The inclusion of elite transwomen athletes in sport is controversial. The recent International Olympic Committee guidelines allow transwomen to compete in the women’s division if their testosterone is held below 10 nmol/L. This is significantly higher than that of cis-women. Science demonstrates that high testosterone and other male physiology provides a performance advantage in sport suggesting that transwomen retain some of that advantage. To determine whether the advantage is unfair necessitates an ethical analysis of the principles of inclusion and fairness. (...) Particularly important is whether the advantage held by transwomen is a tolerable or intolerable unfairness. We conclude that the advantage to transwomen afforded by the IOC guidelines is an intolerable unfairness. This does not mean transwomen should be excluded from elite sport but that the existing male/female categories in sport should be abandoned in favour of a more nuanced approach satisfying both inclusion and fairness. (shrink)

It is difficult to develop good arguments when the central terms of the discussion are unclear – as with the current confused state of sex and gender terminology. Sports organisations and sports re...

Cage-Fighting, also known as Mixed Martial Arts, is a combat sport that allows participants to grapple, punch, kick, elbow and knee—a combination of elements from many martial arts. While it...

The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and (...) products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes. (shrink)

In his latest paper, Loland1 tackles the question of whether athletes with differences of sexual development may compete in the women’s division. The topic is one of the most complex in sport and, as such, is fraught with debate. On one hand, the higher testosterone levels of athletes with DSD means they have an unfair performance advantage over their female competitors. On the other hand, it is argued that women with DSD should be able to compete in the gender division (...) with which they identify, especially as many will have been raised with a clear gender identity. Loland uses the Rawlsian notion of ‘fair equality of opportunity’ in which individuals with similar talents and ambitions should have roughly equivalent prospects for competitive success. For example, in most situations in society, one’s age, biological sex, ethnic and religious background, colour of skin, or sexual orientation are irrelevant to whether an individual should be given a job or is eligible for social welfare. In addition to being irrelevant, these factors are also stable—they are inequalities that ‘individuals cannot control or impact in any significant way’.1 However, Loland recognises that some stable inequalities, such as biological sex and body size, are relevant to FEO in sport. For example, a featherweight boxer may have similar talents and …. (shrink)

Athletes who wish to compete in spite of high risk of injury can prove a challenge for sports doctors. Overriding an athlete's choices could be considered to be unnecessarily overbearing or paternalistic. However simply accepting all risk-taking as the voluntary choice of an individual fails to acknowledge the context of high-level sport and the circumstances in which an athlete may be being coerced or in some other way be making a less than voluntary choice. Restricting the voluntary choices of an (...) athlete may still be possible but under very limited circumstances. This article explores the ways a sports doctor might respond in ensuring a choice is indeed voluntary and, if so, under what circumstances limits might be placed. Responding to such risk-taking by, for example, limiting the actions of an athlete or assisting them to compete, involves attempting to balance the athlete's aims against some set of ideals of good health or medical ends. (shrink)

Social media and Internet technologies present several emerging and ill-explored issues for a modern healthcare workforce. One issue is patient-targeted Googling, which involves a healthcare professional using a social networking site or publicly available search engine to find patient information online. The study’s aim was to address a deficit in data and knowledge regarding PTG, and to investigate medical student use of SNSs due to a close association with PTG. The authors surveyed final year medical students at the Otago Medical (...) School, University of Otago in January 2016. A subset completed focus groups that were analysed using thematic analysis to identify key themes relating to students’ attitudes towards PTG, and reasons why they might engage in PTG. Fifty-four students completed the survey, which showed that PTG was uncommon. Attitudes were varied and context dependent. Most participants saw problems with PTG and favoured more explicit guidance on the issue. SNS usage was high ; participants were concerned by the content of their SNS profiles and who they were connecting with online. Participants showing high SNS use were 1.83 times more likely to have conducted PTG than lower use groups. The diverse attitudes uncovered in this study indicated that teaching or guidelines could be useful to healthcare professionals considering PTG. Though ethically problematic, PTG may be important to patient care and safety. The decision to conduct PTG should be made with consideration of ethical principles and the intended use of the information. (shrink)

Background Social media and Internet technologies present several emerging and ill-explored issues for a modern healthcare workforce. One issue is patient-targeted Googling, which involves a healthcare professional using a social networking site or publicly available search engine to find patient information online. The study’s aim was to address a deficit in data and knowledge regarding PTG, and to investigate medical student use of SNSs due to a close association with PTG. Method The authors surveyed final year medical students at the (...) Otago Medical School, University of Otago in January 2016. A subset completed focus groups that were analysed using thematic analysis to identify key themes relating to students’ attitudes towards PTG, and reasons why they might engage in PTG. Results Fifty-four students completed the survey, which showed that PTG was uncommon. Attitudes were varied and context dependent. Most participants saw problems with PTG and favoured more explicit guidance on the issue. SNS usage was high ; participants were concerned by the content of their SNS profiles and who they were connecting with online. Participants showing high SNS use were 1.83 times more likely to have conducted PTG than lower use groups. Conclusions The diverse attitudes uncovered in this study indicated that teaching or guidelines could be useful to healthcare professionals considering PTG. Though ethically problematic, PTG may be important to patient care and safety. The decision to conduct PTG should be made with consideration of ethical principles and the intended use of the information. (shrink)

In New Zealand, there are adolescents who are at risk of pregnancy and who do not want to become pregnant, but are not using contraception. Cost and other barriers limit access to contraception. To address the gap between contraceptive need and contraceptive access, this paper puts forward the concept of proactive contraception provision, where adolescents are offered contraceptives directly. To strengthen the case for proactive contraception provision, this paper addresses a series of potential objections. One is that such a programme (...) would cause harm; another that such a programme would not have sufficient benefit. In rebutting these objections, the conclusion is reached that proactive contraception provision is a model worth pursuing as a means of meeting the needs of the New Zealand adolescent population and may be of interest more widely. (shrink)

Boundaries between research and clinical practice blur in health research conducted by clinician-researchers. We describe a typology, of clinician-researcher dual-role tensions, with two overarching catalysts: acting as a clinical resource for patient-participants and forming researcher–participant relationships mirroring clinician–patient relationships. Using the typology as an analytic template we explored blurred boundaries in five illustrative, non-clinician, critical studies. Like clinician-researchers, critical researchers act in ways that promote rapport and relationships with their participants, which can blur boundaries. While clinician-researchers see tension between clinician (...) and researcher roles, we ask what roles critical researchers attempt to distinguish: ethically minded citizen and researcher, socially conscious community member and researcher, or friend and researcher? Anticipating catalysts of dual-role tension may assist critical researchers in planning and conducting robust research. (shrink)

In this paper we consider the three categories offered by Howard Brody for understanding power in medicine. In his book, The Healer's Power Brody separates out power in medicine into the categories of Aesculapian, Social, and Charismatic power. We examine these three categories and then apply them to a case. In this case set in an Obstetric ward, a junior member of the medical staff makes a clinical decision about a patient. This clinical decision is overruled by a senior medical (...) staff member who then carries out his plan with disastrous consequences for the woman and her baby. This case challenges the three categories of power offered by Brody and highlights the need for a further category of Hierarchical power to be added to Brody's framework. We conclude by suggesting that there is a need to recognise the discrepancy in power not only between physician and patient but also between senior and junior staff in a clinical setting. (shrink)