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On Josh Allen, the NFL, concussions, and informed consent

Players have the right to make a voluntary decision about their health

Buffalo Bills v Houston Texans Photo by Tim Warner/Getty Images

Last Sunday, with 6:02 left in the fourth quarter of the Buffalo Bills’ loss to the Houston Texans in Week 5, Bills Mafia had its collective breath taken away. Superstar quarterback and pretty-much-consensus terrific human being Josh Allen was taken to the ground, with his head visibly slamming against the turf. Allen was briefly evaluated in the blue medical tent and returned to the game after missing just one play — allowing for a collective sigh of relief.

Regardless, many of us are still worried about that situation, and wonder if Allen was actually alright or if the NFL’s independent evaluations may have failed again. Bills fans have witnessed a fair bit of this with also pretty-much-consensus terrific human being Tua Tagovailoa. He was rushed to action after a “back injury” and has endured multiple scary situations since then.

Tagovailoa’s latest injury happened once again during a game against the Bills, and now his career may be at risk. That, and the somewhat uncertain injury to Josh Allen last Sunday, leads me to my day job...


Toughness and Informed Consent

Injuries in sports are an interesting dilemma. Athletes performing through the pain is the stuff of legend. A great moment becomes epic if we learn that the performer was hurt while they did it. I’m not going to try to dispel that either, because a lot of the time I believe that’s valid.

Consider what we know of Buffalo Bills Hall of Fame running back Thurman Thomas, who reportedly played much of his college tenure and entire NFL career on a partially torn ACL. Thomas didn’t want to miss a year of college play, perhaps partly unwilling to cede his role to a young Barry Sanders who sat behind him. As Thomas revealed, he played the remainder of college and all of his professional career with an 85% torn ACL.

Or consider what measures safety Jordan Poyer took to ensure he could play a road game against the Kansas City Chiefs Despite a collapsed lung injury. Not cleared to fly, Poyer drove to Arrowhead Stadium to suit up. Unable to board a plane, but content to start at safety in the NFL.

That’s the stuff of legend, undoubtedly, from both former Bills greats. It’s especially true if considering Thomas’ jaw-dropping career without knowing the injury adversity he fought through.

But not all injury experiences are identical to what Thurman Thomas experienced as an all-timer who wore his badge of toughness like a pair of Darryl Talley’s Spider-man sleeves. Or what Jordan Poyer was willing to risk by playing with an acute lung injury.

I don’t know what (intramural) moment makes me most proud. My game-winning goal in the broomball championship had a victory. The time I played through an, ahem, sensitive slapshot in a floor hockey game has the guts.

Toughness is a virtue that I don’t believe should be tossed away. Concussions are a different situation entirely. One critical factor is often missing for players and even if it’s Josh Allen, it’s my opinion to always err on the side of caution. That factor is informed consent.

I hint at elements of my day job from time to time and while it may not be my primary role, a routine part of my work involves the idea of informed consent. For those of you unfamiliar with the phrase, the idea is that for risky decisions someone with legal authority who can appreciate the nature of the situation should make the decision. The default decision-maker for an adult is themselves.

When I took that slapshot, I was legally able to make the decision to continue. When Jordan Poyer hit the road for 15 hours rather than the skies with the team to play after a collapsed lung, he was legally able to make that decision. Thurman Thomas told us that he was able to make such a decision as a college athlete. All of us deserve adulation for toughing it out. I’ll concede that maybe, just maybe Poyer and Thomas deserve a tad bit greater adulation than I did.

If toughness is so great, why are concussions different? Informed consent requires several elements that vary a little bit based on what legal decision is being made, but two elements are common. Decisions should be made free from duress, and the decision-maker needs to be able to appreciate the risks of their choice.

Sports injuries are already tenuous as a result of the first part of that idea. Are players truly free from duress? Teammates and coaches may question their toughness and dedication if they take themself off the field. We know that fans sure will. We’re already in the gray area for informed consent.

Let’s take a look at common concussion symptoms:

  • Dizziness
  • Confusion
  • Feeling like you’re in a fog
  • Memory loss, especially memory surrounding the injury itself
  • Ringing in the ears
  • Delayed neurological responses (speech and language often impacted)

For certain situations, being intoxicated or in a similarly altered state may legally be a reason that a person can’t provide informed consent. Take another look at those symptoms. I would argue that for many, having a concussion renders you similarly unable to truly provide informed consent.

How can one appreciate the risks of their decision when they can’t even focus on the decision? How can a coach or medical professional rationally discuss the risk at hand with a person who can’t hear them, and may not be able to rationally respond? What kind of decision can a person make if they’re not able to even remember what just happened to them?

I’m hoping Josh Allen was actually fine following the hit he took in Houston. I’m hoping he continues to be fine. If you’re curious as to why I’ll never be upset to see him sit after a situation like we just witnessed, you have my answer right here. I don’t have confidence that players are capable of providing informed consent for what could be one of the most critical medical moments of their life. They can’t make the decision, so someone needs to do it for them.