Ethical Issues in Return to Play: How to Deal with Parents and Coaches

Return-to-play decisions for any group of athletes can be challenging and subject to multiple competing interests. These decisions can be even more complex when they involve not just players and coaches but also the parents. Parental involvement in youth athletic participation is important, but over-involvement or the wrong types of parental intervention can hinder the athlete’s experience. It is also important to realize that the athlete’s health is paramount, despite economic and social pressures otherwise. While parents, coaches, teammates, and even team physicians may benefit from early return to play, the athlete shoulders nearly all the risks should premature return to play result in detrimental health effects. For these reasons, sports medicine professionals must ignore competing interests and focus only on the patient’s best interest. The keys to successful return to play in these settings are to initiate clear communication with all involved parties early in the process, to implement objective return-to-play guidelines and assessment criteria, to maintain strict ethical standards, to reinforce the priority on the patient’s health, and to make sure that the player, parents, and coach buy in to these principles as well.