National Football League: The Fault in Concussion Protocol (2017)

Controversy

Concussions in Football

In the 1800s, rugby started to become popular in America, but it was not adapted for American culture. Thus, American football was created. Football started in 1920 with 11 clubs in Canton, Ohio. These eleven clubs made up the American Professional Football Association, founded by Jim Thorpe, but was renamed to the National Football League (NFL) just two years later. The rival league to the NFL, known as the American Football League (AFL), formed in 1940 (Klein 2014). Football became increasingly popular and became sports fans' favorite sport in 1965. Then, in 1966, the commissioner of the AFL-NFL, Pete Rozelle, agreed that the NFL and the AFL would begin merging in 1967 and be fully merged by 1970. The first Super Bowl was the game between the best team from the AFL and the best team from the NFL in 1967. During the merger, the teams from the AFL became the American Football Conference and the teams from the NFL became the National Football Conference ("Pro Football Hall..."). Now, the Super Bowl game, arguably the most important game of each year, is between the champions of each conference. These are violent games in nature, and they cause many injuries, including concussions.

Concussions are severely detrimental to a person’s health. A concussion is defined as a traumatic brain injury caused by a bump, jolt, or blow to the head that causes the brain to move back and forth rapidly in the head. Symptoms can occur immediately after the injury, or they can be delayed by as much as several hours. Without being properly treated, a concussion can have long term effects to a person’s health, including (but not limited to) Chronic Traumatic Encephalopathy (CTE), changes affecting thinking, sensation, language, and emotion, and even death ("What is CTE?").

Over the last few years, many lawsuits have been pursued against the NFL by the families of players who eventually suffered from CTE. According to the Concussion Legacy Foundation, CTE is when a "protein called Tau forms clumps that slowly spread throughout the brain, killing brain cells" ("What is CTE?"). Many players who suffered from CTE died; this is and was such a big issue that a movie was made to bring awareness to this issue. The movie, starring Will Smith, came out in 2015 and is called Concussion. Due to these issues, the NFL was forced to change their policies.

Tom Savage - December 10, 2017

On December 10th, 2017, NFL quarterback of the Houston Texans, Tom Savage, fell to the ground after being violently tackled during an offensive play. In a video that can be seen on YouTube, Tom Savage hit his head on the ground and went on to have seizure-like body movements. According to Tiki Barber, a former player in the NFL, Tom Savage exhibited clear signs of having a concussion. He stated that Savage was "staring blankly into the sky with his hands twitching and him not being able to move" (Time_Sports 2017). Afterwards, he was taken through the NFL's Sideline Concussion Assessment, which is a method that NFL and NFL affiliates use to determine if a player has a concussion. The assessment cleared Savage to continue playing in the game. After only one series of plays, he was taken back out of the game for further assessment and was deemed incapable of returning; the second assessment showed that Savage did, in fact, have a concussion (Seifert 2017).

Jacoby Brissett - November 12, 2017

On November 12th, 2017, Jacoby Brissett, quarterback of the NFL's Indianapolis Colts, also suffered a head injury during an offensive play against the Pittsburgh Steelers. Slow to stand up, he completed the same sideline concussion protocol that Savage did, and was cleared to continue playing. However, after a few plays, he was taken out and declared to have a concussion (Seifert 2017).

One might ask, how did the concussion protocol clear both players when they exhibited visually evident concussion symptoms? The current NFL concussion process starts with the referee sending the player in question to the sideline. This occurs when the referee or medical professionals see that a player exhibits one or more of the following symptoms: confusion, amnesia, loss of consciousness, “blank or vacant” look, slow rise from the ground, balance issues, or a clutching of the head. When being examined, medical professionals look for headaches, dizziness, balance difficulties, nausea, amnesia, disorientation, a ringing in the ears, and sensitivity to light or sound. During the initial test after a player suffers a head injury or concussion-like symptoms, players are taken to a tent where they are asked about the history of the event, such as what they were doing, what happened, etc. The policy also requires video of the hit to be evaluated by the medical professionals. Then, they are given a focused neurological exam that includes a cervical spine examination, speech evaluation, and a physical movement and eye movement evaluation. If the test results in a positive diagnosis of a concussion, or inconclusive or suspicious results, the player must be sent to the locker room for further evaluation. If they are not cleared, they cannot return to the game. If a player is cleared, the policy requires that the player is constantly evaluated while they play for the rest of the game. If any other symptoms appear, they will be sent to the locker room. Some concussion symptoms have delayed onset (Seifert 2017).

The NFL requires that an unaffiliated neuro consultant (UNC) must be present at every game in order to evaluate players who may get concussions (Mortensen 2017). However, this has not always been the case. Before Tom Savage and Jacoby Brissett suffered head injuries, only the team's medical professional was required to be at the game evaluating players' health. Realizing that there were flaws in this system after these incidents occurred, the NFL incorporated their new rule of requiring a UNC at every game. The UNC must give their professional opinion and if it does not match the team physician’s opinion, the UNC will be given an opportunity to explain their reasoning behind their opinion. Ultimately, however, the decision is up to the team physician, and they will communicate their decision to the player. Many teams use their own hired medics; therefore, each medic is affiliated with the team, and not directly with the NFL. It seems that medics are subject to coercion from the teams. Since they are paid by the teams, they are strongly encouraged to evaluate the important players of that team as healthy, whether they actually are or not.

Through considerations of each of the four ethical theories, it is found that the NFL allowing teams to rely on their own medical professionals when evaluating players is ethically impermissible.

Individualism

According to Milton Friedman's Individualism Theory, the goal of business is to profit, so anything done in order for a business to make a profit is ethically permissible as long that it stays within the law (Salazar 2018). Since there are no laws state-wise or in the United States in general preventing sports affiliations from putting injured players back into games, the NFL did not do anything wrong according to individualistic theory. The NFL franchise brought in $13 billion in 2017. This was largely in part of keeping their good players in the game. Since the best players in any sport are the ones to play most often, they are the most susceptible to head injuries and concussions. They are also the ones that bring in the most money. People generally admire and support good players, so they bring in the most revenue. When a player like this gets injured, it damages the revenue and business. Putting important players, who may be injured, back into the game keeps supportive fans in tune. Though they may not play as well, the benefits outweigh the risks regarding the NFL business. Therefore, under Individualism, players returning to the game based on the recommendation of the team's medical professionals is ethically permissible.

Utilitarianism

John Stuart Mill created the Utilitarianism Theory of Ethics and it is centered around people's happiness. In this theory, everyone deserves happiness equally, so it evaluates all of the stakeholders' happiness and reaches an ethical conclusion based on the number of people who will be happy (Salazar 2018). In this situation, the stakeholders are the injured NFL players, their families, their teammates, the coaches, the NFL and its affiliates, and all NFL fans. In both cases of injury, the teams sent the injured players back into the game after evaluation. Doing so caused the players to potentially become more injured, so they would not be happy. The teams are affected because they could win the game if their good players are in the game, but they could lose the game if the players who are playing are extremely injured. Therefore, the teammates would be indifferent in this sense. The players' families would be upset to learn that their loved one is playing while injured. Since it could lead to further injury, it is dangerous to continue playing, and the families would not be happy to learn that this was occurring. The NFL fans would be upset. It is known that fans who learned about the effects of concussions and the nature of football relating to concussions have turned away from the sport. They refuse to allow their children to play for fear that they will get concussions that will have lasting damage. Therefore, under Utilitatianism, players returning to the game based on the recommendation of the team's medical professionals is ethically impermissible.

Kantianism

A player entering the medical tent

Kantianism is an ethical theory that was developed by Immanual Kant. The theory behind this is that people should do the right thing for the right reason. A person or business should act in Good Will; that is, the acts should be intrinsically good. This stems from a person's innate rationality. Additionally, it it ethically impermissible under Kantianism to use people as a mere means to an end. This includes lying and deceit. The idea behind Kantianism is also the fact that people should be able to make their own decisions based on all of the information (Salazar 2016). Relating back to the incidents involving Tom Savage and Jacoby Brissett, the NFL medical professionals surely did not send the players back into the game for the right reason. It was clear that both exhibited clear signs of having a traumatic brain injury on the field, yet they were both cleared to continue playing. The medical professionals had to know that these players were unfit to continue playing, but for the sake of the NFL and the game's outcome, they sent the players back into the game. Therefore, the medical professionals in the NFL did not act in Good Will; these decisions were made for the wrong reasons. Additionally, the players were used as a mere means to an end. Their health was endangered in order for the team to win and the NFL to make more money. The medical professionals are professionals; they were given all of the information needed to make the right decision, yet they failed to do so. Therefore, under Kantianism, players returning to the game based on the recommendation of the team's medical professionals is ethically impermissible.

Virtue Theory

Virtue Theory was thought to have been invented by Aristotle, but it has not gained much popularity over the years. This ethical theory is based on the idea that if something or someone fulfills their purpose, then it is good. A virtue is something that helps and makes people or things better. Therefore, virtues enable someone or something to fulfill its purpose. According to Aristotle, a person is happy if they fulfill their function. The four virtues of character are courage, honesty, self-control, and fairness (Salazar 2018). For this case, the football players who were sent back into the game injured were fulfilling their purpose of being football players. Savage and Brissett fulfilled their function of playing football, which is their career. On the other hand, the teams' medical professionals were not courageous. They did not stand up for what they know is right, which would be to bench these players. Evidently, the medical professionals were not honest; they should have known that the players were concussed, yet they were not honest and, therefore, did not do the right thing. Therefore, under Virtue Theory, players returning to the game based on the recommendation of the team's medical professionals is ethically impermissible.

Most of the information presented points to the idea that what the medical professionals did was unethical. Though they may have been coerced into doing so, sending injured Savage and Brissett back into the game was not the right thing to do.

Works Cited

Klein, Christopher. “The Birth of the National Football League.” History.com, A&E Television Networks, 4 Sept. 2014,
     www.history.com/news/the-birth-of-the-national-football-league.

Mortensen, Chris. “NFL Adds Neurotrauma Consultants as Part of Revised Concussion Protocol.” ABC News, ABC News
     Network, 29 Dec. 2017, abcnews.go.com/Sports/nfl-adds-neurotrauma-consultants-part-revised-concussion-
     protocol/story?id=52045389.

“Pro Football Hall of Fame.” Pro Football Hall of Fame Official Site,
     www.profootballhof.com/football-history/history-of-football/.

Salazar, Heather. "Kantian Business Ethics." Vaidya, Anand, Fritz Allhoff and Alexander Sager. Business in Ethical Focus.
     Broadview Press, 2016.

Salazar, Heather. Western New England University. Spring Semester 2018 Class Notes.

Seifert, Kevin. “How Is the NFL Concussion Protocol Supposed to Work?” ESPN, ESPN Internet Ventures, 11 Dec. 2017,
     www.espn.com/blog/nflnation/post/_/id/261317/how-is-the-nfl-concussion-protocol-supposed-to-work.

Time_Sports. “Tiki Barber: Tom Savage Fiasco Shows NFL Concussion Protocol Can't Be Taken Seriously.” USA Today,
     Gannett Satellite Information Network, 11 Dec. 2017, www.usatoday.com/videos/sports/2017/12/11/tiki-barber:-tom-
     savage-fiasco-shows-nfl-concussion-protocol-can't-taken-seriously/108511582/.

“What Is CTE?” Concussion Legacy Foundation, 30 Aug. 2017, concussionfoundation.org/CTE-resources/what-is-CTE.