Ethical issues in return-to-sport decisions

Return-to-sport decisions should also promote an athlete’s autonomy. Autonomy allows for self-determination and the individual governance of actions. Autonomy is linked to informed consent, and allows an athlete to actively participate in return-to-sport decisions. However, maintaining full and thorough informed consent in return-tosport decisions may be problematic, particularly due to the numerous external pressures associated with team sports. It may be difficult to preserve individual athlete autonomy with external pressures such as financial gain and coach, team, family and public expectations. Return-to-sport decisions may also be strongly influenced in competition or match situations by desires to compete, to win, and to avoid disappointing team members. The FIMS code of ethics regarding return-to-sport decisions states: ‘It is the responsibility of the sports medicine physician to determine whether the injured athletes should continue training or participate in competition. The outcome of the competition or the coaches should not influence the decision, but solely the possible risks and consequences to the health of the athlete.’ 7 In return-to-sport decisions, the primary obligation of healthcare professionals is to the individual athlete. Sufficient and appropriate information should be given to an athlete to facilitate informed decision-making. 6,8,9 The healthcare professional should