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Ethical dilemmas faced by the team physician: overlooked in sports medicine education?
  1. Mats Börjesson1,2,
  2. Jon Karlsson3
  1. 1Swedish School of Sport and Health Sciences, Stockholm, Sweden
  2. 2Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
  3. 3Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
  1. Correspondence to Professor Mats Börjesson, Lidingövägen 1, 114 86 Stockholm, Sweden; mats.brjesson{at}

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The oldest known ethical rules for physicians are found in the 282 Hammurabi law codes (, originating from 1800 bc, stating that “if a physician makes a large incision with the operating knife and kills him, …his hands shall be cut-off.” Today, the primary aim of every physician is to help or heal their patients, or at least not to harm them in the process; what is best known as ‘primum non nocere’. The team physician faces challenges to these ethics. This paper reflects on some delicate ethical situations, on and off the pitch, related to the work of the team physician at the elite level, well illustrated in the recent soccer World Cup. The authors who are experienced team physicians having served for a total of 50 years at elite national and international levels, including at European and World Cups/Championships and Olympic Games, argue that sports ethics may be overlooked in sports medicine education.

Substitute the star?

Whenever an injury occurs the team physician typically has 30 s on the pitch or a few minutes on the sidelines to clear a player to continue to play. The physician may be pressured by the coach/manager for a quick decision, with the coach often expecting the player to be cleared to play on. The physician must consider the short and long-term risks and benefits to the player if he or she continues to play. The physician's primary responsibility is towards the player, regardless of the coach/manager's wishes.

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  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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