The film Concussion chronicles the work of Dr. Bennet Omalu regarding Chronic Traumatic Encephalopathy. Among the most pressing bio-ethical issues raised by the film is the nature of medical authority, the impact of VIP status on quality of care, the extent to which people’s actions can be attributed to health conditions and where doctor’s loyalty should lie with respect to their patients and employers.
One of the most prominent facets of Concussion is an exploration of the nature of medical authority. Particularly striking is the conflation of national origin and credibility. In one notable line of the film, Omalu is classified as “not American…not even African American” speaking to an unfortunate nativist and racialized facet of scientific standing. This is reinforced by the fact that Dr. Omalu holds eight advanced degrees yet finds himself treated as a “voodoo doctor” in constant need of a more acceptable i.e white American mouthpiece to be heard. On the other side of the coin are those who use their unquestioned authority to influence scientific progress. In the context of the film, this refers most prominently to the NFL’s use of its financial, social and political influence to hinder Omalu’s work, threaten his mentor, citizenship status, and professional future and self-regulate the research related to their business. Physicians who use their credentials as an aegis for the NFL at the cost of scientific truth and players’ lives raise still further questions. The nominal central purpose of bioethics is to make decisions that best serve patients. Consequently, it is vital to consider the social, political and professional factors that shape and lend credibility to medical choices.
A further issue that Concussion forces us to contemplate is the extent to which an individual’s actions can be attributed to their health status. While there is a long history of celebrities leading complicated personal lives, football is uniquely associated with issues such as financial recklessness, domestic violence and a variety of other deleterious events which can in certain cases be associated with CTE. Given that the condition can only be diagnosed after death, one questions the extent to which current and former players can utilize the possibility they have a traumatic brain injury as an alibi for their unsavory actions. Similar to the issues surrounding genetic pre-determinism overly conflating brain injury to behavior can serve to rob victims of justice or provide an excuse precluding the need for players to evaluate their decision making and improve their lives. Enormous sympathy must be extended to victims of brain injury and their families. This understanding should not come at the cost of rectitude and potential growth, however. The import of such considerations extend beyond football as the emergence of genetic arguments, and other health-related defenses as a means to influencing sentencing have engendered unprecedented questions about the interplay of health conditions and behavior within jurisprudence.
The final issue raised by the film that I wish to address is where a doctor’s loyalty should lie. While physicians swear an oath to prioritize patients they are simultaneously employees, citizens, and family members. Each of these disparate roles brings with it new loyalties and responsibilities. This takes a variety of forms in Concussion most notably the unique pressures facing team doctors. NFL doctors build deep relationships with the players under their care yet are ultimately employees of the league and consequently have a professional responsibility to help support revenue generation by getting the players back on the field whatever it takes. While most doctors do not face such a grave dichotomy in normal practice more subtle variations such as the need to protect hospital or practice profits by triaging patients with respect to their insurance status pervade the modern enterprise of medicine as doctors struggle to balance quality measures and patient outcomes. Connected to this issue of divided loyalties is the differential treatment provided to celebrity patients. The inciting incident of the film is Omalu’s decision to conduct a full autopsy on Mike Webster as protocol demanded. Had Dr. Omalu bowed to his colleague’s request that such an intensive examination was unnecessary the discovery of CTE would have not have occurred and the full scope of the dangers of football would have remained obscured. The bioethical relevance of this issue is readily apparent given that one should strive to provide high caliber equitable care regardless of the patient’s identity. If a patients’ status or physicians’ divided loyalties result in a compromised quality of care it represents a major hurdle to the ethical practice of medicine.