Who is Really at Risk?

Pacemaker woman banned from boxing ring: Agamedes wonders, Who is really being protected?

Under the headline, Woman boxer banned again, today's West (13 Mar 10) notes that Elisha Buckley has again been banned from competing in boxing trials. Buckley is a champion woman boxer -- with a pacemaker.

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An "independent cardiologist" has said that it is safe for Buckley to compete, to fight against other women in trials for a world amateur boxing championship. So why has AIBA, the Amateur International Boxing Association, reinstated the ban?

I don't really know much about pacemakers but I can read. So I went to that great source of all knowledge -- good and bad -- the internet. Just a quick scan of the first few Google hits on "pacemaker lifestyle impact risk".

For some reason, doctors seem to be concerned about infection... Oh, okay, that may be because the body is cut open to install the pacemaker. And cutting open a body leads to the chance of infection. Heart rate... battery life... aha: lifestyle. This seems to sum it up: "Pacemaker patients can even participate in more strenuous activities such as marathons or scuba diving after consultation with their cardiologists. Any activity restrictions usually result from other medical problems and not from the pacemaker." (Wood & Ellenbogen (*), 2002)

Okay, that's an old (2002) article. But it's the first that I found that covers what I'm interested in: the risk of physical impact on the heart.

Again from Wood & Ellenbogen: "There are some situations, however, that are to be avoided if you have a pacemaker, such as full-contact sports, which may damage the pacemaker." Boxing may not be a "full contact" sport -- but the aim of boxing is to make heavy contact of your fist against your opponent's body. The chest -- containing the heart and the pacemaker -- must be a prime target.

So who is at risk?

Elisha Buckley may want to put herself at risk, to put herself into a situation where an opponent will try to hit her as hard as possible. Buckley is fully entitled to put herself at risk. A cardiologist has evaluated the risk and -- we must assume -- stated that the risk of damage to the pacemaker is low.

What about the opponent? Put yourself in the place of the next person to box against Buckley:

Your opponent is known to have a pacemaker. You can visualise exactly where that pacemaker is hidden. Do you deliberately aim for that pacemaker because it is a point of potential weakness? If you want to win -- of course you do.

Or do you -- as a considerate human being -- avoid punching directly onto the pacemaker? Do you avoid that area of potential weakness -- and set yourself up for losing? Or, can you possibly pretend that you do not know about the pacemaker, and fight your normal fight? No way! You either fight to win, or fight to lose. If you want to win, you learn everything you can about your opponent. Then you avoid strengths -- and attack at points of weakness.

On the other hand... Perhaps that pacemaker really is a point of weakness... Perhaps a severe impact may cause it to fail... and the results could be fatal.

Imagine this: You aim punches at the chest. You know that there is a pacemaker. You bypass Buckley's defence and score a major hit -- right over the pacemaker. The force of your punch moves the pacemaker, it stops working, Buckley is rushed to hospital.

Do you feel really bad? Of course you do. But you fought to win, and won.

Will Buckley's lawyers say, oh well, not your fault, just send flowers and we'll forget the whole thing... Oh, sure, like that'll happen!

Buckley is entitled to take any risk that she likes. (No strictly true. After all, we do live in a nanny state. But true enough.) Buckley may accept risk for herself -- but she is not entitled to change the sport, nor to bring extra risk to others.

By bringing a potential handicap to the sport, Buckley would affect other fighters. Do they hit hard at what they hope is a weakness? Or do they weaken their own chances, by avoiding the risk. Either way, Buckley will change the sport.

It's unfortunate that she needs a pacemaker. The pacemaker does not entitle Buckley to make the sport more risky for other boxers.

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(*) Wood & Ellenbogen, 2002: Cardiac Pacemakers From the Patient’s Perspective, by Mark A Wood MD & Kenneth A Ellenbogen MD, Circulation, American Heart Association, at http://circ.ahajournals.org/cgi/content/full/105/18/2136 as at March 2010