Mike McNamee

The use of platelet rich plasma as a novel treatment is discussed in the context of a qualitative research study comprising 38 interviews with sports medicine practitioners and other stakeholders working within the English Premier League during the 2013–16 seasons. Analysis of the data produced several overarching themes: conservatism versus experimentalism in medical attitudes; therapy perspectives divergence; conflicting versions of appropriate evidence; subcultures; community beliefs/practices; and negotiation of medical decision-making. The contested evidence base for the efficacy of PRP is presented in the context of a broader professional shift towards evidence based medicine within sports medicine. Many of the participants while accepting this shift are still committed to casuistic practices where clinical judgment is flexible and does not recognize a context-free hierarchy of evidentiary standards to ethically justifiable practice. We also discuss a tendency in the data collected to consider the use of deceptive, placebo-like, practices among the clinician participants that challenge dominant understandings of informed consent in medical ethics. We conclude that the complex relation between evidence and ethics requires greater critical scrutiny for this emerging specialism within the medical community.

This article examines the normative foundation of Paralympic classification, focusing on three interconnected ideals articulated in the International Paralympic Committee’s Classification Code: fairness, meaningful competition, and sporting excellence. We develop a specific fair equality of opportunity principle for Paralympic sport (FEOPps), providing a philosophically grounded ethical framework for evaluating classification systems. The principle requires that inequalities between competitors in sport-specific activity limitations resulting from an eligible impairment be eliminated where pragmatically possible and otherwise minimized. This applies when inequalities significantly and systematically impact performance and remain beyond competitors’ influence and control. Building on Rawlsian contractualism and Loland’s fair play theory, we argue that fairness takes lexical priority over other considerations, establishing deontological constraints within which meaningful competition and sporting excellence can be pursued. Meaningful competition occurs when athletes with evenly matched performance potential engage in fair contests with uncertainty of outcome, thereby enabling the display of authentic sporting excellence achieved through talent and effort. This neo-Aristotelian interpretation connects Paralympic sport to broader ideals of human flourishing through meritocratic practices that cultivate virtue and excellence. Applying our ethical framework to current procedures, we show how FEOPps provides both philosophical justification and practical guidance for Paralympic classification systems while highlighting the need for continued normative reflection on the fundamental nature and purposes of Paralympic sport.

Criticisms of the ethical justification of antidoping legislation are not uncommon in the literatures of medical ethics, sports ethics and sports medicine. Critics of antidoping point to inconsistencies of principle in the application of legislation and the unjustifiability of ethical postures enshrined in the World Anti-Doping Code, a new version of which came into effect in January 2009. This article explores the arguments concerning the apparent legal peculiarities of antidoping legislation and their ethically salient features in terms of: notions of culpability, liability and guilt; aspects of potential duplication of punishments and the limitations of athlete privacy in antidoping practice and policy. It is noted that tensions still exist between legal and ethical principles and norms that require further critical attention.

Vulnerability is a multifaceted concept used across disciplines, yet in the context of sport integrity, it remains underexplored and lacks a clear conceptualisation despite its growing usage and wider application. This paper critically examines how the concept of vulnerability is currently incorporated in different sport integrity contexts and research literature. It proposes a novel understanding of vulnerability informed by the fields of research ethics and bioethics, specifically in relation to established analyses and operationalisations of vulnerability. Drawing on the layered account of vulnerability, we conceptualise vulnerability as relational and dynamic, moving beyond fixed and stereotypical categorisations of vulnerability. Our understanding of vulnerability expands the understanding of this concept from its more common association with doping behaviours and populations and illustrates how the layered approach can be helpful in identifying and analysing vulnerability across different sport integrity contexts. In doing so, this paper demonstrates how a bioethics-informed approach can enhance the conceptual clarity and support a more consistent application of vulnerability within sport integrity field.

Since the manipulation of sport competitions became one of the main threats to sport integrity, both the academy and international organizations have sought to establish a coherent conceptual framework that defines what criteria determine a manipulation and what are the factors that might cause it. Although the literature has shown that the manipulation of sport competition is a multifaceted phenomenon that includes individual, relational, organizational and institutional variables, most of the authors have focused their explanations on individual factors, and institutional prevention campaigns continue to understand match-fixing as a problem of moral failure of on-field sports actors. This work proposes a novel dynamic framework for analysis based on the theoretical roots on Morin’s paradigm of complexity and Archer’s critical realism. In addition to articulating the micro, meso, and macro factors together, the paper defends the idea of three conceptions of integrity, personal, competition and institutional, often operating simultaneously in the same space. Each one of these integrities, operates across individual, organizational and structural levels, acting recursively on the others, generating the gears of the global sports integrity. We then discuss the reasons, structures, opportunities and incentives that each of these integrities creates and fuels. We argue that the errors and ineffectiveness of the fight against the manipulation of sport competitions are largely due to a lack of understanding of, and appreciation for, the different conceptions of integrity and their interactions that require different approaches and differentiated public policies. We conclude with innovative possibilities for more effective policy-making processes in this space.

Classification is one of the distinctive features of Paralympic sport. Despite the existence of classification rules and a well-defined classification process, some Paralympic athletes intentionally misrepresent their abilities to classifiers in order to be allocated to a lower performing competition class, in which they secure an unfair advantage over other athletes. Such deception undermines the integrity of the competition by exploiting a vulnerability in the classification process. Such manipulation is hard to mitigate and harder still to prove that an athlete had; intentionally misrepresented their abilities or; failed for innocent reasons to make maximum efforts during the classification or; had acted under coercive pressure from others in their entourage or environment. These challenges are compounded in the case of Paralympic athletes that have an intellectual impairment or who are accompanied by a parent/guardian who acts as a proxy, rendering evaluations as to responsibility even more complex. This article presents a conceptual analyses of intentional misrepresentation of abilities in Paralympic sport, and the differentiation of responsibility for offence thereupon, as stipulated in the draft of the International Standard for Intentional Misrepresentation, accompanying the new 2025 Athlete Classification Code (IPC, Citation2024). Drawing on philosophical and legal analysis we (i) set out existing shortcomings associated with Paralympic classification; (ii) articulate the range of potential intentional misrepresentational acts with respect to classification manipulation; and (iii) articulate the range of negative effects on the integrity of Paralympic sport.

This special issue examines critical ethical, legal, and policy debates surrounding brain trauma in sport, focusing on challenges in concussion management practices and protocols. Brain injury concerns extend beyond traditional contact sports like boxing, encompassing sporting activities involving rapid acceleration, deceleration, and surface impacts, such as cycling and equestrian sports. Among such problems are the identification and management of brain injuries, the roles of officials and healthcare professionals, and the broader implications for sport integrity and athlete careers. The special issue is organized into four sections: ethics of concussion medicine, socio-legal aspects, sport ethical dimensions, and public health policies. Contributions discuss concussion management in youth sport, sport federations’ and athletes’ duties involvement in concussion-related research, strategies to support and enhance athlete autonomy, public health-informed brain injury frameworks, conflict of interest in concussion management protocols, litigation and liability in concussion research and collaboration, race and genomics in brain-injury scientific discourses, rule changes in sport to reduce head impact, the contextual nature of brain injury and athlete decision-making, the ethical use of genetic testing in brain-injury related research, marketing strategies to advertise tackle football to children and adolescents, and policy purposes and evidence underpinning concussion management practices. This comprehensive exploration offers diverse disciplinary insights, making it a crucial resource for sport humanities scholars, policymakers, and medical professionals. Keywords: brain injury, sport ethics, concussion, sport law, sport policy.

This article critically examines the development and consensus outputs of the Concussion in Sport Group. We examine the six Consensus Statements between 2001 and 2023 to explore the challenges that the presence of contextual forces pose to the development of effective and ethically justifiable medical guidelines to manage situations involving brain-injured athletes. First, we discuss the implicit and explicit ethical framework and goals underlining the statements. Secondly, drawing on a relational account of athlete choice, we expound on the limitations of the framework, concentrating on those resulting from a simplified understanding of athlete autonomy. Thirdly, we conclude by proposing a series of recommendations to improve concussion management protocols: (1) adopting a broader understanding of autonomy built upon relational accounts, beyond just the healthcare professional-athlete relationship; (2) further minimizing conflicts of interest that increase athletes’ vulnerability and hinder decision-making ability; (3) enhancing healthcare professional training to allow better adjustment of treatment plans to athletes’ contexts; and (4) promoting research on sociocultural elements affecting athletes’ vulnerability and autonomy.

Since the manipulation of sport competitions became one of the main threats to sport integrity, both the academy and international organizations have sought to establish a coherent conceptual framework that defines what criteria determine a manipulation and what are the factors that might cause it. Although the literature has shown that the manipulation of sport competition is a multifaceted phenomenon that includes individual, relational, organizational and institutional variables, most of the authors have focused their explanations on individual factors, and institutional prevention campaigns continue to understand match-fixing as a problem of moral failure of on-field sports actors. This work proposes a novel dynamic framework for analysis based on the theoretical roots on Morin’s paradigm of complexity and Archer’s critical realism. In addition to articulating the micro, meso, and macro factors together, the paper defends the idea of three conceptions of integrity, personal, competition and institutional, often operating simultaneously in the same space. Each one of these integrities, operates across individual, organizational and structural levels, acting recursively on the others, generating the gears of the global sports integrity. We then discuss the reasons, structures, opportunities and incentives that each of these integrities creates and fuels. We argue that the errors and ineffectiveness of the fight against the manipulation of sport competitions are largely due to a lack of understanding of, and appreciation for, the different conceptions of integrity and their interactions that require different approaches and differentiated public policies. We conclude with innovative possibilities for more effective policy-making processes in this space.

The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes.

Advances in genetics and related biotechnologies are having a profound effect on sport, raising important ethical questions about the limits and possibilities of the human body. Drawing on real case studies and grounded in rigorous scientific evidence, this book offers an ethical critique of current practices and explores the intersection of genetics, ethics and sport. Written by two of the world's leading authorities on the ethics of biotechnology in sport, the book addresses the philosophical implications of the latest scientific developments and technological data. Distinguishing fact from popular myth and science fiction, it covers key topics such as the genetic basis of sport performance and the role of genetic testing in talent identification and development. Its ten chapters discuss current debates surrounding issues such as the shifting relationship between genetics, sports medicine and sports science, gene enhancement, gene transfer technology, doping and disability sport. The first book to be published on this important subject in more than a decade, this is fascinating reading for anyone with an interest in the ethics of sport, bioethics or sport performance.

"The ethics of sports medicine is an important emerging area within biomedical ethics. The professionalisation of medical support services in sport and continuing debates around issues such as performance-enhancing technologies or the health and welfare of athletes mean that all practitioners in sport, as well as researchers with an interest in sports ethics, need to develop a clear understanding of the ethical aspects of the sport-medicine nexus. In this timely collection of articles, sports ethicist Mike McNamee and other leading international scholars explore the conceptual and practical issues that shape and define ethics in sports medicine. Examining central topics such as consent, confidentiality, pain, doping and genetic technology, this book establishes an important baseline for future academic and professional work in this area. "--

Philosophy and the Sciences of Exercise, Health and Sport is a unique interdisciplinary study that calls on researchers in these disciplines to reflect more critically on the nature and aims of scientific enquiry. In doing so, the book questions the underlying assumptions and development of science itself. Written by a range of internationally respected philosophers, scientists and social scientists, each chapter addresses a key issue in research methodology. Questions asked by the authors include: Do natural and social scientists need to understand the philosophy of science? Are statistics misused in sport and exercise science research? Is sport science research gender-biased? How do external and commercial interests skew professional guidelines in health and sport reserach? Should scientists focus their attention on confirmation of theories, or on attempts to falsify them? Philosophy and the Sciences of Exercise, Health and Sport serves notice to exercise, health and sport researchers to think more philosophically about their subject and its scientific bases. It is essential reading for postgraduate researchers seeking to establish a sound theoretical foundation for their work.

The Routledge Handbook of the Philosophy of Sport is a landmark publication in sport studies. It goes further than any book has before in tracing the contours of the discipline of the philosophy of sport and in surveying the core themes, approaches and theories that form its disciplinary fabric. The book explores the ways in which an understanding of philosophy can inform our understanding of important prevailing issues in sport. Edited by two of the most significant figures in the development of the philosophy of sport, Mike McNamee and Bill Morgan, and with contributions from many of the world’s leading sport philosophers, this is an invaluable companion reference volume for any course in the social scientific study of sport, and an essential addition to the bookshelf of any serious scholar of the philosophy and/or ethics of sport.

Morgan has argued that attitudes to the medicalisation of sports are historically conditioned.While the history of doping offers contested versions of when the sports world turned againstconservative forces, Morgan has argued that these attitudes are out of step with prevailingnorms and that the World Anti Doping Agency's policy needs to be modified to better reflectthis. As an advocate of critical democracies in sports, he argues that anti-doping policy mustacknowledge and reflect these shifts in order to secure their legitimacy. In response, wecritically present the World Anti-Doping Agency's policy that incorporates the Prohibited Listof Substances and Methods for athletes. We evaluate the validity of the therapy-enhancementdistinction in relation to its role in both justifying and sustaining the operation of theProhibited List. In particular, we focus on the case of thyroxine, which has been the subjectof controversy in athletic doping. While thyroxine is not currently banned, critics haveclaimed that its use in the absence of a relevant pathology is tantamount to doping. Wechallenge Morgan's claim that a conventionalist defence of the therapy-enhancementdistinction is the best available, and his conclusion that this properly supports a morepermissive stance towards performance-enhancing drug use. Furthermore, we reject hisconventionalist support for democratic line drawing in relation to doping and in particular thestatus of thyroxine with regard to the prohibited list. We offer a modified defence of the statusquo, a qualified, naturalist account of health and disease, where athletes may be prescribeddrugs that are genuine responses to medical necessity that do not, or do not typically, threatenthe goods of athletic excellence.

In this paper, we explore the issue of the elimination of sports, or elements of sports, that present a high risk of brain injury. In particular, we critically examine two elements of Angelo Corlett’s and Pam Sailors’ arguments for the prohibition of football and Nicholas Dixon’s claim for the reformation of boxing to eliminate blows to the head based on the empirical assumption of an essential or causal connection between brain injuries incurred in football and the development of a degenerative brain disease known as chronic traumatic encephalopathy ; and John Stuart Mill’s rejection of consensual domination. We present four arguments to contest the validity of Corlett, Dixon’s and Sailor’s positions. Specifically, we argue that certain autonomy-based arguments undermine paternalist arguments for reform; the nature of the goods people pursue in their lives might justify their foregoing future autonomy; Mill’s argument against consensual domination draws on ambiguous and arbitrary distinctions; the lack of consensus and empirical evidence regarding CTE arising from brain injuries in sport underdetermines calls for reform. We conclude that these proposals for reforming or eliminating sports with high risks of brain injuries are not well founded.

The influence of neuroscience looms large today. In this introductory essay, we provide some context for the volume by acknowledging the expansion of applied neuroscience to everyday life and the proliferation of neuroscientific disciplines. We also observe that some individuals have sounded cautionary notes in light of perceived overreach of some claims for neuroscience. Then we briefly summarize the articles that comprise this volume. This diverse collection of papers represents the beginning of a conversation focused on the intersection of sport, ethics and neurophilosophy. As such, the essays also represent a new mode of interaction between philosophy and science with sport in the center of the discussion.

In light of the World Anti Doping Agency’s 2013 Code Revision process, we critically explore the applicability of two of three criteria used to determine whether a method or substance should be considered for their Prohibited List, namely its (potential) performance enhancing effects and its (potential) risk to the health of the athlete. To do so, we compare two communities of human guinea pigs: (i) individuals who make a living out of serial participation in Phase 1 pharmacology trials; and (ii) elite athletes who engage in what is effectively ‘unregulated clinical research’ by using untested prohibited or non-prohibited performance enhancing substances and methods, alone or in combination. Our comparison sheds light on norms of research ethics that these practices exacerbate with respect to the concepts of multiplicity, visibility, and consistency. We argue for the need to establish a proper governance framework to increase the accountability of these unregulated research practices in order to protect the human guinea pigs in elite sports contexts, and to establish reasonable grounds for the performance enhancing effects, and the risks to the health of the athlete, of the methods and substances that might justify their inclusion on the Prohibited List.