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Introduction

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I know that a football club doctor would never have the audacity to tell you the truth … Front up in the medical room with severe internal bleeding and they will say something like “it’s just a scratch—you’ll be right.” I guess that’s why they have football club doctors and why players should never go to anyone else.

A 1970s Australian Rules football star quoted in The Age (Melbourne), 6 July 1979

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The broad goal of medical ethics is to improve the quality of patient care by identifying, analyzing, and attempting to resolve the ethical problems that arise in the practice of clinical medicine.1 In addition, the increased professionalism of sport has raised numerous significant ethical issues in sports medicine. Influences such as the clinician’s employer (sports team or organization), the athlete’s desire to play with pain and injury, and the economic consequences of playing or not playing all complicate medical decisions.2, 3

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Five of those contentious areas are discussed below:

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  • conflict of interest

  • confidentiality

  • performance-enhancing drugs

  • infectious diseases

  • ethics in sport.

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In 1993 the Federation International de Sports Medicine (FIMS) espoused three principles to guide the clinician treating athletes:4

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  1. Always make the athlete a priority.

  2. Never do harm.

  3. Never impose your authority in a way that impinges on the individual right of the athlete to make his or her own decision.

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Conflict of interest

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The goal of most clinicians is to reduce suffering and prolong healthy life. Athletes, especially professional athletes, have as their priority a desire to perform. A major objective for a sports clinician is to support athletic achievement.2 As a result of the dynamics of professional sports, medical decision making can be affected by a host of factors not normally encountered in standard practice.

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Decision making can potentially be affected by pressures exerted from a variety of sources that may influence both clinicians and the patient/players. A professional team clinician should recognize these potential influences and their effect on ethical medical decision making. These pressures may come from players, management and coaches, and the clinicians themselves.5

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The team clinician may come under pressure to allow the athlete to play from a number of different sources. The players themselves are usually the greatest potential source of pressure on the clinician. Athletes are highly motivated. An athlete may prefer to risk his or her health for the sake of participation and success in the game, motivated by machismo, peer pressure, pride, institutional pressures, and also economic considerations.6

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Pressure may also come also from the coach, team mates, parents, or team administration. This can take several forms, including pressuring the athlete who will in turn attempt to influence the clinician’s decision making. Other forms of pressure may come about from direct or indirect ...

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