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Informed Consent Isn’t Just for Academics

Montreal Canadiens v Washington Capitals - Game Five — Brooks Laich of the Washington Captials says he would like to stop having people babysit him.

There has been a lot of talk these last few weeks regarding head injuries and fighting in the NHL. Some people are talking about head hits and what the NHL is doing to prevent them. Some people are talking about concussions and the best way to treat them. Others are talking about the cognitive dissonance shown by those in a league that, while claiming to be “cracking down on headshots,” still allows bare-knuckle fighting within the rules of the game. All are valid discussions, and all are a long way from being resolved, one way or the other.

With all of these discussions, what has interested me is the most is that very little has been heard from the men who actually PLAY the game at its highest level. Where do they weigh in on these subjects? While the media has been up in arms with the latest round of “we need to ban fighting in the NHL” hoopla, the players have been largely silent on the matter. That is, they had been, up until this past Friday (Oct 14). Then, following a game between Pittsburgh and Washington (in which the already belaboured debate surrounding the Asham-Beagle fight began) Brooks Laich, a member of the Washington Capitals (and coincidentally, also the team’s NHLPA rep) was quoted as saying the following (via Chuk Gormley of CSN Washington)

I really don’t care about that awareness crap. To be honest, I’m sick of hearing all this talk about concussions and about the quiet room. This is what we love to do. Guys love to play, they love to compete, they want to be on the ice. How do you take that away from someone? We accept that there’s going to be dangers when we play this game. We know that every time we get dressed. I don’t know, sometimes it just feels like we’re being babysat a little too much. We’re grown men and we should have a say in what we want to do.

At the time, Laich was referring to the NHL’s concussion protocols that were introduced last year in an attempt to prevent players from reinjuring (or further injuring) themselves after sustaining a head injury. That said, what struck me about this statement wasn’t Laich’s stance on the concussion protocols, but rather his attitude toward the risks that he and every player in the NHL assumes when stepping on the ice. Basically he was saying “I’m a grown man. I know there are risks involved in what I do. But I’m making a conscious choice in taking those risks. The consequences are my responsibility.” In essence he was claiming that he and every player who laces up skates in the NHL gives their informed consent to take certain risks with their health when they step on the ice.

One part of me wholeheartedly agrees with Laich. He’s a grown man and he openly acknowledges and accepts that there are risks (some of them serious) associated with what he does for a living. Besides, professional hockey players are not the only professionals in this world who take risks with their health (both in the short- and long-term) in the execution of their jobs. Coal miners risk cave-ins and black lung. Fisherman risk drowning. Lumberjacks risk disfigurement and death from falling trees and heavy machinery. This past weekend we even saw the worst case scenario unfold during the Vegas 300 Indy race when Dan Wheldon was tragically killed in a mid-race crash. All of these individuals know the risks of their respective professions, and still choose to take part. Some do it for love, some do it for money, but all make a conscious choice. Why should hockey players be any different?

And yet there is another part of me that seems to think that, while Laich is right to a point – he is a grown man making his own decisions – his information is incomplete. Many sources define informed consent as when an individual has a clear appreciation and understanding of the facts, implications, and future consequences of an action. But long term brain injury is a serious health risk, and there is still a great deal about concussions that is unknown, even to doctors researching the phenomenon. So if neurologists are still grappling with the problem, how does a professional hockey player really expect to be fully informed about the risks, with a “clear appreciation and understanding of the facts?” Besides, if the precautions mean he misses a shift or two in the “quiet room,” that seems a small price to pay in the name of preserving his long term neurological health.

As with any issue as complex as this, there are no easy answers. There are no “perfect” solutions. But one of the biggest questions I find myself asking – and that I feel may underscore all of these debates – is this: What constitutes “informed” consent? Especially when it comes to an injury that may impair one’s decision making capability, at what point are we able to draw the line, sit back and say “You’ve been warned. Continue at your own peril.”?

Brendan Shanahan: Making the NHL’s Hardest Job Just a Bit Easier

1003-shanahan — Brendan Shanahan looks to be as effective in his role with the NHL as he was on the ice during his craeer.

The NHL season starts tomorrow, but already we have seen a flurry of activity within the league. Most notable among the goings on have been the record number of suspensions handed down by the NHL’s newly appointed VP of Player Safety, Brendan Shanahan.

In addition to being the face of the NHL’s new “tough on head shots” policy, Shanahan has not only been making waves for the number of suspensions he’s handed down thus far, but also for the manner in which he’s doing it. No longer content to rely on a press release outlining the player, infraction, and discipline applied, Shanahan is taking to the internet, and has produced a small video explanation of every single disciplinary action that has come to his attention. These videos include a short clip of the incident(s) in question (from multiple angles and slow motion), a citation of the applicable rules, what, if any discipline has been decided upon, and, most importantly, his reasoning behind why or why not a certain decision was reached (The videos can be found on the NHL’s website, in the video section under the Player Safety channel).

One of the things I most remember about the discipline handed out by Colin Campbell (Shanahan’s predecessor) is a total lack of transparency. He would make an announcement that a certain player was under review, then shortly thereafter issue a decision via press release, often with little to no explanation to how he applied the rules in making his decision. Often times these press releases were criticized in the media for failing to set guidelines for players and coaches that were easy to follow, and that Campbell’s discipline was often inconsistent and arbitrary. This often set up a very acrimonious relationship between the players and the NHL as an organization, since there was such a perceived lack of clarity or consistency in the application of discipline.

In my opinion, part of what makes Shanahan’s new approach with these video such a great idea is that Shanahan is announcing that his tenure will be much different from that of Campbell’s without openly criticizing his predecessor. By showing the exact play, quoting the exact rule, and clearly outlining his decision making process, Shanahan has put himself in a much different light that those who have held his role before him. In many ways he has announced his presence, in addition to the dawning of a new era in the NHL with regards to headshots, in a very clever way. Not only that, but he has put himself in a better position with regards to the league, the players, and the media since he has preempted any attempts to call his judgment into question. Players, coaches, and teams may disagree with his decisions, but he has set up a system that is easy to defend and is accessible to all.

Most importantly, in my opinion, the transparency that he has introduced into this aspect of professional sports is a stroke of genius. It has so many potential benefits, and relatively few drawbacks. Among the ways that this approach can be beneficial, some of the following are what appeal to me:

1 – Trust. One of the biggest things that these videos do is instill a sense of trust that anyone appearing before Shanahan’s desk will receive a fair shake. By clearly outlining what his criteria are for legal and illegal plays, he is setting a bar that is equal across the league. Gone are the days of “you’re suspended because we said so.” Players, coaches, and teams may not agree with Shanahan’s decisions, but at least they are able to see how he came to a decision.

2 – Clarity. One of the factors that can erode relationships within a group faster than anything else is a lack of clarity. A lack of clarity of roles, of rules, and of repercussions can often lead to frustration amongst everyone involved. By showing a clear decision making process, Shanahan is allowing the rest of the league to buy-in to his process, as well as giving crystal clear examples of what types of plays will and will not result in suspensions.

3 – Consistency. In addition to holding players to set guidelines with regards to their play, the other thing that Shanahan has done is very subtly set himself a set of guidelines. Players will be able to judge how consistent Shanahan is in applying discipline based on his previous decisions – a fact of which I am almost positive Shanahan must have been aware of when he made the decision to release his rulings via video. By allowing himself to be held to certain standards, he once again is building the relationship between the NHL and the players employed therein.

All of these really contribute to the players’ understanding his decision making process, as well as having the added benefit of building a more cooperative relationship between Shanahan’s office and the players under his purview.