplay decisions. The athlete, physician, team, and league
all face complex and conflicting choices which affect
ethical behavior, player health, and financial viability.
ETHICAL ISSUES
http://ergooccmed.com/uncategorized/419/
 Should continued employment depend on the success
of the team? Conflicts of interest exist between shortterm success and long-term health risks of the player.
 How do physicians balance the responsibility to
disclose information to coaches and management?
 How do team physicians earn the trust of both the
players and management?
the year the NFL adopted a more stringent
concussion policy, including provisions to remove
players from games and to require medical clearance by
both the team physician and an independent physician
6.4 number of missed days after a concussion in 2009
16 number of missed days after a concussion in 2012
6 number of years of an average player’s career
$118,750 average player’s salary per game
 How much autonomy should a player have in deciding
if he can play, especially if his cognition is impaired?
52 percentage of NFL players who would try to conceal
 Will improved imaging technologies aid treatment or
inhibit provider discretion and player autonomy?
$286,000,000 average NFL team’s revenue per year
 Does a lack of evidence based clinical guidelines for
treating concussions create an ethical dilemma when
considering new treatment options in a win-at-allcosts professional sport environment?
a concussion rather than risk being pulled from the game
4
former NFL players have a 4 times higher chance of
being diagnosed with Alzheimer Disease or ALS than a
member of the general population
4,500+
Player Considerations
http://nesn.com/2009/12/biggest-challenge-for-nfls-concussion-policy-is-changing-attitudes/
 Are strict return-to-play protocols paternalistic? Do they
limit the autonomy of the athlete to refuse treatment?
 Will athletes mask TBI symptoms in order to return to
play? To what degree does loyalty and concern for
one’s personal reputation and job security influence a
player’s decision making?
is the number of former players claiming the
NFL withheld information about the effects of head
trauma
Owners of Teams and League Considerations
theadvocate.com
 Owners of teams run a business. To what degree do
explicit and implicit coercion influence team
physicians, coaches, and athletes to win at all costs?
 How do owners mitigate conflicts of interest between
protecting assets (players) and providing a quality
product by ensuring the best players are on the field?
 Will players intentionally establish lower baselines in
the preseason to game neuropsychological testing?
 How does the cost of injury prevention vs. the cost of
long-term morbidities influence league decisions?
 As imaging technology advances and athletes are
sidelined more frequently, will self-reporting decline?
 How will the TBI litigation by former players affect the
future of the league? ($765-$914 million)
 Will more studies linking TBI to neurodegenerative
processes influence the decisions of players?
 Should the league or owners be liable when the
players choose to engage in a dangerous sport?
CONCLUSION
Interest in players’ safety will continue to drive scrutiny
and ethical debate in professional football. Advances in
neuro-imaging have the potential to alter current
concussion protocols and return-to-play decisions.
Players, physicians, and owners have much at stake.
DISCLAIMER AND REFERENCES
This poster was approved for general release by the Operations Security Officer and the
Public Affairs Officer of the AMEDD Center and School, Ft. Sam Houston, TX. The views
expressed hereon are those of the authors only and do not reflect policy of the Army Baylor Graduate Program in Health and Business Administration, the Department of the
Army, the Department of the Air Force, or the Department of Defense. References are
available on request.