By Kimberly S. Peer, EdD, ATC, FNATA
Associate Professor, Kent State University
Adjunct Graduate Faculty, NEOMED University
Editor-in-Chief, Athletic Training Education Journal
Ethics in athletic training is quite complex. Ask anyone in the profession and you will likely hear the passion for the work we do every day. However, Athletic Trainers are known for having a tremendous amount of power and responsibility. As quoted by Stan Lee, Voltaire and made more popular in the “Spiderman” movies, “With great power comes great responsibility.” An Athletic Trainer’s role involves tremendous responsibility and requires an untenable amount of moral courage to stand up for what we believe is right, even at the risk of personal or professional loss.
Athletic Trainers are often considered part of the team and function in close collaboration with players, coaches, managers and other team personnel. How much Athletic Trainers really know about the inner workings and dynamics of any given team remains unclear; however, what is clear is there are potential conflicts of interest. An Athletic Trainer is bound by the NATA Code of Ethics and the BOC’s Standards of Professional Practice. Although these documents provide a clear stance on the ethical expectations of an Athletic Trainer, there are still gray areas that can potentially impact an Athletic Trainer’s career.
What if you are not directly involved in a situation but are aware of a potentially unethical issue? For example, consider the recent NFL Patriots’ “Deflategate” scandal. What if the Athletic Trainer, through his/her relationship with the personnel on the team, was aware of some inappropriate activities? Clearly, it did not impact the health or well-being of the athletes playing the game. Clearly it was not within the scope of practice for the healthcare provider. But clearly, it was unethical. What should be done in cases such as these if the Athletic Trainers are aware? Where do the guidelines set forth by the professional documents that guide our ethical behaviors start and stop? Are they relevant only when related to the scope of our clinical practice?
The true measure of a professional is his or her character. Character is built by doing what is right even when no one else is watching. It is anchored in integrity and requires consistent behaviors over time. Character takes a long time to establish yet a short time to fall. Once compared to an old oak tree, a tree takes years and years to grow strong and tall. It can withstand minor trauma, such as a storm or an ax hit, but given a strong chainsaw, that great tree can easily fall. One’s character is just like the oak tree and takes time to establish through consistent, strong and responsible behavior, even in the face of adversity.
Athletic training professionals are placed in difficult situations. They are often aware of activities that could impact the outcome of a game, recruitment or an athlete’s academic progress. Although one might think that it is “not my business,” an ethical professional reflects moral courage in all they do, not just those things immediately impacting their professional life. Doing the right thing is about your core – about knowing what is right and wrong. It is being willing to stay the course to do the right thing even when it is difficult.
Several cases below can stimulate discussion regarding the challenges facing Athletic Trainers. Balancing legal and ethical considerations appears to be the most common approach to solving ethical dilemmas; however, the law is not the only governing factor in ethical decision-making. Consider the following cases and questions.
Ethics in the Locker Room: Key Challenges
You have an athlete who is to go for a bone scan. If cleared, she is to play in the championship match 1 week from now. You arrange to have a bone scan for her, and she fails to show. She says she forgot. You arrange a second appointment. She fails to show. She is now in your office begging you to squeeze her in for a scan.
Should you squeeze the athlete in 1 last time? Should you once again ask a favor of the radiology department, which has made exceptions and squeezed her in twice already? Should you work for what is best for the athlete by pushing her through again? Should you teach her responsibility and social respect by having her learn from her irresponsible behaviors, which impacted not only you as an AT, but also the other patients who could not be seen when she failed to show for her appointments? What is the right thing to do?
It is a well known practice for collegiate linemen to gain weight and mass to fill the role of the line position. As average weights for linemen have increased dramatically in the past decade, many in this position are provided unlimited access to food and are encouraged to gain weight. Many institutions are providing unlimited access to food for these athletes with total disregard for the long-term health implications of weight gain. Although several universities are now creating transition plans for overweight graduating athletes to help them re-align their eating habits to match their decreased level of physical activity, most athletic departments do not consider this a problem despite increased news coverage of this very topic.
What is the role of an AT in managing this dilemma in collegiate athletics? Is it our concern that lifelong eating habits are established during these times and will likely impact the overall well-being of the athlete throughout his lifetime? Is it our concern that many disease pathologies associated with obesity may evolve from these unhealthy practices? Does this deserve the same consideration as eating disorders in female athletes? What do we do to break these trends? Is it the role of the university to even worry about the athlete’s health once they graduate? Does the athlete assume responsibility when he agrees to play?
Clearly there are many answers to these problems. Athletic Trainers have to look toward the long-term health of the athlete rather than just the short-term issues. Athletic Trainers assume considerable risk when standing up to a coach and/or athletic director who wants special consideration for their athletes.
As Athletic Trainers continue to struggle with these ethical dilemmas, it is clear our scope extends far beyond the technical/clinical skills we provide to encompass a broad range of long-term issues. Although the solutions to these dilemmas are many, the ability of the AT to foresee the bigger picture remains critical.
So what is the take-home message? No one said it was going to be easy!