BJSM Authors: Lynley Anderson,1 Dan Exeter,2 Lynne Bowyer1 1Bioethics Centre, University of Otago, Dunedin, New Zealand 2Unisports Centre for Sports Medicine, Auckland, New Zealand Correspondence to Lynley Anderson, Bioethics Centre, University of Otago, PO Box 913, Dunedin, New Zealand; lynley.anderson@otago.ac.nz Received 25 May 2011 Accepted 22 September 2011 Published Online First 28 October 2011 assist athletes to make decisions about their sporting careers in light of what they value. Doctors can also play an important role in educating and interpreting the risk for athletes found to have an SCDlinked condition, but they are not the arbiters in deciding what level of personal risk is acceptable for an individual. Doctors can advise, but the fi nal decision is not rightfully within their domain. SCD is a rare and distressing event, and it is understandable that some members of the medical community wish to respond by excluding athletes identifi ed as being at high risk. However, we should not extrapolate this sense of medical responsibility into paternalistic measures that limit the actions of others in this situation. What this study adds • A discussion of the diffi culties associated with screening for SCD-linked conditions used as a basis for mandatory exclusion of athletes. • An ethical exploration of the arguments for and against mandatory exclusion of athletes identifi ed with SCD-linked conditions. • A clear explication of the role of doctors in responding to those found to have risk factors for SCD including risk interpretation, support, guidance and respect for athlete decision making. Acknowledgements The authors would like to thank the following people for their comments on earlier drafts: Dr Neil Pickering, Associate Professor Heather Dyke, Professor Grant Gillett, Professor Martyn Evans, Sports Physicians at Unisports Centre for Sports Medicine (Auckland), and other staff and students at the Bioethics Centre, University of Otago. Funding A small grant of around £500 was obtained from the University of Otago for a research assistant. Competing interests None. Provenance and peer review Not commissioned, externally peer reviewed. References 1. Corrado D, Basso C, Pavei A, et al. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 2006;296:1593–601. 2. Steinvil A, Chundadze T, Zeltser D, et al. Mandatory electrocardiographic screening of athletes to reduce their risk for sudden death proven fact or wishful thinking? J Am Coll Cardiol 2011;57:1291–6. 3. Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientifi c statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2007;115:1643–455. 4. Wilson MG, Basavarajaiah S, Whyte GP, et al. Effi cacy of personal symptom and family history questionnaires when screening for inherited cardiac pathologies: the role of electrocardiography. Br J Sports Med 2008;42:207–11. 5. Corrado D, Basso C, Rizzoli G, et al. Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol 2003;42:1959–63. 6. Bahr R. Can electrocardiographic screening prevent sudden death in athletes? No. BMJ 2010;341:c4914. 7. Maron BJ, Shirani J, Poliac LC, et al. Sudden death in young competitive athletes. Clinical, demographic, and pathological profi les. JAMA 1996;276:199–204. 8. Papadakis M, Whyte G, Sharma S. Preparticipation screening for cardiovascular abnormalities in young competitive athletes. BMJ 2008;337:a1596. 9. Pelliccia A, Di Paolo FM, Corrado D, et al. Evidence for effi cacy of the Italian national pre-participation screening programme for identifi cation of hypertrophic cardiomyopathy in competitive athletes. Eur Heart J 2006;27:2196–200. 10. Harmon KG, Asif IM, Klossner D, et al. Incidence of sudden cardiac death in national collegiate athletic association athletes. Circulation 2011;123:1594–600. 11. Drezner J, Corrado D. Is there evidence for recommending electrocardiogram as part of the pre-participation examination? Clin J Sport Med 2011;21:18–24. 12. Mill JS. On Liberty. London: Penguin Books 1974. 13. Feinberg J. Harm to Self. New York, NY: OxFord University Press 1986. 14. Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112; [1985] 3 All ER 402 (HL). 15. Dreyer C. ‘In that case’ response. N Z Bioeth J 2004;5:34–5. 16. Ljungqvist A, Jenoure P, Engebretsen L, et al. The International Olympic Committee (IOC) Consensus Statement on periodic health evaluation of elite athletes. Br J Sports Med 2009;43:631–43. 17. Maron B, Brown R, McGrew C, et al. Ethical, legal and practical considerations affection medical decision-making in competitive athletes. J Am Coll Cardiol 1994;24:854–60. 20 Sport & Geneeskunde | juni 2012 | nummer 2 Pagina 19
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