Reviving Ethics in Sports: Time for Physicians to Act
Andrew Pipe, MD
THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 6 - JUNE 2021
When will we face the fact that we're producing some really ugly, violent young men?" observed my friend, an internationally prominent basketball coach, who is given neither to hand-wringing nor to strident overstatement. His disquieting words cast a pall over an already disheartening conversation about the state of contemporary sports.
The evils and excesses in sports are, indeed, many and serious. And physicians who care for athletes are not just innocent bystanders. We are affected by the problems, and we have a responsibility and opportunity to combat them.
Disillusionment With Sports
Sports are often glibly described as a way for athletes to develop character and skills for living. Sadly, recent sports-related events and the resulting public disillusionment suggest that this may be more myth than reality. In fact, evidence suggests that athletes may have a higher risk for maladaptive behaviors than their nonathletic peers (1).
The public has begun to lose patience with these negative behaviors of athletes and others in sports. Frequent reports of gratuitous violence, bizarre and hazardous training practices, drug use and doping scandals, the emotional, physical, and sexual abuse of young athletes, the charades that can surround college sports, and the mindless behavior of some professional athletes have left people disenchanted. The bloated salaries of professional athletes have also contributed to public disillusionment. Sports officials, dazzled by sold-out stadiums, huge television contracts, and sycophantic news media, can be particularly oblivious to public disenchantment.
An International Phenomenon
Disenchantment has led citizens of many countries to take action. When the Australian national track and field organization was hiring a director for its programs, it turned to a former East German coach who was linked directly to the systematic administration of performance-enhancing drugs now known to be characteristic of the excesses of that regime. Australians were outraged, and, after a nationwide outcry, the decision was reversed.
In the United States, the National Coalition Against Violent Athletes was formed to educate the public about assaults by athletes, provide victims with referrals for legal advice and counseling, and encourage college officials and professional team administrators to punish abusive athletes aggressively (Sports Illustrated. March 16, 192021:20-22).
Confidential polling of Canadians indicates that parents are withholding their children from participation in certain sports because of concerns about institutionalized violence and drug use (Paul Melia, personal communication, July 1996).
French authors have called for the creation of an independent national commission to protect the rights of adolescent athletes. The appeal is accompanied by a plea that physicians and those who supervise training programs respect professional ethical principles and be guaranteed independence to address athletes' training and well-being (2).
As sports medicine physicians, we have unique ethical responsibilities concerning the athletes in our care, the sports organizations we work for, and the ideals of sportsmanship and fair competition. It is easy at times, when caught up in the pressure of competition, to lose sight of the full range of responsibilities. The temptation is to focus only on the individual athlete's capacity to perform, while ignoring the broader implications of the physician-patient relationship or the need for leadership in addressing problems in sports.
Our primary responsibility is to protect athletes' health and well-being as defined most broadly. Superficially, this role may seem perfectly compatible with the interest of the sports organization with which we and the athlete are associated. However, what's best for an athlete's long-term health may conflict with the organization's short-term interest in winning. As a result, we may have a problem of divided loyalty, which raises significant questions about the ethical practice of our profession.
Furthermore, medical organizations now pay—in cash or kind—for the right to care for some teams or leagues, presumably because of the publicity these groups receive. It is difficult to be anything but suspicious about this kind of arrangement. Are the athletes' best interests being served when the responsibility for their care is awarded to the highest bidder?
This arrangement raises a larger issue as well. Many people in North America have little or no access to medical care. The spectacle of medical organizations lining up to pay for the opportunity to provide such care to athletes fosters cynicism toward sports and medicine. As long as patients are famous, this practice seems to say, medical providers will actually pay to capture some of the publicity glow, while the unknown and uninsured must pay the full fare for their care—or do without.
What Can We Do?
Given these trends, what are our responsibilities to athletes, athletic organizations, and the sports world? We must lend our training, experience, and scientific perspective to the identification and resolution of a range of sporting issues.
Intervene with patients. Physicians who care for high school or community-based athletes can help their patients—and often patients' parents—to place sports aspirations in a realistic perspective. Physicians who care for college athletes can intervene to minimize their identified risk-taking behaviors (1).
Speak out. We can be credible spokespersons for the elimination of gratuitous violence, the enhancement of safety, and the disavowal of harmful training practices and environments.
The rate of athletic injury is a significant public health concern in many countries and remains a challenge for sports medicine physicians. We have a particular responsibility to speak out forcefully about rules that compromise health and safety or impose unrealistic demands on athletes or their physicians.
Physicians must recognize their special obligation regarding drug use. Antidoping rules should be clear, consistent, scientifically based, and focused on performance-enhancing substances. Sports should feature competition among athletes, not contests among biological preparations.
Develop a code of ethics. A fundamental step to promote ethical conduct in sports medicine, and in sports generally, would be the development of a sports medicine code of ethics. Such a code would illuminate our obligations and identify the tenets of responsible professional practice in the sports arena.
Sports Physicians as Stewards
Most of us have continued to be involved in sports because of our own positive experiences. We understand the powerful role of sports in the physical and emotional development of youth and recognize the importance of exercise to the health of the communities we serve.
We also appreciate sports as a potent cultural force that deserves and requires thoughtful stewardship. If we engage in that stewardship by helping sports institutions confront broad social issues and by lending our ethical perspective to the resulting debates, we can help create a sports culture that encourages fair competition and truly promotes the well-being of athletes and society.
Dr Pipe is the physician for Canada's National Men's Basketball Team and chair of the Canadian Centre for Ethics in Sport. In 1992 he served as chief medical officer to Canada's Olympic Team. He practices at the University of Ottawa Heart Institute and is an editorial board member of The Physician and Sportsmedicine. Address correspondence to Andrew Pipe, MD, University of Ottawa Heart Institute, 1053 Carling Ave, Ottawa, Ontario, Canada K1Y 4E9.
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