Although there are calls elsewhere to ban boxing, the Australian Medical Association advocates a less restrictive rule. Professional boxers would submit to brain scans and MRIs—but what to do with the results of such tests? Critics say that boxers should decide which risks they take, but boxers are not the only ones in the debate. Healthcare workers understandably want some say in which risks people take, because the hospital is where boxers go when injuries occur (assuming they live). These issues of ethics and obligation are not made easier to resolve by the many disputed comparisons in this debate. Is boxing like other risk taking behaviour? Are physicians like other public employees? Until such questions are answered, a compromise would have check ups made mandatory, without forcing boxers to act on any knowledge gained.

There is no shortage of comparisons in the debate over boxing. Boxing, we hear, is like fast food: dangerous yes, but it does offer some benefits. No, the opposing side contends, boxing is like a pistol duel: once considered sophisticated, it is now just a ritualistic violence. Perhaps boxing is like smoking: inform boxers of the risks and let them at it. Then again, if boxing is like smoking, people who do not realise how dangerous it is need protection from it. Depending on who you listen to, boxing is an expression of individualism and personal sacrifice—the next best thing to running your own country—or it illustrates the danger in letting concern for autonomy overstretch the social fabric. And so the comparisons continue, without really convincing anyone. Not surprisingly, reformist proposals that could include mandatory brain scans for boxers are viewed as intrusive by some and insufficient by others.

Turf consciousness enters into the debate too. Journalists snub academics in the field of sport philosophy. Academics, with the exception of some historians, repay the favour by ignoring boxing’s pop culture aspects. Social scientists gather empirical data (in psychology of sport, and sociology of sport) relevant to boxing. Yet because others find key terms like “violence” unclear, or the application of the data to boxing arbitrary, the scientists typically get little notice outside of their field. Doctors have the straightest path to mainstream media, and clearly understand the health risks and the prospects for treatment, but that does not mean anyone listens. This debate finds Joyce Carol Oates cited more often than the British Medical Association. It is also a debate where those who collect empirical data offer judgments well beyond the evidence, whereas those more suited to abstract speculation offer empirical generalisations instead. Lastly, there are the boxers. They take the risks, but are listened to least. Is this because they have the fewest initials after their names, or because some boxers seem less interested in debate without fists? Either way, it is unfortunate that boxers, who might have something meaningful to add, are drowned out in the debate over their sport.

This debate finds Joyce Carol Oates cited more often than the BMA

In this context, sorting through the comparisons is not easy, and that is what needs to be done. Take the inevitable comparison to sports like hockey, where the health risks include death. What those who compare this way will not concede is that a boxer can be killed even if no rules are broken. Fighters can even predict the killing before the fight, for the press. In hockey, soccer, or tennis, a threat to “destroy” the opponent is brushed aside as metaphorical.

For some in the medical community, this places boxing outside the threshold for acceptable risk. Waiving clinical evidence, the Australian Medical Association and others call for restrictions, some want a ban, and they do this on comparative grounds. Boxing is portrayed as a public hazard—like dirty drinking water—that the public must be protected from.

It is tempting to let doctors recommend safety equipment, thank them for their research, and politely ask them to stop interfering in boxing. Boxing is like mountain climbing, the argument might go: it is risky, but adults should be allowed to climb as long as they do not endanger others. Healthcare workers seem hesitant to accept this, possibly because their profession is itself hard to compare. In most professions, the person who provides a service is free to decline, on moral and economic grounds. If I continue to splash through wet paint, you will tell me you are no longer interested in shining my shoes, no matter what I pay. Society does not give healthcare workers this option; society expects healthcare workers to treat even those who repeatedly disregard their warnings. It would be an interesting show of frustration and solidarity if doctors were to decline any association with boxing, even refusing to go near the ring (but do not expect this to happen).

Given this social expectation, doctors naturally want a say in which risks people take. Are they being reasonable? I am wary of healthcare workers who make pronouncements about the social merits of boxing or any other pursuit. However, their remarks are not always far fetched. Boxing does differ from skydiving or American football, for example, sports that defenders routinely compare it to. Boxing involves acts that are frowned upon outside the sport. Parents do not tell their children not to jump out of airplanes or tackle each other—they don’t have to. They tell kids not to hit each other, and many a parent (rightly) suffers guilt at having hit a child.

Does consent matter? Maybe, but consent does not end the debate. Imagine a game where two opponents try to push each other off a rooftop. The risks would include serious injury and death, but would not affect non-athletes. Would it be extreme to force those athletes to undergo mandatory brain scans? Perhaps it would be considered irrelevant whether they consented to the risks. Whatever else might be said about it, boxing is more like hunting than football or track and field events. It involves behaviour that is punished wherever it is identified outside the ring. The elimination of the opponent in boxing also sets it apart from most other sports, insofar as the elimination can, within the rules, be final. This contrasts with, for example, baseball—the “elimination” that the batter suffers when his or her shot is caught is only for the duration of that inning.

Society is probably not ready for rooftop Sumo, but boxing is already here. As people can avoid being affected by boxing, why not let boxers consent to this special risk taking, and make sure that they fight within varying restrictions? Defenders like to note that boxing has a legacy that few activities can match. They are right, and that may be where the key to resolution lies. Despite claims about history being on the side of boxing, this sport has withstood many changes over the centuries. In ancient times, fights with no weight limits lasted until a boxer could no longer stand (this sometimes meant hours of pummelling, culminating in death). Today we have weight categories, time keepers, and restrictions on which areas of the body are acceptable targets. Boxing has changed along with most things in society. If society concludes that there should be additional restraints on what two people can consent to, it could indicate a change in attitudes about punching, not a move towards authoritarianism and paternalism.

Proposed rule modifications and medical testing could be viewed as moves to align boxing with changing social standards. When given a fair hearing by all concerned, including the athletes, these proposals deserve consideration. Boxers might receive advisories about health risks, purchase mandatory health insurance, know that medical care might be selective (the way that pregnant women know that some hospitals will not provide abortion), sign waivers to release anyone from lawsuits, and so on. Why not envision a boxer’s union, with required membership and officials who look after the wealth and health of boxers? At the same time, relieve the medical community of its social obligation towards athletes who play Russian roulette with their health and there should be less need for intervention. We do not prevent someone with a heart condition from entering the local marathon. Force boxers to undergo brain scans and other tests as a condition of employment, but leave them free to fight, until we are willing to radically alter our thinking about risk and personal liberty. For now, it seems best to engage in straight talk about boxing, to understand how it compares with other high risk activities, and create conditions where boxers as well as healthcare workers can exercise their autonomy.