I am a baseball coach/manager. In my stepson's baseball league, another team has a child (these are pony league players - 13 & 14) who has some arm problems. I know he has had an MRI (know the MRI tech) and also that his doctor instructed him never to pitch again. The coach and parents are aware of this too - yet the coach still pitches him in games. Other parents discuss this problem, yet no one seems willing to step up and do something about this. Since I know the story, would it be ethical if I anonymously informed the league? There may be a potential liability issue at stake here too. This kid is going to ruin his arm before he gets to high school. I am also trying to balance the confidentiality of the medical relationship vs. the kid's welfare. Should I even be considering this?

Comments

He will ruin his arm -- that's a major burden for a child who loves sports. The goal of saving his arm seems a lot more important than the other considerations you mention.

But perhaps you don't actually have to make this choice. Instead of informing the league, you might just talk to the MRI technician (who already knows that you know, and is responsible for your knowing, the boy's condition). Urge the technician to tell the doctor that the boy is being pitched by his coach and that his parents apparently approve of this. (The technician can say that this information comes from someone else without saying that this someone else -- you -- knows about the severity of the boy's injury.) The doctor can then decide what to do -- e.g., telephone the boy and/or the parents or write them a stern letter, and, if all else fails, communicate her or his concerns to the league. The doctor best understands the boy's condition and can speak about it with the greatest authority.

I agree with Thomas Pogge's remarks, but I also have a couple of cents to add.

First, consider very seriously and act in light of the fact that your information comes to you second hand (from a lab tech and not the child's physician or parent)--unless, of course you are the MRI technician. Second hand reports are notoriously inaccurate, and so I suggest proceeding with caution and when you act qualifying your comments with the acknowledgment that your information may be inaccurate. The tech may be exaggerating the physician's instructions or otherwise distorting them.

Secondly, it's worth pointing up front that (again unless you are the technician) that it was probably unethical for the technician to have given you medical information about the boy. Medical information is by law, custom, and moral principle extremely private material. The technician's poor conduct in providing you with medical information about the child further calls his or her credibility into question.

Thirdly, while I think Dr. Pogge is correct that the best first route is through the technician--or, better, directly through the physician--if that route doesn't achieve results that satisfy you, you should consider speaking with the parent. Your having this knowledge does give you a moral burden, I'm afraid. Your being a coach/manager magnifies that burden. If you find speaking to the parent uncomfortable or unsatisfying, you may consider informing the league. Now, the parent may deny that a physician has given the child such an instruction--at which point you will likely have no way of proving your claim, and the parents' claim will rightfully trump yours. Remember you will be reporting to the league third hand and, anyway, who is one to believe, the tech or the parent or you? If you somehow have access to hard evidence (and I mean really hard evidence, as overriding a parent is no small matter), you may wish to discuss the matter with a social worker.

Read another response by Thomas Pogge, Peter S. Fosl

Read another response about Ethics, Medicine