Boxing, mixed martial arts, and other risky sports: is the BMA confused?

The BMA’s handbook Medical Ethics Today states unequivocally that “competent adult patients have the right to refuse any medical treatment, even if that refusal results in their permanent physical injury or death.”1 Yet the BMA’s latest statement on its proposed ban on boxing and mixed martial arts states with equal certitude that “the BMA’s opposition to boxing [and mixed martial arts] is based on medical evidence that reveals the risk not only of acute injury but also of chronic brain damage in those who survive a career in boxing.”2

These two statements are difficult to reconcile. On the one hand the BMA says that we should respect Mr Smith’s decision to refuse lifesaving antibiotics for his septicaemia but on the other that we should not respect Mr Smith’s decision to step into a boxing ring against a consenting opponent. The consequence of not intervening in the first case is probable death; in the second, perhaps injury and a minuscule chance of death.

The principle of respect for autonomy forms a cornerstone of modern medical ethics. The principle requires, subject to limited exceptions, that people be allowed to make decisions about how they want to conduct their lives. This principle underpins the BMA’s position that patients have a right to …