A Review of Legal, Ethical, and Governance Issues for Team Doctors.

Objective: To provide a review and discussion of a range of legal and ethical issues commonly faced by team physicians, with reference to high-profile international integrity crises in sport that have involved doctors. The article also presents some recommendations and guidance for team doctors and sporting organizations.
Data Sources: Media reports, legal cases, and journal articles describing recent sporting integrity crises that have involved medical issues and governance reforms which are emerging in response.
Main Results: Many of the modern "integrity crises" in sport have a medical aspect (eg, doping cases, catastrophic injuries and illnesses, "Bloodgate" and other "medical cheating," sexual contact between doctors and athletes, harassment/bullying of doctors, concussion mismanagement, and management of the coronavirus pandemic in sport). A key issue is that while doctors bear ultimate responsibility for any perceived medical negligence, they do not always have ultimate power in decision-making. This is common in the traditional governance structure where the coach/manager "outranks" the doctor and can overrule medical decisions. There can be a blurring of the traditional doctor-patient relationship, especially on tour, and conflicts of interests occur when the needs of the employer/sporting organization differ from the player (patient). Further issues can arise in treating other staff members and players' family members.
Conclusions: Doctors must be aware of range of important legal and ethical issues that arise in the team setting. Medical integrity crises have inspired governance reforms, such as policy development, appointment of chief medical officers, medical staff reporting to integrity departments, and sanctions of teams that breach medical integrity requirements. Sporting organizations must continue to implement and strengthen frameworks reinforcing doctors' seniority in the medical area.
Competing Interests: J. J. Orchard is a cardiac research fellow for Cricket Australia and was supported by a postdoctoral fellowship (award reference No. 104809) from the National Heart Foundation of Australia. D. Maddocks is a coinvestigator in research on long-term follow-up of neuropsychological function in former Australian rules footballers, funded through the Florey Institute of Neuroscience and Mental Health. He has a legal practice in medical law and has provided legal advice to professional sporting clubs and the Australian Football League (AFL). He is a member of the AFL Grievance Tribunal and the AFL Concussion Working Group. J. W. Orchard is the Chief Medical Officer for Cricket Australia. The remaining author reports no conflicts of interest. Many of the modern “integrity crises” in sport have a medical aspect (eg, doping cases, catastrophic injuries and illnesses, “Bloodgate” and other “medical cheating,” sexual contact between doctors and athletes, harassment/bullying of doctors, concussion mismanagement, and management of the coronavirus pandemic in sport). A key issue is that while doctors bear ultimate responsibility for any perceived medical negligence, they do not always have ultimate power in decision-making. This is common in the traditional governance structure where the coach/manager “outranks” the doctor and can overrule medical decisions. There can be a blurring of the traditional doctor–patient relationship, especially on tour, and conflicts of interests occur when the needs of the employer/sporting organization differ from the player (patient). Further issues can arise in treating other staff members and players' family members.
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