Introduction
The process of providing healthcare is fraught with unique legal and ethical challenges for each type of care. Sports medicine has dilemmas that are different from those of usual primary and emergency care. The distinction between regular healthcare provision and sports medicine lies in the dependence of athletes on physical and mental health to perform. As athletes rely on being healthy to achieve results, the ethical issues balancing autonomy, safety, and ability to compete arise.
Moreover, sports medicine law covers a variety of health providers and organizations that interact with athletes. The complex network of factors surrounding legal issues in sports medicine requires one to implement a structured approach to reviewing each case and the system as a whole. The present paper discusses the existing scholarship and legal foundation in sports medicine. It considers the unique features of sports medicine law and the potential approaches to solving legal and ethical dilemmas.
Sports Medicine: Background
Ethical Principles of Care
To review the specifics of sports medicine law, one must consider the similarities and differences in healthcare provision for athletes compared to other types of primary care. Sports medicine is a part of healthcare, thus requiring professionals in this field to adhere to the same ethical standards. Ethical and legal questions at the foundation of care are guided by the principles of autonomy, non-maleficence, beneficence, and justice (Lennon et al., 2022).
Autonomy refers to the ability of the patient to make decisions and determine the best course of action to support personal health. Every provider, including sports medicine physicians, has a moral obligation to consider the individual’s right to decide (Lennon et al., 2022; Mitten et al., 2019). Next, the principle of non-maleficence implies that the healthcare provider should not make decisions that would harm the patient. In sports medicine, this may include determining whether an athlete is fit for participation due to underlying issues or whether one can continue competing upon incurring an injury.
The third principle of beneficence describes the goal of the physician to improve the condition of the patient or otherwise act to protect one’s health. The priority of the athlete’s health is highlighted in this ethical stance, along with the belief that the physician always decides based on the short- and long-term positive outcomes for the patient’s well-being.
Finally, similar to other practitioners, physicians in sports medicine are morally obligated to act justly, considering the environment and the consequences of their actions for the athlete, team members, and their professional career (Chen & Esposito, 2004). Here, the physician may encounter issues such as whether to care for a person and how to administer care in a just way that does not result in conflict or go against existing laws. The principles are standard for all types of medical care, but the examples show how sports medicine has additional ethical and legal implications.
Differences of Sports Medicine from Other Healthcare Fields
Sports medicine generally refers to the interaction between physicians, nurses, and other healthcare providers to assess and care for athletes with an expressed focus on the latter’s performance and ability to participate in sports (Mountjoy et al., 2015). Thus, it is a healthcare field that deals with the prevention and management of injuries and athletes’ fitness. In contrast to primary and emergency care, sports medicine physicians’ goal is to examine athletes’ health to determine whether they can compete and treat issues that are explicitly affecting the players’ ability to participate (Chen & Esposito, 2004). Focusing on acute injuries and overall health leads to the development of different knowledge, focus, and expertise, further distinguishing the field and posing new ethical and legal questions.
Furthermore, the area of sports medicine is separate from other types of care due to the statistical differences in athletes’ most common problems. According to recent data, approximately 30 million children and teenagers participate in sports activities (Johns Hopkins Medicine, 2022). Annually, athletes experience over 3.5 million injuries, and almost a third of all childhood injuries are related to organized sports (Johns Hopkins Medicine, 2022). Thus, the risk of injury is high among all ages, creating additional reasons to increase sport-related safety precautions and improve the quality of care. These needs also require the legal system to investigate the existing laws and act rigorously to ensure that athletes are protected and that organizations have clear policies for providing healthcare.
Apart from general statistics, the data reveals the most prevalent issues among athletes, serving as a foundation for research and policy creation. For instance, brain injury is the most common cause of death among people encountering sports-related injuries (Bitonte & Boyadjian, 2017; Drysdale, 2013). Another severe problem that remains inadequately addressed is sudden cardiac events – in the late 2000s, a statistic showed that six young adults passed due to hypertrophic cardiomyopathy or similar cardiac conditions every week (Johns Hopkins Medicine, 2022).
Other issues, such as sprains and strains, also have higher occurrence rates among professional athletes due to the regularity and intensity of training. Contact sports are among the main activities that cause severe injuries, with American football being a major cause of brain injury among professional players (Goldberg, 2013). The specifics of each sport require medical professionals and organizations to consider tailored policies for athletes’ health.
Another consideration that differentiates sports medicine from in-hospital care is the mobility of care providers and the movement of teams and individual athletes nationally and internationally. In many sports, teams and professionals hire a physician who works on-site to prevent and manage health problems before and during training and competition (American Medical Society for Sports Medicine [AMSSM], 2018). As a result, this professional is the primary source of medical help for most athletes, and this professional’s expertise and certification are decisive when administering care. Moreover, the decision-making of physicians also determines the outcome of athletes’ health and performance. Thus, the relationship between participants and the medical professional creates specific causes for legal and ethical discussion.
In the United States, healthcare requires a license and certification in a specific field. Thus, medical professionals have to work in their scope of skills, referring patients to other professionals if their license does not cover the type of care needed (AMSSM, 2018). Moreover, their ability to practice is tied to specific regions, usually limited to one state per certification. Here, the issue of legal capacity to care for athletes arises, as sports teams and individual professionals have to travel often. Different competitions happen outside of one state where athletes practice, and international events further complicate the legal position of team physicians. This issue is a significant theme in the current legislation, and it is a cause of ethical and legal discussions in the existing literature.
Existing Legislation
Sports Medicine Licensure Clarity Act
As noted, sports medicine has many specifics that general medical laws do not consider. Thus, some additional acts have to be introduced to cover the scenarios unique to the health of athletes and their relationship with team physicians and other health providers. Moreover, according to the United States justice system, many instances that create a system of sports medicine law are covered in individual cases that determine the future course of action by forming a precedent. First, the central law that regulates the behavior and practice of healthcare providers in sports medicine is the Sports Medicine Licensure Clarity Act (SMLCA) of 2018. Before 2018, sports medicine professionals did not have a solution specifically designed for their practice needs and accounted for the unique nature of physician-athlete information exchange and expertise.
The SMLCA was introduced to cover the legal issues related to the practice of trainers, team physicians, and other medical staff members working with athletes and sports organizations. Among the main points of the act is the legal protection for traveling physicians, which allows them to care for athletes when traveling across the US (H.R.302 – FAA Reauthorization Act of 2018 [FAARA], 2018). As explained above, the medical practice in the country is safeguarded by the physicians’ need to acquire licenses in the states where they operate regularly. Additionally, states establish their own laws regarding practice scope, which may differ significantly for some procedures, although many states have similar policies.
As such, upon moving, the healthcare professional is required to reapply for a license to practice in the new location legally and be protected by local laws. However, the need to travel often and to different states complicates the team physicians’ ability to care for athletes and creates an ethical and legal challenge (AMSSM, 2018). The act resolves this problem by allowing licensed physicians to practice in other states when traveling with the team if the state of licensure and the destination state have similar laws regarding practice (FAARA, 2018). At the same time, the act improves the clarity of liability claims, as the practitioner’s liability is assumed to happen in the state of licensure.
As a result, the physician’s ability to provide care is vastly increased while protecting their practice and improving the safety and health of athletes. This law simplifies the process of traveling for athletes and their physicians. Moreover, it makes legal issue resolution more transparent if the physician becomes liable for any action related to the athlete’s health outside of the primary licensure state. Furthermore, it also specifies that the physician is allowed to act only in the scope of licensed practice.
The central ambiguity that exists in the act is the definition of state licensure systems as “substantially similar” (FAARA, 2018). In the SMLCA, this characteristic is explained as the need for two states to have a form of licensure that permits healthcare professionals to provide medical services in the specified scope. Thus, this description may raise some questions about the legality of physicians’ actions.
Good Samaritan Laws
Another set of policies that relate to sports medicine professionals and cover their unique features as health care providers are Good Samaritan laws. Every US state has a version of Good Samaritan law that protects the choice of healthcare professionals’ decision to provide care in cases where they are not bound by a professional duty (López & Maccarrone, 2017). In the case of sports medicine, this law is applied as team physicians usually have a working relationship with a specific team rather than a healthcare organization that sees patients regularly. Therefore, when a team participates in an event, the medical professional only has a duty to oversee the health of the athletes in the team while not being contractually obligated to care for individuals outside of this relationship. However, the ethical responsibility to care for people in need of emergency care puts physicians at risk of liability for not providing care or resulting in poor health outcomes.
For example, if a team of athletes participates in a tournament, and a fan at the bleachers loses consciousness, the team physician does not have a duty to care for this individual. However, it would be an ethical decision to exercise one’s medical expertise and help. In this case, the Good Samaritan law is applicable as it allows the healthcare provider to assist the person without exposing oneself to liability for practice outside of contractual obligation and scope. At the same time, this law also protects one from being sued for any type of unintended wrongdoing and consequences of care (Cornell Law School, 2022). Here, the common elements of the physician’s actions are the voluntary aspect, an ethical strive for beneficence, and the lack of reimbursement or contractual obligation to provide help.
Case Law System
The combination of the two laws mentioned above constitutes a major framework for approaching legal cases that involve sports medicine cases. Another part of sports medicine law is the case law system, which is based on the review and creation of precedents that guide future legal decisions. Some of the decisions by the court establish a foundation for other judgments and determine the course of legal action in the country.
Among the examples that changed the course of sports medicine law are the suits of the NFL players and the link between American football and increased rates of brain injury among players (Lueke, 2011). The case where more than 4,500 players formerly participating in NFL games sued the organization based on its concealment of the risk of brain injury as a result of the long-term competition was resolved in a settlement (Bandini, 2013; Weinmeyer, 2014). As such, the case was never introduced to the court, which limited its potential to affect the current state of the health review of football players.
More minor cases continue to shape the legal system and define the actions that healthcare providers should take to prevent injury and improve athletes’ health. For example, such cases as Mayall V. USA Water Polo establish that concussion management should be sufficient when the player is diagnosed with a concussion and can continue competing. Here, the basis of the decision was previous court cases that formed the definition of “assumption of risk” (Mayall V. USA Water Polo).
In many sports, especially in contact sports, some risk is assumed because of the high speed and interaction between players. Thus, the threat of negligent behavior comes from dangerous conditions that are not a part of the sport, such as reckless or aggressive behavior (Goldberg, 2013). In this case, the liability lies on the organization, which allowed behavior that was not standard for athletes to remain and did not have a system of returning to the game, causing further injury.
Specific Ethical and Legal Concerns
Health Problems
Brain Injury
Apart from specifically designed and implemented laws, sports medicine has several issues that require attention when analyzing their legal and ethical aspects. The first problem is the conditions that occur most often in athletes and require regular examination. In scholarship and legal cases, the two identified problems are heart conditions and brain injury.
First, brain injury is found to be the most frequent problem that causes athletes to stop their careers, suffer long-term consequences, or even pass away. At the present time, the majority of legislation surrounding this issue is focused on two types of sports – boxing and American football (Bitonte & Boyadjian, 2017). As noted previously, American football is a leading cause of brain injury due to being a contact sport that requires tackling as a basic tactic.
The most notable case, while not receiving an outcome that significantly changed the legal system, was the National Football Players’ Concussion Injuries Litigation. This particular case consisted of more than 2,500 accounts of players who aimed to sue the National Football League (NFL) and a manufacturer of helmets for negligence, death, and misleading information about the consequences of competing in football (Bandini, 2013). Apart from the claims of fraud and negligent production of helmets, the medical concerns were related to the failure to warn players about how their continuous brain injury would significantly diminish their physical and mental health.
In this case, a well-documented comparison is made to tobacco manufacturers misrepresenting data about the harms of smoking cigarettes in the long term (Goldberg, 2013). While the lawsuits did not result in significant changes in the legal system, they became a testament to the risk that American football posed to players, resulting in the growing recognition of the legal and ethical issues of sports medicine in scholarship and case law.
Before this significant case, individual instances of concussion in athletes also increased the attention on this condition. In 2009, House Bill 1824 – Zackery Lystedt Law – was passed, which required young athletes with a suspected concussion to be cleared by medical personnel before continuing their participation (Lueke, 2011). Thus, one can see that the increased focus on this issue has resulted in limited changes to the legal system and placed more responsibility on physicians and organizations reviewing the players’ health. Nonetheless, the following acts of 2013 reveal that the problem was not solved after 2009. It still needs additional legislation to prevent conditions such as mild traumatic brain injury, chronic traumatic encephalopathy, and more (Bandini, 2013; Lueke, 2011). These cases showcase that each instance of concussion is being reviewed individually, with new precedents adding liability to healthcare providers.
Heart Conditions
Heart conditions are the second major healthcare issue covered by case law. As mentioned above, cardiac events lead to several weekly deaths among young athletes (Gray, 2007). Heart conditions are often not diagnosed before a person passes away (Gray, 2007). Such statistics imply a gap in research and legal action that requires medical professionals to examine athletes thoroughly before letting them participate in practice, training, and sports events. Current guidelines do not require diagnostic tests as a part of the examination of the cardiovascular system due to the high prices of equipment and procedures (Gray, 2007; Oliva et al., 2017).
Additionally, while the Centers for Disease Control and Prevention list the heart as one of the central systems that team physicians must check regularly, no specific framework for these examinations exists (Oliva et al., 2017). As a result, cases of sudden cardiac arrest continue to appear in the legal system, showing a level of negligence in the management of emergency care and examination before participation.
In contrast to brain injury cases, which entail long-term health check-ups, equipment quality, and the consequences of participation, heart problem cases are concerned with pre-screening and emergency care. As sudden cardiac arrest usually leads to severe consequences, athletes are unlikely to continue participating, thus increasing the need for the identification of heart problems before the start of any physical activity (Oliva et al., 2017).
As noted, the US does not have a country-wide policy concerning pre-screening, thus leaving many ethical and legal questions surrounding this problem unanswered. At the same time, some lawsuits (Larkin v. Archdiocese of Cincinnati) introduce broad restrictions on athletes with heart conditions that require physicians to assume liability by providing medical clearance before participation (Oliva et al., 2017). Similarly, responsibility is placed on the organizations that hold sports events to provide proper emergency care to treat sudden cardiac arrest as a result of such cases as Kleinknecht v. Gettysburg College (Oliva et al., 2017). Thus, attention to heart problems is primarily present in individual cases.
Instances
Furthermore, apart from specific conditions, ethical and legal challenges emerge in sports medicine due to the location of competition or sports activity, the type of event, participating athletes, and the limited contractual obligation of physicians. Here, one may separate such cases as pre-participation examinations, injuries that occur during training or competitive events, regular check-ups outside of activity, and long-term consequences of one’s health after a career in sports. Another potential liability law category contains other emergencies related to non-athletes or athletes from other teams.
Athlete Approval for Competition and Training
To begin with, many legal issues arise for organizations and team physicians in the stage of approving athletes for participation and training. Here, the cases of sudden cardiac arrest mentioned earlier constitute a small portion of the possible issues physicians should check before allowing individuals to compete or practice. There exists a lack of a framework that lists all necessary checks for each sport, which could provide more transparency into what physicians must examine prior to signing off on an athlete (Leggit & Wise, 2020). Scholarship demonstrates a lack of regulation surrounding preparticipation checks, which increases the potential of legal disputes, such as the cases considered in previous paragraphs.
The American Academy of Family Physicians (AAFP) and a range of other medical organizations aim to fill the void of ethical and legal systems and present recommendations for the procedures that should be reviewed in the preparticipation stage. Major conditions that should be examined include the risk of sudden cardiac arrest, concussion history, musculoskeletal health, and mental health. The recommendations also note that female-specific risks, such as anterior cruciate ligament injuries and menstrual complications, should be investigated in addition to common problems.
Similarly, physicians should consider the concerns of transgender athletes, who often experience more stress and have higher psychiatric morbidity risks (Leggit & Wise, 2020). Lastly, athletes with disabilities should be examined with a focus on inclusion and safety. These guidelines do not carry any legal weight but are based on the organizations’ extensive knowledge of patient outcomes, presenting a solid ethical framework for reducing potential issues.
Injuries
The next part of the medical care process is athletes’ injuries during events and training. Injuries that occur after athletes are approved for participation subject the organization and medical professionals to several types of liability and place a certain amount of responsibility on the physicians’ decision-making. First, injuries incurred during active participation or practice may reveal negligence during pre-examination, as discussed above. Here, the legal cases refer to pre-participation and are not tied to the physician’s response after the injury. The second type of issue results from the emergency response to dealing with an injury. Depending on the athlete’s condition, the physician may treat the problem on their own, relying on the scope of available expertise, which is determined by their license and area of operation (Giles et al., 2020). Here, the act mentioned above (SMLCA) is applicable if the injury happens during the athlete’s travel to a location other than the provider’s primary state of practice.
Moreover, injuries that happen during an event also place the responsibility on the physician as the latter has to determine whether an athlete is fit for continuing physical activity or needs to withdraw to recover. In this case, the ethical guidelines of beneficence, non-maleficence, justice, and autonomy are applied, and each matter is resolved on an individual basis, according to the physician’s expertise. It should be noted that potential liability occurs if the physician prioritizes the team’s outcomes or makes a determination that leads to further harm to the athlete. For example, in the case of Mayall V. USA Water Polo, the physician and the organization are liable for approving the athlete’s further participation in the game, which leads to additional concussions and prolonged concussion syndrome. Thus, injuries should be considered from several ethical and legal points, accounting for future risks, further damage to the athlete’s health, and the ability to provide emergency care.
Health Between Competitions
Apart from athletes’ health directly before or during events, sports medicine law considers the long-term health outcomes of participants and their health maintenance in between competitions. In this case, case law takes precedence as individual instances of adverse effects are covered in the legal system with more attention. Additionally, no acts that cover the consequences of the negligence of athletes’ health exist currently. The scholarship identifies the example of NFL and football players’ increased rates of brain injury as a primary example of lacking legislation, showing the ineffectiveness of court law in preventing poor health outcomes (Drysdale, 2013; Goldberg, 2013; Weinmeyer, 2014).
Moreover, investigations reveal a lack of ethical discussions surrounding the ethics of sports medicine in demanding and health-threatening sports, as decisions to continue participating are made by physicians on an individual basis. Therefore, similar to the aspects of athletic activities covered above, regular check-ups and the continuation of one’s sports career do not have a specific system to which physicians and sports organizations must adhere.
Difficult Diagnostics
The ethical challenge of long-term health consequences is further complicated because some conditions are difficult to diagnose in time. For instance, as sudden cardiac arrest often occurs in athletes with no diagnoses related to heart problems, routine assessments may not reveal this issue, prepare the athlete, or stop them from participating before the situation arises (Asmelash, 2021; Oliva et al., 2017). Similarly, such conditions as chronic traumatic encephalopathy were previously impossible to diagnose without a post-mortem analysis of brain tissue (Filippi et al., 2022).
The lack of medical knowledge contributed to the high prevalence of cases where athletes competed despite increasing risks to their physical and mental health. Some ways of detecting this illness exist, such as positron emission tomography (PET) scans. However, they are still underexplored in entering the medical field as a standard and available practice (Filippi et al., 2022). Thus, the problem of underdiagnosis persists, requiring case-by-case investigation of legal issues.
Injury of Competitors
The final potential problems that expose physicians and sports organizations to liability are events where non-athletes or athletes from other teams are injured and require urgent medical care. As established previously, physicians enter into contractual relationships with teams and individual athletes or specific organizations, and their obligation is commonly only to care for a particular group of people. However, as medical personnel are present during tournaments, they may encounter instances where other individuals – fans, other workers, members of other teams, and more – have a health emergency. Thus, if no alternative sources of help are available, team physicians may choose to provide care.
In this case, the autonomy of such decisions is a vital part of US law, and medical professionals not bound by duty can refuse to help. Nevertheless, it would be unethical, as it would go against the principles of beneficence and non-malfeasance. While being an ethical rather than a legal concern, the choice to help is vital to one’s medical profession.
If the professional chooses to provide medical help, the Good Samaritan law is the basis that protects them from liability and establishes the grounds for legal action. While the laws differ from one state to another, they are similar in that they free the physician from being liable while the offered help is voluntary and is performed with beneficence. Some variations may be in the law depending on whether the physician receives any reward (López & Maccarrone, 2017). However, if the behavior of the provider is consistent with the law, then there are no grounds for potential liability.
Framework for Exploring Specific Issues
Based on the existing scholarship and laws, one can create a system for assessing legal and ethical questions specific to sports medicine. It is possible to approach each issue from three distinct points – using the acts if they are applicable, referring to precedents reviewed in the case law, and applying the principles of medical ethics on a case-by-case basis. Thus, scholarship recommends reviewing case studies to present the framework for exploring sports medicine and explaining the related legal concepts. The following hypothetical case examples show how one can demonstrate different types of laws and ethical methods to build the system of sports medicine law.
The First Scenario: Application of the SMLCA and the Good Samaritan Law
As stated previously, the number of acts and general laws that guide the practice of sports medicine law is highly limited, thus also being applicable in a few cases. Investigating the reviewed issues that are common among athletes and the work of team physicians, the instances of travel and non-athlete injury are the most common situations, where such acts as the SMLCA and the Good Samaritan law are applicable. The first hypothetical scenario is when the team that usually trains and performs in one state is invited to compete in another. The team physician with a license in the primary state of practice travels with the team for assessment and emergency care.
During the event, one of the team players is injured, and a physician is required to decide whether they can continue competing. In this case, the SMLCA allows the physician to operate in the full scope of their license, provided that the states’ licensure policies are similar. The conditions are the same in the following scenario, but a person sitting in the bleachers suddenly loses consciousness, and the team physician is the closest available medical professional.
In this case, the SMLCA cannot be applied, as it only covers medical help to athletes or staff members of the athletes (AMSSM, 2018). Instead, the Good Samaritan law allows the physician to provide emergency care and be protected from liability (López & Maccarrone, 2017). Although the two scenarios are different, they are both covered by national laws, thus presenting a transparent judgment framework.
The Second Scenario: Application of Case Law
The following potential approach to sports medicine is case law, which covers a variety of issues and treats them as precedents. In this case, such problems as liability due to negligence, missed care, lack of information, and injury consequences are investigated. It should be highlighted that court determinations continuously shape the legal framework of sports medicine.
Major precedents can change the course of legal action depending on the outcome and judges’ decisions. While it is impossible for medical personnel to be aware of each existing case related to sports medicine, it is vital to consider the currently accepted standards outlined in-laws about harm, assumed risk, and the responsibility of the organizers and medical professionals in protecting athletes.
For instance, one may consider a case when a high school volleyball team player incurs a concussion. The physician decides to let the student continue playing, as the symptoms are mild and the athlete wants to continue. However, during the rest of the game, the student’s symptoms lead to him being concussed again, which worsens his condition. The student’s parents then state that the physician and the organization are liable for the athlete’s health consequences. Based on the decision in Mayall V. USA Water Polo, the physician may be open to liability if the court proves that volleyball is not a sport where concussions are a common assumed risk. Here, the use of specific previous cases is vital for establishing the framework for judging which course of action is ethical, legal, and safe for athletes.
The Third Scenario: Application of Medical Ethical Principles
Finally, the last approach to investigating legal and ethical issues is the review of the physician’s actions based on the basic principles of healthcare – beneficence, non-malfeasance, justice, and autonomy. While not a legal system, this set of concepts is helpful for physicians to ground their decisions in medical ethics and exercise caution to prevent legal action. Medical professionals can resort to this method when approaching complex ethical dilemmas that do not have a substantial body of previous court decisions.
For instance, a case may concern an athlete with a mild heart condition who does not show any symptoms and takes part in a non-contact individual sport. While the physician is concerned with the discovered medical issue, the athlete performs as usual and wants to exercise authority and continue competing, asking the provider to approve them for an upcoming event. Here, the issue lies in the balance between autonomy and beneficence – the physician does not see any major problems with the athlete’s performance or health but is concerned with the risk of cardiopathy. The decision to reject the athlete for a competition would go against the principle of autonomy, being grounded in the possible risk of injury. In contrast, the approval of the athlete challenges the principle of beneficence. The ethical dilemma further depends on the specific details of the athlete’s health, the opinion of the parents, and the organization’s policy regarding heart conditions.
Conclusion
The sphere of sports medicine law contains many ethical and legal questions that remain unexplored in legislation and scholarship. Sports medicine possesses many unique features that differentiate it from standard primary care. As a result, it is also a subject of investigation, requiring additional attention to the decision-making of medical staff and the health of athletes. Children, teenagers, and adults may participate in sports professionally, which places significant stress on their physical and mental health. Simultaneously, their well-being is directly connected to their ability to perform, and their performance can lead to injury. Thus, the duties of team physicians are to prevent harm and manage injuries to help athletes continue competing.
Several laws allow medical personnel to continue working with athletes across state and country borders while protecting them from liability. The most notable are the SMLCA of 2018 and Good Samaritan law, while many existing court cases build a foundation of precedents to cover common athlete health issues. The framework suggested in this paper considers each case individually, applying laws, court decisions, and ethical principles depending on the scenario.
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