Abstracts
Abstract
Academic scholarship has steadily reported unfavourable clinical findings on the sport of boxing, and national medical bodies have issued calls for restrictions on the sport. Yet, the positions taken on boxing by medical bodies have been subject to serious discussions. Beyond the medical and legal writings, there is also literature referring to the social and cultural features of boxing as ethically significant. However, what is missing in the bioethical literature is an understanding of the boxers themselves. This is apart from their brain injuries, the debates about the degenerative brain disease known as chronic traumatic encephalopathy (CTE), and related issues about the disease. This article argues that the lives of boxers, their relationships, their careers, and their futures, also requires its own research, particularly in telling stories about their lives, and those lives and futures which boxing affects. The article uses two approaches. First, to imagine a more enduring “whole of life viewpoint” by using an extended future timeframe. Second, to consider perspectives of a person’s significant others. After reviewing the boxing literature, the article discusses social settings and then explores the hidden social relationships in life after boxing. With these longer time and close relationship viewpoints, three important themes emerge: family and kinship; age, stage and career; and the effects of boxing fatalities. These analyses are used in conjunction with relevant clinical findings which complement the telling of stories to improve medical information, and engages professional and public empathy for people’s experience of illness and difficulties in coping.
Keywords:
- adverse health outcomes,
- sports,
- boxing,
- burdens of disease,
- neurocognitive impairments,
- family and kinship,
- life and career,
- narrative bioethics
Résumé
Les études universitaires n’ont cessé de faire état de résultats cliniques défavorables à la boxe, et les organismes médicaux nationaux ont lancé des appels à la restriction de ce sport. Jusqu’à présent, les positions prises sur la boxe par les organismes médicaux ont fait l’objet de discussions sérieuses. Au-delà des écrits médicaux et juridiques, il existe également une littérature faisant référence aux caractéristiques sociales et culturelles de la boxe comme étant éthiquement significatives. Cependant, ce qui manque dans la littérature en bioéthique, c’est une compréhension des boxeurs eux-mêmes. Et ce, en dehors de leurs lésions cérébrales, des débats sur la maladie cérébrale dégénérative connue sous le nom d’encéphalopathie traumatique chronique (ETC), et des questions liées à cette maladie. Cet article soutient que la vie des boxeurs, leurs relations, leurs carrières et leur avenir nécessitent également une recherche spécifique, en particulier pour raconter des histoires sur leurs vies, ainsi que sur les vies et l’avenir que la boxe affecte. L’article utilise deux approches. La première consiste à imaginer un « point de vue global de la vie » plus durable en utilisant un cadre temporel futur étendu. Deuxièmement, il s’agit de prendre en compte le point de vue des proches d’une personne. Après avoir passé en revue la littérature sur la boxe, l’article traite du cadre social, puis explore les relations sociales cachées dans la vie après la boxe. Dans cette perspective de temps plus long et de relations proches, trois thèmes importants émergent : la famille et la parenté; l’âge, le stade et la carrière; et les effets des décès liés à la boxe. Ces analyses sont utilisées en conjonction avec les résultats cliniques pertinents. Celles-ci complètent la narration d’histoires pour améliorer l’information médicale, et suscitent l’empathie des professionnels et du public pour l’expérience de la maladie et les difficultés à y faire face.
Mots-clés :
- effets néfastes sur la santé,
- sport,
- boxe,
- fardeau de la maladie,
- déficiences neurocognitives,
- famille et parenté,
- vie et carrière,
- bioéthique narrative
Download the article in PDF to read it.
Download
Appendices
Bibliography
- 1. Jordan BD. Neurologic aspects of boxing. Archives of Neurology.1987;44:453–459.
- 2. Lundberg GD. Boxing should be banned in civilized countries—Round 3. JAMA 1986;255:2483-2485.
- 3. British Medical Association. The boxing debate. London: British Medical Association, 1993.
- 4. Jayarao, M, Chin, LS, Cantu, RC. Boxing-related head injuries. The Physician and Sportsmedicine. 2010;38:18-26.
- 5. Constantoyannis C, Partheni, M. 2004. Fatal head injury from boxing: a case report from Greece. British Journal of Sports Medicine. 2004;38:78-79.
- 6. Cournoyer, J, Hoshizaki, TB. Head dynamic response and brain tissue deformation for boxing punches with and without loss of consciousness. Clinical Biomechanics. 2019;67:96-101
- 7. Canadian Medical Association/Association médicale canadienne Boxing (Update 2001) 2001 May 28.
- 8. American Medical Association. Hazards of Boxing H-470.980. 2019.
- 9. Australian Medical Association. AMA Position Statement: Combat Sport 2015.
- 10. Warburton, N. Freedom to box. Journal of Medical Ethics. 1998;24:56-60.
- 11. Gillon R. Doctors should not try to ban boxing--but boxing’s own ethics suggests reform. Journal of Medical Ethics. 1998;24:3-4.
- 12. Leclerc S, Herrera CD. Sport medicine and the ethics of boxing. British Journal of Sports Medicine 1999;33:426-429
- 13. Sokol DK. Boxing, mixed martial arts, and other risky sports: is the BMA confused? BMJ. 2011;43:d6937.
- 14. American Academy of Pediatrics, Canadian Paediatric Society. Boxing Participation by Children and Adolescents. Pediatrics. 2011;128: 617-623
- 15. Anderson J. The legality of boxing: a punch drunk love? London: Birkbeck Law Press, 2007.
- 16. Rudd S, Hodge J, Finley R, Lewis P, Wang M. Should we ban boxing? BMJ. 2016;352:i389.
- 17. Jones K. A key moral issue: should boxing be banned?. Culture, Sport, Society. 2001;4:63-72.
- 18. Fulton J. “What’s your worth?” the development of capital in British boxing. European Journal for Sport and Society 2011;8:193-218.
- 19. Dixon N. Boxing, paternalism, and legal moralism. Social Theory and Practice. 2001;27:323-344.
- 20. Simon RL. 1991. Fair play: sport, values, and society. Boulder, CO: Westview Press.
- 21. Castellani RJ, Perry G. Dementia pugilistica revisited. Journal of Alzheimer’s Disease. 2017;60:1209-1221.
- 22. Blennow K, Hardy J, Zetterberg H. The neuropathology and neurobiology of traumatic brain injury. Neuron. 2012;76:886-899.
- 23. Casson IR, Viano DC. Long-term neurological consequences related to boxing and American Football: A Review of the literature. Journal of Alzheimer s Disease. 2019;69:935-995.
- 24. Randolph C. Chronic traumatic encephalopathy is not a real disease. Archives of Clinical Neuropsychology. 2018;33:644–648.
- 25. Rabow MW, Goodman S, Chang S. et al. Filming the family: a documentary film to educate clinicians about family caregivers of patients with brain tumors. Journal of Cancer Education. 2010;25:242–246.
- 26. Chan S. More than cautionary tales: the role of fiction in bioethics. Journal of Medical Ethics 2009;35:398-399.
- 27. Nussbaum MC. Poetic justice: the literary imagination and public life. Boston: Beacon Press, 1995.
- 28. Nussbaum MC. Love’s knowledge: essays on philosophy and literature. New York: Oxford University Press, 1990
- 29. Huxley A. Brave new world, a novel, Garden City, NY: Doubleday, Doran & Co., 1932.
- 30. Huxley, A. Le meilleur des mondes. Pocket, 2017.
- 31. Kendal E. Utopian literature and bioethics: exploring reproductive difference and gender equality. Literature and Medicine. 2018;36(1):56-84
- 32. Dubiel H. What is “narrative bioethics” Frontiers in Integrative Neuroscience. 5(10).
- 33. Jonsen AR. The birth of bioethics. The Hastings Center Report. 1993;23:S1-S4.
- 34. Frank AW. Not Whether but how: considerations on the ethics of telling patients’ stories. Hastings Center Report. 2019;49:13-16.
- 35. Kuczewski MG. The Soul of Medicine. Perspectives in Biology and Medicine. 2007;50:410-420.
- 36. Chambers T. From the ethicist’s point of view: the literary nature of ethical inquiry. The Hastings Center Report. 1996;26:25-32.
- 37. McKee AC et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. Journal of Neuropathology & Experimental Neurology. 2009;68:709–735
- 38. Yang C, Nag S, Xing G, Aggarwal NT, Schneider JA. A Clinicopathological Report of a 93-Year-Old Former Street Boxer With Coexistence of Chronic Traumatic Encephalopathy, Alzheimer’s Disease, Dementia With Lewy Bodies, and Hippocampal Sclerosis With TDP-43 Pathology. Frontiers in Neurology. 2020;11:42.
- 39. Kosaka K (Ed.), Dementia with Lewy Bodies: clinical and biological aspects. Tokyo: Springer Japan, 2017
- 40. Nag S et al. Hippocampal sclerosis and TDP‐43 pathology in aging and Alzheimer disease. Annals of Neurology 2015;77:942-952.
- 41. Patterson RH. On Boxing and Liberty. JAMA.1986;255:2481-2482.
- 42. Sokol DK. The not-so-sweet science: the role of the medical profession in boxing. Journal of Medical Ethics. 2004;30:513-514.
- 43. Beauchamp T, Childress JF. Principles of biomedical ethics (8th ed.). New York: Oxford University Press, 2019.
- 44. Collier C, Haliburton R. The need for a Canadian bioethics. Impact ethics. 2013
- 45. Trotter G. Outside outpatient ethics: Is it ethical for physicians to serve ringside? Journal of Clinical Ethics. 2002;13:367-374.
- 46. Schwartz MB. Medical safety in boxing: administrative, ethical, legislative, and legal considerations. Clinics in Sports Medicine. 2009;28:505-514
- 47. Hytten K, Tønsaker SK. Medical ethics in combat sports that permit knockouts. Tidsskr Nor Legeforen. 2017;137:17
- 48. Gauthier J. Ethical and social issues in combat sports: should combat sports be banned? In: Kordi, R, Maffulli, N, Wroble RR, Wallace WA. Combat Sports Medicine. London: Springer, 2009:73-88.
- 49. Malcolm B. Concussion in sport: public, professional and critical sociologies. Sociology of Sport Journal. 2018;352:141-148.
- 50. Beauchez J. The ‘sweet science’ of bruising: boxing as a paradigm of the sociology of domination. Revue française de sociologie. 2017;58: 97-120.
- 51. Ribeiro NF. Boxing culture and serious leisure among North-American youth: an embodied ethnography. Qualitative Report. 2017;22:1622-1636
- 52. Wacquant L. Body & Soul: Notebooks of an Apprentice Boxer. New York: Oxford University Press, 2004.
- 53. Sheard KG. ‘Brutal and degrading’: the medical profession and boxing, 1838–1984. The International Journal of the History of Sport. 1998;15:74-102
- 54. Lavery B. Beautiful burnout. London: Faber and Faber, 2010.
- 55. Williams, R. Sucker punch. 2010.
- 56. World Health Organization Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Final report of the Commission on Social Determinants of Health. Geneva: WHO, 2008.
- 57. Satariano B, Curtis SE. The experience of social determinants of health within a southern European Maltese culture. Health & Place 2018;51:45-51.
- 58. Martin, AC. The use of film, literature, and music in becoming culturally competent in understanding African Americans. Child and Adolescent Psychiatric Clinics of North America. 2005;14:589-602.
- 59. Payman V, Yates S, Cullum S. Early onset dementia in New Zealand pacific boxers: a case series. New Zealand Medical Journal. 2018;131(1474):20-26.
- 60. Fairbairn-Dunlop TP, Savaii K, Puni E. What makes for a good marriage or partnership? Samoan case study. Wellington, New Zealand: Pasefika Proud, 2016.
- 61. Morton H. Becoming Tongan: an ethnography of childhood. Honolulu: University of Hawai’i Press, 1996.
- 62. Al-Zu’abi AZ, Jagdish JS. Marriage: an integrated study in the context of cultural variation. Domes. 2008;17(1):68-91.
- 63. Witkowski SR. Kinship. American Behavioral Scientist. 1977;20: 657-668.
- 64. Marini M.G. The place of illness-centred movies in medical humanities. In: Marini MG., editor. Narrative medicine: Bridging the gap between evidence-based care and medical humanities. Cham: Springer, 2016:71-80
- 65. Considine, P. director. Journeyman. London: Studiocanal, 2018.
- 66. Morgan J. Out of the ring: boxing and long-term brain damage. Lancet Neurology. 2017;(17):848.
- 67. McKee L. The unspoken damage of boxing. The Independent 2016 November 21.
- 68. Bradley J. Lessons from my Life’s Work. Narrative Inquiry in Bioethics. 2011;1:135-137.
- 69. Berkman LF, Soh Y. Social determinants of health at older ages: the long arm of early and middle adulthood, Perspectives in Biology and Medicine. 2017;60:595-606.
- 70. de Medeiros K. What Can Thinking Like a Gerontologist Bring to Bioethics? Hastings Center Report 2018;48(S3):S10-S14.
- 71. Seifert T, Bernick C, Jordan B, Alessi A, Davidson J, Cantu,R, Giza C, Goodman M, Benjamin J. Determining brain fitness to fight: has the time come? The Physician and Sportsmedicine. 2015;43:395-402.
- 72. Wacquant LJD. The pugilistic point of view: how boxers think and feel about their trade. Theory and Society. 1995;24:489–535.
- 73. Rutter JD. Dismantling the face: toward a phenomenology of boxing. Cultural Studies Critical Methodologies. 2007;7:281-293.
- 74. Kamm, R. Boxing. In: Glick, I, Stull, T, Kamis, D. editors. The ISSP manual of sports psychiatry. New York and Milton Park: Routledge, 2018: 236-267
- 75. Baird LC, Newman CB, Volk H, Svinth JR, Conklin J, Levy ML. Mortality resulting from head injury in professional boxing. Neurosurgery. 2010;67:1444-1450.
- 76. Ohhashi G, Tani S, Murakami S, Kamio M, Abe T, Ohtuki J. Problems in health management of professional boxers in Japan. British Journal of Sports Medicine. 2002;36:346-352.
- 77. Jamora RDG et al., Parkinsonism among retired Filipino boxers. Basal Ganglia. 2017;10:1-3.
- 78. Lepreux S, Auriacombe S, Vital C, Dubois B, Vitaet A. Dementia pugilistica: a severe tribute to a career. Clinical Neuropathology. 2015;34:193-198.
- 79. Popplewell B. After the death of two young fighters, should we tolerate boxing’s brutality? The Globe and Mail. 2019.
- 80. Svinth JR. Death under the spotlight: The Manuel Velazquez boxing fatality collection, 2011. Journal of Combative Sport 2011.
- 81. Worsell E. Dog rounds: death and life in the boxing ring. London: Blink Publishing, 2017. Kindle Edition.
- 82. Ryan D. A matter of life and death. New Statesman 2018;147(January 26-February 1):40-42
- 83. Harding G. Boxer David Whittom dies after 10 months in a coma following Fredericton fight. CBC News 2018 March 17.
- 84. Pruss V. Gary Kopas says he questioned the referee but he also wanted to win the Fredericton fight. CBC News 2017 May 29
- 85. Taylor C. What the experience of illness teaches. Narrative Inquiry in Bioethics. 2013;3(1):45-49.
- 86. Gillon R After 20 years, some reflections and farewell! Journal of Medical Ethics. 2001;27:75-77.
- 87. Heiskanen B. The urban geography of boxing: race, class, and gender in the ring. New York Routledge, 2012.
- 88. Murray CJL. Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bulletin of the World Health Organization 1994;72:429-445.
- 89. Smart V, Ellenwood L. Pain, agony and ‘years of duress’: How hockey wives are fighting back over players’ chronic brain injuries. CBC News 2019 November 24.