Ethical practice and sports physician protection: a proposal.

PREAMBLE It is in the nature of medical practice that it is always likely to yield ethical problems because of the role that health, illness and injury play in the lives of patients. Sports physicians can fi nd themselves in particularly diffi cult (though not unique) contexts because of the role of the body in athletic performance, especially at elite and professional levels. Contrary to recent articles, 1 – 4 however, Sports Medicine should not be viewed as giving rise to distinct or unique ethical diffi cul-ties. Such diffi culties as arise in Sports Medicine merely refl ect the kinds of challenges and dilemmas (eg, confi dentiality, confl icts of interest, consent, disclosure, working with vulnerable populations) as are found in other branches of medicine, though not necessarily in precisely in the same confi gurations. One common professional response to the recognition of ethical demands and professional ambiguity is to establish codes of conduct such as those published by the American College of Sports Medicine (ACSM), 5 the Australasian College of Sports Physicians (ACSP), 6 the International Federation of Sports Medicine (FIMS) 7 and the Faculty of Sport and Exercise Medicine (FASEM). 8 Within the literature of applied ethics, 9 sports ethics 10 and sports medicine ethics, 11 the limitations of these codes as instruments of education, guidance and punishment have long been noted. Most recently, within BJSM, the ACSP has presented and defended their new Code within the broad aim of contributing to the development of a professional community of practitioners. 12 One of the merits of the Code that the article draws attention to is the articulation of standards of expectation, differentiating among other things between those actions that are, on the one hand, compulsory from exhortations to best practice on the other. (They capture the distinction in 'must' and 'should' statements.) Nevertheless, that code itself has recently been criticised 13 for a range of issues that it neglects or which it fails to recognise are at odds with extant practice. One of the standard criticisms of any code of professional ethics, which has often been overlooked in discussions of sports medicine ethics, arises from the notion of scope of application. To whom do the rules apply? Sports Medicine is not unique in being professionally fractured along disciplinary and geographical lines. The idea of a universal code, an Esperanto of sports medicine ethics, is almost certainly a pipe …