Informed Consent Isn’t Just for Academics

 

Brooks Laich of the Washington Captials says he would like to stop having people babysit him.

There has been a lot of talk these last few weeks regarding head injuries and fighting in the NHL. Some people are talking about head hits and what the NHL is doing to prevent them. Some people are talking about concussions and the best way to treat them. Others are talking about the cognitive dissonance shown by those in a league that, while claiming to be “cracking down on headshots,” still allows bare-knuckle fighting within the rules of the game. All are valid discussions, and all are a long way from being resolved, one way or the other.

With all of these discussions, what has interested me is the most is that very little has been heard from the men who actually PLAY the game at its highest level. Where do they weigh in on these subjects? While the media has been up in arms with the latest round of “we need to ban fighting in the NHL” hoopla, the players have been largely silent on the matter. That is, they had been, up until this past Friday (Oct 14). Then, following a game between Pittsburgh and Washington (in which the already belaboured debate surrounding the Asham-Beagle fight began) Brooks Laich, a member of the Washington Capitals (and coincidentally, also the team’s NHLPA rep) was quoted as saying the following (via Chuk Gormley of CSN Washington)

I really don’t care about that awareness crap. To be honest, I’m sick of hearing all this talk about concussions and about the quiet room. This is what we love to do. Guys love to play, they love to compete, they want to be on the ice. How do you take that away from someone? We accept that there’s going to be dangers when we play this game. We know that every time we get dressed. I don’t know, sometimes it just feels like we’re being babysat a little too much. We’re grown men and we should have a say in what we want to do.

At the time, Laich was referring to the NHL’s concussion protocols that were introduced last year in an attempt to prevent players from reinjuring (or further injuring) themselves after sustaining a head injury. That said, what struck me about this statement wasn’t Laich’s stance on the concussion protocols, but rather his attitude toward the risks that he and every player in the NHL assumes when stepping on the ice. Basically he was saying “I’m a grown man. I know there are risks involved in what I do. But I’m making a conscious choice in taking those risks. The consequences are my responsibility.” In essence he was claiming that he and every player who laces up skates in the NHL gives their informed consent to take certain risks with their health when they step on the ice.

One part of me wholeheartedly agrees with Laich. He’s a grown man and he openly acknowledges and accepts that there are risks (some of them serious) associated with what he does for a living. Besides, professional hockey players are not the only professionals in this world who take risks with their health (both in the short- and long-term) in the execution of their jobs. Coal miners risk cave-ins and black lung. Fisherman risk drowning. Lumberjacks risk disfigurement and death from falling trees and heavy machinery. This past weekend we even saw the worst case scenario unfold during the Vegas 300 Indy race when Dan Wheldon was tragically killed in a mid-race crash. All of these individuals know the risks of their respective professions, and still choose to take part. Some do it for love, some do it for money, but all make a conscious choice. Why should hockey players be any different?

And yet there is another part of me that seems to think that, while Laich is right to a point – he is a grown man making his own decisions – his information is incomplete. Many sources define informed consent as when an individual has a clear appreciation and understanding of the facts, implications, and future consequences of an action. But long term brain injury is a serious health risk, and there is still a great deal about concussions that is unknown, even to doctors researching the phenomenon. So if neurologists are still grappling with the problem, how does a professional hockey player really expect to be fully informed about the risks, with a “clear appreciation and understanding of the facts?” Besides, if the precautions mean he misses a shift or two in the “quiet room,” that seems a small price to pay in the name of preserving his long term neurological health.

As with any issue as complex as this, there are no easy answers. There are no “perfect” solutions. But one of the biggest questions I find myself asking – and that I feel may underscore all of these debates – is this: What constitutes “informed” consent? Especially when it comes to an injury that may impair one’s decision making capability, at what point are we able to draw the line, sit back and say “You’ve been warned. Continue at your own peril.”?

7 thoughts on “Informed Consent Isn’t Just for Academics”

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