|  | Current Issues | No.56 May 2009 |
|  |  | print / save view |

The Ethics of Doping: Health, Medicine and Sports Michael McNamee |
ICSSPEs working programme Part of the Working Programme for ICSSPE has been the theme “Ethics and Professionalisation”. ICSSPE has been involved in many ethics-related projects, such as contributing to the process which culminated in the new 2009 World Anti Doping Code. The theme is intended to cut across all of ICSSPEs partners, from Physical Education to Sport Sciences. In this short essay, which is a synopsis of a public lecture given in Swansea earlier this year (mms://mrcstr1.swan.ac.uk/healthscience/ethics), I want to show how the issue of doping is an ethical and professional issue that cuts across the domains of sports, health and medicine and which has implications for the ethical justification of Physical Education too. The essay and lecture is part of a new development that I am trying to lead on for ICSSPE and its partners: To develop an international virtual research network in the ethics of sports and exercise medicine, as a new branch of medical ethics. I shall refer to this as Sport Medicine Ethics (SME) and warmly invite members to email me of their interest in joining the network. I hope the following remarks serve to stimulate your interest. Introduction The problem of deception, of which doping is merely one prominent kind, is as old as Western Ethics itself. In Book II of The Republic, Plato reports the well known story of Gyges’ ring. Gyges, a lowly shepherd, takes his flock into a cave and there finds a corpse wearing a beautiful golden ring which could make the bearer become invisible, he duly took the ring. Aware of his new found possibilities, he uses the ring’s powers to seduce the King’s wife and take over the kingdom. In the Platonic dialogue which follows, Socrates’ interlocutor, Glaucon, argues that any sane person would do the same as Gyges. The story throws into sharp relief the value of a life lived justly where one is at peace with oneself – but with little reward - as opposed to one that is lived ignobly while accruing wealth and power and (what seems at least to be) happiness. Consideration of this general ethical problem can lead us to ask critical questions of sport too, for a flourishing sporting life may not necessarily be an ethically praiseworthy one. In a number of respects, it will be argued, the myth of Gyges’ and his ring is directly analogous the problem of doping in elite sports. It involves the use of deception and the striving for what has been called external goods (wealth, status, and honour) without due regard for the means by which one achieves them, the costs to a person’s good character and a failure to appreciate what constitutes a good life. I do not want to repeat all the standard arguments against doping here . What I do want to note is that in a number of places, sports scientists (e.g. Kayser et al, 2005) and medical ethicists (e.g. Foddy and Savulescu, 2007; Savulescu, 2007) have argued that a medical or health-related norm should govern doping rules. They argue that if doping practices are not harmful then they should –other things being equal-be permitted. They thus ignore important aspects of ethics of sports in general and the ethics of anti-doping in particular. So for example, with the blood boosting substance EPO (which naturally occurs in the body) they argue that athletes should be able to enhance their performance with injections of EPO so long as the viscosity of their blood does not go beyond a medically determined level that would pose a risk to the athlete’s health. Here we have a norm from medical ethics which is supposed to be transplanted (please forgive the pun) into the ethics of sports. I am against this approach and I will proceed to say why now. In the World Anti Doping Agency’s (WADA) newly revised code , WADA operates with three criteria to determine whether a product or process ought to be banned. They are not restricted to health related reasons and only two of the criteria need to apply in order for a product or process to be banned: Performance enhancing; Harmful to health (or potentially so); Against the spirit of sport And in terms of operationalising these criteria, the following guidelines apply: 4.3.1 A substance or method shall be considered for inclusion on the Prohibited List if WADA determines that the substance or method meets any two of the following three criteria: 4.3.1.1 Medical or other scientific evidence, pharmacological effect or experience that the substance or method, alone or in combination with other substances or methods, has the potential to enhance or enhances sport performance; 4.3.1.2 Medical or other scientific evidence, pharmacological effect or experience that the use of the substance or method represents an actual or potential health risk to the athlete; 4.3.1.3 WADA's determination that the use of the substance or method violates the spirit of sport as described in the Introduction to the Code. It is the latter notion – the spirit of sport – that philosophers and ethicists sometimes pick upon to demonstrate the vagueness or ambiguity that gives anti-doping policy makers a difficult time. They argue that the list contains elements that are not instantiated in real life or which are contradictory. The list is full is as follows: Ethics, fair play and honesty
Health Excellence in performance Character and education Fun and joy Teamwork | Dedication and commitment Respect for rules and laws Respect for self and other participants Courage Community and solidarity
To take just one criticism which flags up contrasts between sports ethics, medical ethics, and sports medicine ethics. Those who are sceptical of the coherence or legitimacy of anti-doping argue that the use of certain medical products can be used for therapy and therefore ought also to be used for enhancement purposes without the threat of an anti-doping ban. How should those who think it is right to ban certain doping products and processes respond? Well, at the risk of appearing an uncritical apologist for global sports institutions like the IOC or WADA, I think there good counter-arguments to these important critical questions and postures. Let us take the therapy/enhancement issue. Sceptics say that therapy- enhancement distinction is not clear and is therefore cannot be used to defend the legitimacy of anti-doping postures (Miah, 2004). The commonly used example is from an accepted medical practice. Those who wish to travel to far off places often go to their doctor to be immunised against diseases their body is not equipped to resist. Thus immunisation takes us beyond our normal range of functions to prevent disease. It seems a standard medical intervention and an enhancement practice. There is a similar example from elite cycling: Floyd Landis’ hip was so deteriorated that it required therapeutic surgery which solved his arthritic condition but enhanced his functional capacity. This example seems to point to the fact that sports medicine itself legitimates enhancement practices, so why not doping? One very strong response is as follows . The sceptics think because the therapy/enhancement distinction is blurred it cannot be used to justify doping bans. But a distinction does not have to be absolutely clear for it to be workable in policy or practice. This phenomenon is well known in philosophical circle and it is usually referred to as “conceptual vagueness”. Think how we actually use concepts that are vague in everyday discourse without excessive difficulty. Here are two examples Day and night Colours (e.g. in traffic lights) No one can point to the precise time at which day becomes night or night becomes day. But none of us has any difficulty when using the concepts in everyday discussion. Equally, think of the colour spectrum: at what precise point does yellow become orange, or orange become red. None of us can point to an exact shade yet again we have no difficulty in everyday cases. So if you drive through a red light on your way home tonight, don’t try to tell the police officer that they should not fine you because there is not a determinate point at which the amber (caution) light became red (stop). We handle conceptual vagueness all the time in everyday life and so we should in anti-doping policy too. Thus conceptual vagueness does not do the work that the sceptics think it does. The mere existence of blurred boundaries does not render anti-doping policy illegitimate. There is a final point regarding the therapy-enhancement distinction. It seems clear to me that it is wrong to call immunisation - the standard example - an enhancement practice which opens the door to legitimised medical doping. It seems rather that it is a practice aimed at preventing diseases and therefore falls under a more general therapeutic notion, not one of enhancement. In summary, I do not wish to restrict doping ethics to medical ethics. I think we can have fruitful discussions between medical ethicists, sports ethicists, sports scientists and sports medics. That is why I wish to establish a Sports Medicine Ethics Research Network. But I think we need a clearer appreciation of sports as ethical practices (McNamee, 2008) to begin with. It is commonplace to think that the excellences of sports are merely physical ones and then it seems sensible to restrict the ethics of doping only to issues of harm. But this picture is the product of a corrosive dualism between mind and body. Not only are values such as strength, speed and skill prominent, but they are allied to qualities such as perception, memory and judgement. Moreover, sports require and reproduce a range of ethical qualities both in the achievement of the goal of victory and in the preservation of the best traditions of the particular activity. Doping legislation goes some way to preserving the ethical demands of sports as sites of moral educational example and serves to underwrite one historically important goal of Physical Education in so doing . References Foddy, B., and Savulescu, J. (2007) “Ethics of performance enhancement in sport: drugs and gene doping.” In Principles of healthcare ethics (2nd edition) In R.E. Ashcroft, A. Dawson, H. Draper, J. McMillan (Eds.). London: Wiley, 2007, pp. 511–520. Kayser, B, Mauron, A. and Miah, A. “Legalisation of performance-enhancing drugs.” Lancet. 366, 2005, S21. McNamee, M. J. (2008) Sports, Virtues and Vices: morality play, London: Routledge. McNamee, M. J. (2008a) Why anti anti-doping doesn’t cut the mustard British Medical Journal, 337 http://171.66.124.147/cgi/eletters/337/jul04_1/a584#201679 Miah, A. (2004) Genetically modified athletes, London: Routledge. Savulescu, J. “Doping true to the spirit of sport.” Sydney Morning Herald, 08.08. 2007. Available at http://www.smh.com.au/news/opinion/doping-true-to-the-spirit-of-sport/2007/08/07/1186252704241.html. Accessed 18 .05.09. For a survey of which see McNamee, M. J. (2008). see http://www.wada-ama.org/en/dynamic.ch2?pageCategory.id=250. Accessed 18th March 2009 But see also McNamee (2008a) for a fuller set of responses. The full lecture, of which this is only a small part, is available at mms://mrcstr1.swan.ac.uk/healthscience/ethics and can be used freely (with acknowledgement) as an educational lecture by anyone who wishes to. Contact Prof. Michael McNamee Swansea University Swansea, Wales, UK Email: m.j.mcnamee@swansea.ac.uk icsspe.org/index.php?m=15 The Ethics of Doping: Health, Medicine and Sports Michael McNamee