Lynley Anderson

Ethical issues concerning New Zealand sports doctors

Success in sport can provide a source of national pride for a society, and vast financial and personal rewards for an individual athlete. It is therefore not surprising that many athletes will go to great lengths in pursuit of success. The provision of healthcare for elite sports people has the potential to create many ethical issues for sports doctors; however there has been little discussion of them to date. This study highlights these issues. Respondents to a questionnaire identified many ethical matters, common to other areas of medicine. However they also raised problems unique to sports medicine. Some of these ethical difficulties arise out of the place of the sports doctor within the hierarchy of sport. Yet others arise out of the special relationship between sports doctors and individual players/athletes. This study raises some important questions regarding the governance of healthcare in sport, and what support and guidance is available to sports doctors. As medical and scientific intervention in sport escalates, there is a risk that demands for enhanced performance may compromise the health of the athlete, and the role the sports doctor plays remains a critical question.

Contractual obligations and the sharing of confidential health information in sport

As an employee, a sports doctor has obligations to their employer, but also professional and widely accepted obligations of a doctor to the patient (in this case the individual team member). The conflict is evident when sports doctors are asked by an athlete to keep personal health information confidential from the coach and team management, and yet both doctor and athlete have employment contracts specifying that such information shall be shared. Recent research in New Zealand shows that despite the presence of an employment contract, there appears to be a wide range of behaviours among sports doctors when an athlete requests that information about them be kept from team management. Many seem willing to honour requests to keep health information about the athlete confidential, thereby being in breach of the employment contract, while others insist on informing team management against the wishes of the athlete. There are a number of potential solutions to this dilemma from forcing doctors to meet their contractual obligations, to limiting the expectations of the employment contract. This paper suggests that at times it may be appropriate to do both, making the position of the doctor clearer and supporting the ability of this group to resist pressure by coaches and management through having a robust code of ethics.

Competing loyalties in sports medicine: threats to medical professionalism in elite, commercial sport.

This paper explores the ways in which the environment of elite-level and, in particular, commercial sport produces expectations and pressures on sports doctors that may compromise their professional standards. Specifically, this paper addresses the pressures and demands that emerge from varying groups and individuals with whom doctors have relationships within the world of elite sport including: the athlete, coach, management, media (including broadcasters) and sponsors. Using grounded theory and drawing upon qualitative data collected from semi-structured interviews with 16 sports doctors the study explores the ethical concerns of medical practitioners working with elite athletes and teams in New Zealand. Key emerging themes include: the complex environment within which sports doctors work, including the limited control over their work environment, the pressures arising from the commercial interests of sport, the issue of competing obligations, and emerging threats to medical professionalism.

Writing a new code of ethics for sports physicians: principles and challenges

A code of ethics for sports physicians needs to be clear, appropriate and practically useful to clinicians in everyday clinical circumstances and for situations that may be difficult or contentious. For a code of ethics to be so apposite requires that it have some basis in the ethical concerns of clinicians. This article reflects on the recent experience of rewriting the code of ethics for the Australasian College of Sports Physicians, describing the findings from the research, the processes and challenges that arose, and providing suggestions for other code writers in this field.

Ethical Considerations in Using Facebook for Health Care Support: A Case Study Using Concussion Management

Social networking sites (SNS) are now part of everyday life, and SNSs such as Facebook, YouTube, and Twitter are among the most accessed Web sites on the Internet. Although SNSs are primarily used for staying in touch with friends and family, they are increasingly being used for health‐related purposes for a variety of conditions, including concussion awareness. As health interventions begin to be more commonly provided through SNSs (particularly Facebook), ethical issues have been raised with regard to confidentiality, privacy, and trust; these issues need to be addressed. This article outlines some of the key considerations when providing a concussion intervention through Facebook and discusses potential solutions to these issues.

Australasian College of Sports Physicians—position statement: the place of mesenchymal stem/stromal cell therapies in sport and exercise medicine

Purpose and scope This Position Statement has been written expressly for members of the Australasian College of Sports Physicians (ACSP); however, it may also be of interest to the wider medical community, sporting organisations, athletes and the general community. It has been informed by a comprehensive review of the scientific literature and the opinions of kindred organisations. This statement outlines the use of mesenchymal stem cell (MSC) therapies in the broad context of Sport and Exercise Medicine, recognising that every medical practitioner should respect: (1) the evidence for the therapeutic use of MSCs and (2) the priority for patient health and welfare.

Doctoring risk: Responding to risk-taking in athletes

Athletes who wish to compete in spite of high risk of injury can prove a challenge for sports doctors. Overriding an athletes choices could be considered to be unnecessarily overbearing or paternalistic. However simply accepting all risk-taking as the voluntary choice of an individual fails to acknowledge the context of high-level sport and the circumstances in which an athlete may be being coerced or in some other way be making a less than voluntary choice. Restricting the voluntary choices of an athlete may still be possible but under very limited circumstances. This article explores the ways a sports doctor might respond in ensuring a choice is indeed voluntary and, if so, under what circumstances limits might be placed. Responding to such risk-taking by, for example, limiting the actions of an athlete or assisting them to compete, involves attempting to balance the athletes aims against some set of ideals of good health or medical ends.

Concussion Ethics and Sports Medicine.

Despite considerable scientific dispute the science of concussion, there has been a proliferation of position statements and professional guidelines published on sports concussion management over the last 15 years. A number of ethical and clinical problems associated with concussion management protocols remain concerning, (i) diagnosis and management; (ii) conflicts of interest and coercion; (iii) same day return to play; and (iv) reporting, auditing and confidentiality. These issues are critically discussed in the light of recent Consensus Statements. It is argued that the use of independent match day doctors may ameliorate some of these concerns.

Once a clinician, always a clinician: a systematic review to develop a typology of clinician-researcher dual-role experiences in health research with patient-participants

BackgroundMany health researchers are clinicians. Dual-role experiences are common for clinician-researchers in research involving patient-participants, even if not their own patients. To extend the existing body of literature on why dual-role is experienced, we aimed to develop a typology of common catalysts for dual-role experiences to help clinician-researchers plan and implement methodologically and ethically sound research.MethodsSystematic searching of Medline, CINAHL, PsycINFO, Embase and Scopus (inception to 28.07.2014) for primary studies or first-person reflexive reports of clinician-researchers’ dual-role experiences, supplemented by reference list checking and Google Scholar scoping searches. Included articles were loaded in NVivo for analysis. The coding was focused on how dual-role was evidenced for the clinician-researchers in research involving patients. Procedures were completed by one researcher (MB) and independently cross-checked by another (JHS). All authors contributed to extensive discussions to resolve all disagreements about initial coding and verify the final themes.ResultsDatabase searching located 7135 records, resulting in 29 included studies, with the addition of 7 studies through reference checks and scoping searches. Two overarching themes described the most common catalysts for dual-role experiences – ways a research role can involve patterns of behaviour typical of a clinical role, and the developing connection that starts to resemble a clinician-patient relationship. Five subthemes encapsulated the clinical patterns commonly repeated in research settings (clinical queries, perceived agenda, helping hands, uninvited clinical expert, and research or therapy) and five subthemes described concerns about the researcher-participant relationship (clinical assumptions, suspicion and holding back, revelations, over-identification, and manipulation). Clinician-researchers use their clinical skills in health research in ways that set up a relationship resembling that of clinician-patient. Clinicians’ ingrained orientation to patients’ needs can be in tension with their research role, and can set up ethical and methodological challenges.ConclusionThe typology we developed outlines the common ways dual-role is experienced in research involving clinician-researchers and patient-participants, and perhaps the inevitability of the experience given the primacy accorded to patient well-being. The typology offers clinician-researchers a framework for grappling with the ethical and methodological implications of dual-role throughout the research process, including planning, implementation, monitoring and reporting.

Sudden cardiac death: mandatory exclusion of athletes at risk is a step too far

Sudden cardiac death (SCD) in young athletes is a distressing event and it is not surprising that some physicians working with sports people are proposing that preventive action should be taken. There is a push for a system similar to that established in some countries, which involves screening and mandatory exclusion of those at risk. We argue that while screening can provide useful information to at-risk athletes making decisions about their future athletic careers, mandatory exclusion of athletes is paternalistic and such decisions are not rightfully within the domain of medicine.