Doctor Doctor: Mr. M.D.

Bioethics issues have played and will continue to play an increasing role in Sports Law. And they have become front and center with the case of Chris Bosh of the Miami Heat.

For the last two seasons, Bosh has missed considerable playing time as a result of his susceptibility to blood clots in his legs. In one instance, a clot traveled to his lungs causing a pulmonary embolism, a blockage in one of the lung’s arteries, a dangerous and sometimes fatal condition. Bosh ended up in the hospital for nine days, losing 30 pounds and missing the last 30 games of the 2014-15 season

Patients susceptible to blood clots are treated with blood thinning medications such as Xarelto, an anticoagulant. In fact, Bosh appeared in a commercial for the drug touting its ability to help his condition. In the ad, which opens with the ten-time all-star nailing a 3-pointer, Bosh says: “When I was sidelined with blood clots in my lungs, it was serious. Fortunately, my doctor had a game plan.” That doctor, of course, is not one employed by the Miami Heat, but his personal physician in whom he has placed his trust to not just keep him alive but to keep him on the court so he can earn the remaining $76,000,000 on his contract.

Drugs such as Xarelto don’t actually thin the blood. Instead, they slow the chemical process the body uses to clot the blood in the event of an injury like a cut or bruise. For that reason, the main risk of such products is excessive bleeding in the event of such an injury, particularly internal bleeding which can cause heart attacks and strokes. The package insert for Xarelto actually advises the user to “avoid activities that may increase your risk of bleeding or injury.” Obviously, professional basketball would be included in just such an activity.

Therein lies the rub for the Miami Heat who have advised Bosh that he has failed the team physical according to the team’s doctors. Bosh and his doctors claim he is fit to suit up. They say athletes in other sports have had similar clotting problems and have managed the condition, principally by flushing the system of anticoagulants before competing. Professional basketball, however, is sometimes a three game a week affair and anticoagulants are usually prescribed for daily use not an on-again-off-again routine.

What is the right course from a bioethics standpoint? Team doctors certainly have conflicting loyalties. Do they look out for the best interests of the team—which is petrified of any player dying on the court traumatizing the fans—or the interests of the player?

Let’s leave aside the team’s obligations under the Americans with Disabilities Act, which prohibits employment discrimination on the basis of a medical condition like Bosh’s.

The best approach, it seems to me, is to allow the player to make his own medical decisions along with his personal physicians. Teams have the right to consult with those physicians to ensure they are competent and justified in their opinions and treatment decisions, but they should defer to those whose only interest is in the player’s well-being.