The evidence of brain damage associated with football continues to mount. The National Football League recently reported that nearly a third of former players develop long-term cognitive problems. This on top of the NCAA’s $70 million settlement for testing and diagnosis of brain damage in players over the past 50 years.
It is important to be clear that this settlement is largely about football; the risks of concussion from tennis, track, basketball or any of the other NCAA sports are minimal compared with football. Strikingly, these damaged NFL and college players are a small subset of the over 1 million high school football players, boys who are subjected to the same brain-scrambling forces that the NFL and the NCAA are only now beginning to take seriously.
Local school boards, accountable for the health and well-being of the children and youths in their systems, have moral and legal responsibilities to these football-playing boys and their parents.
Nevertheless, given what we know about the harms from football, school boards still condone – not to mention encourage – participation in football. In the face of mounting evidence of harm, financial dilemmas will surely complicate the moral calculus for these boards. Although technological solutions to concussion prevention are unlikely to be effective, they are certain to be costly. Expensive liability lawsuits at the high school level are inevitable.
This duty of securing informed consent is absent from high school sports, an especially damaging deficiency when it comes to football. Most school systems use the Athletic Participation Consent Form developed by the N.C. High School Athletic Association. Near the top of this four-page form, requiring a signature by a parent and the student, is a brief statement on the Risk of Injury, which reads: We acknowledge and understand that there is a risk of injury involved in athletic participation. We understand that the student-athlete will be under the supervision and direction of a CHCCS athletic coach. We agree to follow the rules and instructions of the coach in order to reduce the risk of injury to the student and other athletes. However, we acknowledge and understand that neither the coach nor CHCCS can eliminate the risk of injury in sports. Injuries may and do occur.
This is not an adequate basis for consent. Given the almost daily emergence of new evidence of harm, of the risks of long-term brain damage, it is unlikely that most parents understand what “risk of injury” means for high school football players. Even if parents do understand the mounting evidence, weighing these harms against perceived benefits of football – at the heart of any true consent form – is not an easy task.
If our local schools, unfortunately, continue to support football, at a minimum, school leaders must require a rigorous and informative consent process. The unthinking cultural zeal for football should not undermine the moral obligations we have to our boys and their parents to make educated decisions.
Lewis Margolis, M.D., is the director of the master’s program in the Department of Maternal and Child Health at the UNC Gillings School of Global Public Health.