The idiom “what you don’t know can’t hurt you” usually means the less you know about the possible risks and harms that can befall you, the less likely you are to worry yourself sick about them.
The recently released [AFL charges against the Essendon Football Club](http://wwos.ninemsn.com.au/article.aspx?id=8709696](http://wwos.ninemsn.com.au/article.aspx?id=8709696) and some of its senior managers indicates that there may be much to worry about. The charges allege that the Bombers:
failed to have proper regard to player health and safety, including failing to ensure that all substances had no potentially negative effects on players;
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failed to identify and record the source from which all substances used by players were obtained;
failed to adequately monitor and record the use of substances;
failed to audit or monitor all substances held on the premises of the club;
failed to meaningfully inform players of the substances the subject of the program and obtain their informed consent to the administration of the substances;
created or permitted a culture at the club that legitimised and encouraged the frequent, uninformed and unregulated use of the injection of supplements;
failed to adequately protect the health, welfare and safety of the players.
Essendon coach James Hird denied the charges and promised they would “be vigorously contested once the AFL actually provides due process”.
The potential harm of the saga to athletes’ health is bad enough, but if the charges against the club are upheld, there could be painful sanctions such as a loss of points, draft picks and fines.
But the harm does not stop there. The sport doctor-athlete therapeutic relationship is also at risk.
The proper diagnosis and treatment of a condition or injury requires the athlete to disclose relevant personal, health and lifestyle details. This may include personal and sensitive information that might be embarrassing to the patient and, more importantly, prejudicial if the information was made public.
A sport doctor should expect an athlete’s honest and full disclosure of facts relevant to the athlete’s condition. In turn, athletes should expect that the disclosed information will be treated confidentially and used in a manner to promote their health and well-being.
This requires a high degree of trust between the athlete and the sports medical practitioner. However, it is one thing for athletes to trust that the medical practitioner is going to look after their interests, but it is another thing for it to be a blind trust.
Informed consent
Athletes should expect to play a part in the decision making. Part of a doctor’s duty of care is ensuring the informed consent of the patient. That is, medical practitioners are expected to make the patient aware of the treatment options, as well as the expected benefits, risks and safeguards associated with each.
Athletes are also in a “dependent” relationship in the sense that they are paid employees of their respective clubs, which may make it more difficult for them to say “no” when, say, a medico or sport scientist asks them to consider the use of supplements or dubious performance enhancing or recuperative methods. The risk is exacerbated if those who claim to be high-performance scientists are not professionally accredited.
The principles of promoting the good (beneficence) and doing no harm (maleficence) are enshrined in codes of medical and scientific ethics, such as those of the Australian Medical Association and the National Health and Medical Research Council.
It is not enough that the sport doctor, or anyone else entrusted with the responsibility for player performance and safety, feels that he or she knows what is in the best interests of the athlete; a primary obligation is to provide information so that the athlete can make an informed choice about his or her treatment.
It is also a mark of respect: acknowledging that the athlete is capable of contemplating options, weighing up the pros and cons of those options, and taking responsibility for a choice.
From what we’ve seen in the Essendon supplements saga, professional sport has a way to go yet to be fully professionalised. The more sport becomes big business, the more the onus is on sport organisations to engage in workplace practices that are consistent with the ethical and safety standards in allied professions and industries.