State of the Concussion Debate: From Sceptical to Alarmist Claims
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ORIGINAL PAPER
State of the Concussion Debate: From Sceptical to Alarmist Claims Frédéric Gilbert
Received: 7 March 2014 / Accepted: 7 August 2014 # Springer Science+Business Media Dordrecht 2014
Abstract Current discussions about concussion in sport are based on a crucial epistemological question: whether or not we should believe that repetitive mild Traumatic Brain Injury (mTBI) causes Chronic Traumatic Encephalopathy (CTE). This epistemological question is essential to understanding the ethics at stake in treating these cases: indeed, certain moral obligations turn on whether or not we believe that mTBI causes CTE. After discussing the main schools of thought, namely the CTE-sceptic position (which does not admit a causal relation between mTBI and CTE) and the CTEorthodox position (as defended by those who see a causal association between mTBI and CTE), this article examines the concussion debate in sport and asks if its current articulation helps to answer whether or not we should call for responsive, ethical action(s). Keywords Chronic traumatic encephalopathy . Concussion . Epistemology . Ethics . Mild traumatic brain injury . Policy
What to Believe? Recently, there has been substantial media attention to the potential risks of repetitive mild Traumatic Brain Injury F. Gilbert (*) Ethics, Policy & Public Engagement (EPE), ARC Centre of Excellence for Electromaterials Science (ACES), Faculty of Arts, University of Tasmania, Hobart, Tasmania, Australia e-mail: [email protected]
(mTBI) for contact sport players [1]. This surge in media coverage on mTBI has arisen as a result of the identification of Chronic Traumatic Encephalopathy (CTE) as a possible consequence of multiple concussive, possibly also sub-concussive, injuries in both athletes and war veterans. The symptoms of CTE, as well tauopathy, have been observed in individuals who have suffered repeated mTBI (e.g., ex-boxers, ex-American football players, exice hockey players, ex-rugby players, ex-wrestlers, etc.). However, this unprecedented mass media attention to a potential link between CTE and mTBI has shadowed an ongoing academic debate that revolves around an epistemological question: whether or not we should believe repetitive mTBI causes CTE. The answer to this question does not always, but should have a direct bearing on discussions concerning what is (or is not) ethically required to properly address the situation. Indeed, for ethical prescriptions to have meaningful content, they need to derive from what is known from, or believed on the basis of, epistemic authorities [2]. For instance, medical and scientific authorities believe that tobacco contributes to lung cancer; therefore they prescribe smoking bans and other measures to prevent smoking. What we know about repetitive mTBI as a potential contributor to CTE implies whether or not we should suspend our judgment about calls for certain ethical interventions to either stop or relevantly change contact sports. In other words, depending on what is believed, defended or advocated f
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