Major recent ethical issues facing the sport of football include the longterm effects of head injuries and adequate compensation for these. The chronic damaging effects from football-related head injuries have been widely reported in the media (Winslade & Goldberg, 2010). The authors describe the autopsy of a 21-year-old former college football player who, after he committed suicide, was found to have suffered from chronic traumatic encephalopathy (CTE), visible damage to the brain caused by repeated violent blows. From this young man and others like him, scientists now know that extensive brain damage starts even before football players become professional athletes.
Researchers have also now concluded that “concussion-management protocols” and advancements in helmet technology are not sufficient protection for football players. Much of the damage is from the brain hitting the inside of the skull, which cannot be protected against by, for example, more cushioning inside the helmet. Still unknown, however, is how many brain injuries are too many. It could be just one. In addition to loss of consciousness, helmet-to-helmet collisions can cause bruising or bleeding in the brain, dizziness, confusion, and/or cognitive deficits, from which not everyone recovers. No one wants to live a life of permanent brain damage. Should football be banned?

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There are two issues to consider in determining whether or not to allow the sport of football. First are catastrophic head injuries from severe concussions. These are relatively rare, but can have immediate devastating effects. A study of evidence submitted to the National Center for Catastrophic Sports Injury Research (Boden et al., 2007) determined that the 94 incidents reported represented a rate of 0.67 injuries per 100,000 players at the high school level and 0.21 injuries per 100,000 players at the college level. Of these, there were 75 players with subdural hematoma alone, 10 players with subdural hematoma plus diffuse brain edema, five players with diffuse brain edema alone, and four players with arteriovenous malformation. Eight of these players died as the result of their injuries, while 46 players had permanent neurological problems, for a total of 60% of players who never fully recovered. Researchers also found that guidelines are not being followed that recommend that players not play again until fully recovered; 59% of these players had previous head injuries, 71% of those injuries had occurred during the same season, and 39% were playing despite residual symptoms. This is contrary to guidelines. However, the guidelines have not been mandatory.

The goal is to keep athletes from experiencing a second head injury, which research has shown can have the most severe consequences (Sundman, Doraiswarmy, & Morey, 2015). However, even if players’ careers end after the first head injury, other frequent causes of head injuries include falls and motor vehicle accidents, both of which are more likely after a concussion; so former players still may find themselves with severe repetitive injuries. Also, many symptoms are subjective, and if a player wants to keep playing, it is entirely possible he will just deny symptoms. It is also possible that he will not recognize that he is still having symptoms, which may include changes in cognition.

The second issue is the series of “subconcussive blows” routinely experienced by football players (Sundman, Doraiswarmy, & Morey, 2015). Subconcussive blows are defined as blows to the head that do not produce any identified symptoms at the time. Research has shown that high school and college football players experience an average of 652 subconcussive blows per season, as revealed by recorded accelerometer data; thus an individual player may have received thousands of these blows. This results in the condition known as chronic traumatic encephalopathy (CTE). CTE is a progressive disorder that for football players is diagnosed on average at age 30-50. It is caused by tauopathy – abnormal tau proteins in the brain, similar to Alzheimer’s and Parkinson’s. On imaging, the cause of the tauopathy can be determined due to differences in the pattern and distribution of these proteins in the brain. It is believed that the inflammation in the brain caused by repeated subconcussive blows is the trigger for the tau protein abnormalities. Symptoms of degenerative CTE include disorders of memory and cognition, emotional disorders (such as aggression, impulsivity, depression and anxiety), and motor control disorders. These worsen over time. Former football players commit suicide at a rate about four times the general population, and others are rendered incapable of caring for themselves.

Many of these injuries occur while players are still high school and college students; and even for professional players, a large paycheck does not adequately compensate for the lifelong effects of brain damage. More than 3000 former football players filed a class-action lawsuit against the NFL (Korngold, Farrell, & Fozdar, 2013). The complaint stated that the NFL made a fortune “by promoting… brutality… and inculcating in players… the false and life-threatening ideas that (a) brutal, ferocious, and debilitating collisions are… desired; and (b) playing despite repetitive head impacts is… desirable.” Critical to the case is the issue of whether or not players truly had informed consent when they signed their contracts. Although an average player in the NFL has a salary of $1.9 million per year, many parties to the lawsuit state that they have not been able to afford adequate medical and rehabilitative care. Ultimately, the NFL agreed to settle the class-action suit for a total of $1 billion (Barrabi, 2015), or up to $5 million each. However, that settlement is currently on appeal because many players feel it is inadequate. It is restricted to those who suffered from CTE and died between 2006 and 2014. However, research by PBS’ Frontline discovered that of 91 brains of former football players donated after death, 87 were found to have suffered from CTE, a positive rate of 96% (Barrabi, 2015). Thus while nearly every player has the disorder, under current terms of the settlement, only a relative few will be able to prove that they deserve compensation. Also, average gross profits for the NFL are $9.3 billion every single year. Clearly they can afford a larger settlement.

Therefore, given the potential severity of concussive head injuries and the long-term consequences of repetitive subconcussive injuries, the inadequacy of compensation for all the damage, the significant deterioration of quality of life for former football players over the years, and the inability of a young football player to appreciate the longterm consequences of his choices: Football should be banned. We have yet to appreciate or compensate for the extent of the damage done to players beginning in their teens. Regardless, no player owes sports fans their longterm health for any amount of money.

    References
  • Barrabi, T. (2015). NFL concussion lawsuit settlement: What ‘Frontline’ CTE data means for the appeals process. International Business Times. Retrieved from http://www.ibtimes.com/nfl-
    concussion-lawsuit-settlement-what-frontline-cte-data-means-appeal-process-2104528
  • Boden, B.P., Taccheti, R.L., Cantu, R.C., Knowles, S.B., & Mueller, F.O. (2007). Catastrophic head
    injuries in high school and college football players. American Journal of Sports Medicine, 35
    (7), 1075-1081.
  • Korngold, C., Farrell, H.M., & Fozdar, M. (2013). The National Football League and chronic traumatic encephalopathy: Legal implications. Journal of the American Academy of Psychiatry and the
    Law, 41 (3), 430-436.
  • Sundman, M., Doraiswarmy, P.M., & Morey, R.A. (2015). Neuroimaging assessment of early and late
    neurobiological sequelae of traumatic brain injury: Implications for CTE. Frontiers in
    Neuroscience, 9 (334), 1-15.
  • Winslade, W., & Goldberg, D. (2010). The protection of athletes becoming an ethical issue. Houston
    Chronicle. Retrieved from http://www.chron.com/opinion/outlook/article/The-protection-of-
    athletes-becoming-an-ethical-1695737.php