Concussions. CTE. How can a moral person watch (NFL) football?
There is no simple or singular answer. But there are a number of considerations that people ought to weigh to start getting at an answer. This is a first pass at these considerations, but there are at least four: empirical questions, athlete autonomy, mitigation/education, and fan responsibility.
The main empirical question is what is the causal relationship between concussions (and sub-concussive hits) and CTE (and other long-term brain injuries and conditions).
We know there is a significant risk of concussions in football. We know that there is some relationship between concussions and long-term brain injuries like CTE. But we are still learning about the nature and extent of this relationship. There is a lot that remains unknown.
The literature on neurobehavioral sequelae and long-term consequences of exposure to recurrent head trauma is inconsistent. Clinicians need to be mindful of the potential for long-term problems such as cognitive impairment, depression, etc in the management of all athletes. However, there is much more to learn about the potential cause-and-effect relationships of repetitive head-impact exposure and concussions. The potential for developing chronic traumatic encephalopathy (CTE) must be a consideration, as this condition appears to represent a distinct tauopathy with an unknown incidence in athletic populations. A cause-and-effect relationship has not yet been demonstrated between CTE and SRCs or exposure to contact sports. As such, the notion that repeated concussion or subconcussive impacts cause CTE remains unknown. (McCrory P, et al. Br J Sports Med 2017;51:838–847)
- What is the causal relationship? How deterministic is it?
- What is the nature of the risk for CTE (etc.) from a given number of concussions (&sub) in a given time-frame?
- What other factors: environment, genetic, age, sex, number of impacts, type of impact, etc., can affect this causal relationship in significant ways?
How these questions get answered are essential for drawing conclusions about the danger and risk of football. And we don’t have answers yet. That’s not to say we shouldn’t be cautious and work to reduce concussions in sport. Of course we should (and the above consensus report has extensive recommendations on this front). We know there is danger here—we just don’t how much, how far-reaching it is, or what the extent of the risk is.
The ethics of watching (or playing for that matter) football is not merely an empirical question. Football might be quite dangerous and risky, but that in it of itself is an insufficient warrant to prevent the activity. We still need to weigh the value of individual autonomy and liberty for choice in the projects of one’s life. For most, the presumption is that autonomous choice cannot be interfered with except where it causes harm to others. Several hundred years of political philosophy has tried to clarify every aspect of this: What counts as autonomous choice? What counts as interference? What counts as harm? Can we draw a line between harm to others and harm to self?
Leaving aside those important thorny issues, if we assume the playing of football is sufficiently autonomous then it is hard to see what objection there would be for those wishing to watch it. If it fails to be sufficiently autonomous, then that should give us strong reasons to stop watching (or playing).
The autonomy question is one of the reasons that the concern about concussion and CTE is different from the long-term debilitating injuries to knees, backs, shoulders, and so on that ex-football players suffer with. One might have to use a wheelchair to get around because his knees are so shot, but he still have his mind. He can still make choices and plan his life. But this might not be true for one suffering from CTE or other serious long-term brain injuries. So if there is a strong link between concussion and CTE or other brain-debilitating conditions, then this raises the question of just how autonomous football actual is.
- If we assume the worst about the connection between concussion and CTE, does this undermine autonomy (either now or in the future)?
- Should we interfere now in order to prevent someone from depriving himself of autonomy later in life?
- Can one freely and reasonably choose to deprive himself of autonomy later in life?
Another question that fans should ask themselves is: are the leagues, players, and other stakeholders working towards dealing with, controlling, preventing, and/or treating concussions? If they are not, that might give a fan a good reason to withdraw support for the sport by no longer watching.
Does one’s watching of football causally contribute to concussion/CTE? What responsibility does the fan have?
Let’s say we are reasonably confident that there is high risk of long-term brain damage to those playing football. Let’s further say that this is still compatible with athlete autonomy. A fan might still be concerned that his or her watching is contributing in some way to the damage being done to the player (even if, ex hypothesis, it is autonomously chosen).
This raises complex philosophic questions about collective and aggregated responsibility that can’t be addressed here. Nevertheless, it is obviously true that without fans there is no professional sport. But one’s individual contribution to the practice is beyond minuscule. It is the proverbial drop in the ocean. So if one’s minuscule contribution hardly marks a causally difference one way or the other, then it is reasonable to ask whether withdrawing one’s fan support has any meaningful effect. If it doesn’t, then it seems unreasonable to say that, other things being equal, one has an obligation to stop watching.
How do weigh and balance all this? That’s something worth thinking more about, but I do think that to get to the conclusion that it is wrong to watch football, you have to have good reason to think that at least one or two of the following (if not all) are true:
- The risk of CTE (or other serious long-term brain injury) is severe, significant, and far-reaching.
- That this danger is too severe to be sufficiently autonomous or that the danger has sufficient effect on future autonomy such that we ought to be preventing or significantly restricting the activity.
- The leagues, etc., are not doing even the moral minimum to mitigate, prevent, or educate about concussions.
- Fan responsibility is sufficient that one has an obligation to withdraw their support.
While there is much room for rational disagreement and the need for continual reassessment of these issues, I am not yet prepared to assent to any of these claims.
- J. Angelo Corlett. Should and will Inter-collegiate Football Programs be Eliminated?. Sport, Ethics and Philosophy, 8:2, 2014.
- Patrick Findler. Should Kids Play (American) Football?. Journal of the Philosophy of Sport, 42:3, 2015.
- Francisco Javier Lopez Frias and Mike McNamee. Ethics, Brain Injuries, and Sports: Prohibition, Reform, and Prudence. Sport, Ethics and Philosophy. 11: 3, 2017.
- Pamela R. Sailors. Personal Foul: an evaluation of the moral status of football. Journal of the Philosophy of Sport. 42: 2, 2015.
- McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016 Br J Sports Med 2017; 51:838-847.