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The Role of the Medical Profession in Boxing

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The Role of the Medical Profession in Boxing CONTROVERSY 513 The not-so-sweet science defeat of Max Schmelling in 1938 J Med Ethics: first published as 10.1136/jme.2003.003541 on 5 October 2004. Downloaded from ....................................................................................... united Americans of all races and stifled Hitler’s claim of Aryan super- iority. If a consequentialist position is The not-so-sweet science: the role of the adopted, based on a diachronic evalua- tion of boxing, then boxing should be medical profession in boxing permitted. It is tempting, for those unfamiliar D K Sokol with the sport, to interpret too literally the gruesome pre-fight threats of box- ................................................................................... ers. The animosity is rarely genuine; it is an essential component of the market- The medical profession’s role should be limited to advice and ing plan, as well as an exercise in information psychological intimidation. Dr Herrera’s assertion that fighters ‘‘can he medical establishment’s desire to other high risk sports, claiming that a even predict the killing before the fight, interfere with the autonomous boxer can kill his opponent without for the press’’ is irrelevant. The meta- Twishes of boxers seems at odds with breaking any rules whereas this is not phors of boxing are indeed more belli- the principle of respect for autonomy the case in other sports. This last cose than in other sports, but critics prevalent in contemporary biomedical statement is surely false. A hard hitting should interpret the metaphors as lin- practice. I argue that the role of the rugby tackle can propel a player back- guistic flourishes, not as literal expres- medical profession in boxing should be wards causing him to suffer fatal spinal sions of intent. A boxer who threatens solely an advisory and informational injuries. A cricket ball travelling at a 100 to ‘‘kill’’ his opponent in a pre-fight one. In addition, the distinctions made miles per hour and hitting a player’s conference (or ‘‘eat his children’’, as one between boxing and other high risk unprotected skull can cause death, notorious heavyweight recently said) is sports often rely on an insufficient although no rule is broken. The differ- no more intent on actually killing his knowledge of the sport. This leads to ence between boxing and those other opponent than a baseball pitcher who misdirected criticisms and excessive sports does not revolve around the legi- threatens to pierce the batter’s body emphasis on the colourful discourse of timacy of the act leading to the death with a lightning throw. He primarily boxing, as opposed to the practice of but, possibly, the intent of the agent wants a wider audience, and perhaps a boxing itself. Dr Herrera’s claim in his responsible for the death. A boxer psychological advantage over his oppo- article (see page 514) that boxing differs intends to inflict physical damage to nent. The discourse of boxing is separate from other sports in the acceptability of his opponent. A ‘‘knockout’’, referring from the activity itself, and an analysis its acts outside the realm of sport is to a boxer’s inability to stand up after a of the sport should not be confused with refuted.1 The importance of consent as a count of 10, is the ultimate goal in the an analysis of its discourse. legitimising factor is highlighted, and a sport. Yet even this is a moot point. Dr Herrera’s belief that boxing differs number of possible solutions to improve Many boxers will tell you that their aim from other sports by involving acts that safety within the sport are tentatively is to win the contest, not to reduce their would be frowned upon and, indeed, suggested. opponent’s brain to a pulp. No boxer punishable outside the sport is, to my http://jme.bmj.com/ In the United Kingdom, a competent would rejoice at the severe injury of his mind, incorrect. It is usually unaccep- adult may legally refuse medical treat- opponent. Boxers could invoke the table to run towards a person on the ment, irrespective of the severity of his doctrine of double effect, claiming that street, wrap your arms tightly around condition or the validity of his reasons. death is foreseen but certainly not his legs and push him over with your With the pre-eminence of an autonomy intended. The intention is to win the shoulders, as occurs in rugby. Similarly, based model of bioethics, respecting a fight by outboxing the opponent, which it would be equally objectionable to patient’s wishes forms an integral part is not the same as knocking him out. A punch someone in the head while of acting in his best interests. It is boxer can win on points, by the surren- queuing in the supermarket. What on September 25, 2021 by guest. Protected copyright. puzzling, then, to find that the der of his opponent or of his coach, or by would render these acts acceptable, Australian Medical Association have the referee’s stoppage during the fight. however, is consent. Society allows two called for a ban on boxing on the In other words, a knockout is not consenting people to indulge in certain grounds that the activity is excessively necessary for victory. The other justify- activities, however morally repulsive to hazardous to the health of boxers. The ing conditions of the doctrine of double others, that would be unlawful if often mentioned principle of respect for effect could also be satisfied, although performed without mutual consent. If autonomy is abandoned once the person these would no doubt be contested by boxing is to be banned, then good drops the privileged title of ‘‘patient’’. those who see boxing as a social evil. reasons need to be given to show that This suggests that being a patient As an amateur historian of boxing, I boxing differs sufficiently from other confers certain rights which would not have little doubt that the sport, at least ‘‘dangerous’’ or ‘‘immoral’’ activities exist if that same patient were healthy. in the last 100 years, has done more that even informed consent is inade- How, if at all, can this apparent incon- good than harm, by giving hope to many quate to justify it. I am so far uncon- sistency be justified by those in the young men who perhaps initially had vinced by the reasons given by medical community who wish to see none, and encouraging them into gyms. opponents of boxing. boxing banned? I largely agree with Dr Boxing contests have also served to My own view is that the medical Herrera’s position on the matter, which symbolise broader social and political profession should inform boxers and is essentially that precautionary brain struggles. The first African-American those involved in the sport (coaches, scans should be performed but that heavyweight world champion, Jack referees, and so on) of the potential boxing should not be banned. A few Johnson, who fought in the first few dangers of boxing, as well as suggesting points, however, remain unclear. decades of the 20th century, was an ways to minimise the risks. The obliga- Dr Herrera criticises the frequent inspiration to African-Americans across tion stops there. The role of the profes- comparisons made between boxing and the country. Joe Louis’s resounding sion should be no more than advisory www.jmedethics.com 514 CONTROVERSY and informational—the changes need to often, boxing managers pitch their J Med Ethics 2004;30:513–514. J Med Ethics: first published as 10.1136/jme.2003.003541 on 5 October 2004. Downloaded from be made within the sport itself. Perhaps boxer against evidently better or inferior doi: 10.1136/jme.2003.004952 fights can be reduced from 12 rounds to boxers to keep flawless records or to Correspondence to: D K Sokol, Medical Ethics 10 or eight rounds, just as it was acquire a significant one-off pay cheque. Unit, Department of Primary Health Care and reduced from 15 to 12 a few years ago. More than discrediting the sport gen- General Practice, Imperial College London, Intervals between the rounds can be erally, it heightens the risk of serious Reynolds Building, St Dunstan’s Road, London W6 8RP, UK; [email protected] extended to allow greater time for injury for the sacrificial lamb whose recovery. Headgear can be improved to chances of winning are next to none. Received 21 May 2003 cushion blows further. Referees can stop Boxing is indeed in need of reform, but Accepted for publication 9 February 2004 fights earlier if the contest is unevenly the medical profession’s role in this matched, or if a fighter has suffered should be limited to advice and infor- some particularly punishing blows. mation. The principle of respect for REFERENCE More generally, the world of boxing is autonomy should prevail for boxers 1 Herrera CD. Boxing is like… J Med Ethics in need of a radical change of ethic. Too and patients alike. 2004;30:XXX. the boxers. They take the risks, but are ....................................................................................... listened to least. Is this because they have the fewest initials after their names, or because some boxers seem The search for meaningful comparisons less interested in debate without fists? Either way, it is unfortunate that in boxing and medical ethics boxers, who might have something meaningful to add, are drowned out in C D Herrera the debate over their sport. ................................................................................... This debate finds Joyce Carol Oates Boxers and healthcare workers alike should be able to exercise cited more often than the BMA their rights In this context, sorting through the comparisons is not easy, and that is lthough there are calls elsewhere is an expression of individualism and what needs to be done.
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