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Sport, Sudden Cardiac Death and Liberty

Sport, like life, is dangerous. Several fit young footballers have died of sudden unexpected heart attacks. Doctors are now calling for mandatory testing using ECGs of all athletes. Italy has been pursuing mandatory testing for 25 years. This has revealed over 5% have some abnormality. Some people have congenital heart rhythm abnormalities which place them at high risk of sudden heart attack during or after sport. The call for mandatory testing is a sensible one. The interesting question is what is to be done with the results.

Information can inform people of their particular risk. It can be used to warn those at higher risk. It can also be used to put in place preventative or corrective strategies, like implantable devices to correct lethal heart rhythm abnormalities. But should this information be used to exclude athletes from competition because they are at too high a risk? In recreational sport, should doctors use this information to strongly dissuade eager sportsmen and women from continuing to participate in sport?

This is a question of how much weight we place on individual liberty. I hope, a lot. It would be sad if information about individual elevated risk were used to stop people pursuing the activities they love. Mountaineering would never be allowed. Let’s hope sporting regulatory authorities use this information sensibly to facilitate more informed individual choice, and to enhance personal prevention but not to exclude people from participating in sport on paternalistic grounds.

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