Sports Ethics

Performance Enhancement in Sport: 

Performance Enhancement in Sport Professor Julian Savulescu

Possibility of biological enhancement: 

Possibility of biological enhancement Longevity Stem cell science Quality of life Behavioural genetics dogs Hard working monkey Monogamous meadow vole Sex selection

Non-Disease Genes and the Best Life: 

Non-Disease Genes and the Best Life Impulse control Memory Temper Shyness – blushing Empathy Good humour Looking on the bright side anxiety

Reality of enhancement: 

Reality of enhancement Sport – EPO, anabolic steroids, growth hormone Identification of athletes on the basis of genetic potential – ACTN3 Cognitive enhancement – nicotine, ritalin, modavigil, caffeine Mood enhancement – prozac, recreational drugs, alcohol Sexual performance – viagra Communication – mobile phones Travel – air travel Present: pharmacological and external technology Future: Genetic engineering – artificial chromosomes Internal technology – nanotechnology, AI

Arguments in Favour of Enhancement: 

Arguments in Favour of Enhancement Consistency – environmental manipulations Treatment and prevention of disease Goal of procreation and parenting – child with the best opportunity Nature as a rational parent Family interest – parent and child Public Interest – cost/benefit to society, rational biological/social progress Responsibility for choosing to not enhance – responsibility for child being worse off that could otherwise have been (harm)\

Choosing not to enhance is harming: 

Choosing not to enhance is harming Dietary neglect results in a child with a stunning intellect becoming normal Wrong Failure to institute some diet means a normal child fails to achieve a stunning intellect Equally wrong

Consistency : 

Consistency There is no difference between environmental and genetic intervention Environmental manipulations affect biology – rats who were mothered showed genetic changes Stimulating environment protects against HD in rats Train children to be well behaved, co-operative and intelligent so couples should maximise the genetic opportunity of their children to lead a productive, cooperative social existence Geneticism and genophobia

What matters: no difference to disease: 

What matters: no difference to disease Goodness of health is what drives a moral obligation to treat or prevent disease Health is not what matters But how well our lives goes Drives a moral obligation to enhance

Asthma: 

Asthma Asthma reduces quality of life. Attacks cause severe breathlessness death steroids required to treat it are among the most dangerous drugs which you can take. It can be life long and require lifelong drug treatment. Ultimately it can leave you wheel chair bound with chronic obstructive airways disease.

Morally relevant properties: 

Morally relevant properties The morally relevant property of “asthma”: it is a state which reduces the well-being a person experiences. could substitute cystic fibrosis, osteogenesis imperfecta, Down syndrome, dwarfism, blindness, etc

What is the Best Life?: 

What is the Best Life? Life with the most well-being There are various theories of well-being: hedonistic, desire-fulfilment, objective list. Not just absence of disease.

Non-Disease Genes and the Best Life: 

Non-Disease Genes and the Best Life It is not asthma (or disease) which is important, it is its impact on my life in ways that matter which is important. Imagine there is a tablet to completely suppress its effects People trade length of life for non-health related well-being- smoking, alcohol, risk Non-disease genes may contribute significantly to well-being as much as disease genes

Goal of Reproduction: Person who has a Good Life: 

Goal of Reproduction: Person who has a Good Life Evolution: Genes selected according to environment survival and reproduction Medical Health Rational Good life

Summary Arguments in Favour: 

Summary Arguments in Favour What matters is human well-being Essence of humanity is to choose to be better Parents/society interests Liberty to make own life Take seriously responsibility for outcome

Objections: 

Objections Personal – harmful Spiritual - against the spirit of human activity or unnatural Social-unfair/unjust

1.Harmful: 

1.Harmful Precautionary principle But also benefit to the child We have to weigh risks and benefits to the child Enhancements should be predicted to be in the child’s best interests

Gamble: 

Gamble Heads you win $50; tails you lose $60 Heads you win $50; tails you lose $25 Heads you win $50; tails you lose $1 Change for years of extra life, Units of future well-being Gambling for your child

Objections: 

Objections Can be delayed But in many cases enhancement will have to be performed at embryonic stage to be effective Argument applies to non-delayable enhancements Children are gifts Nature or God Applies to disease Alternative is rational choice

Other Objections: 

Other Objections Coercive Coercion does not exist where the status quo is available Conflict child parental and societal interests Expanding circle child, parent, society – rules against enhancement Radical Skepticism about Value Relative to environment

Social consequences: 

Social consequences Positional vs non-positional goods Non-positional: happy disposition Positional: height But nothing is pure Argument does not apply to predominantly non-positional goods

Strongest objection: Positional Goods: 

Strongest objection: Positional Goods The example of performance enhancement in sport Not purely positional – excellence of performance

Enhancement in Sport: 

Enhancement in Sport In 1976, the East German swimming team won 11 out of 13 Olympic events. In the late 1990s Sports Illustrated reported a survey by Dr Robert Goldman of past and aspiring Olympians. Goldman asked athletes if they would take an imaginary banned drug if it was guaranteed that they would not be caught and that they could win. 195 said they would take it and only three said they would not. 50% even if fatal

Enhancement in sport: 

Enhancement in sport In 1997 Dutch physician Michel Karsten, who claims to have prescribed anabolic steroids to hundreds of world-class athletes, "If you are especially gifted, you may win once, but from my experience you can't continue to win without drugs. The field is just too filled with drug users."

Enhancement in Sport: 

Enhancement in Sport Studies involving the anabolic steroid androgen showed that even in doses much lower than those used by athletes, muscular strength could be improved by 5-20% Most athletes are also relatively unlikely to ever undergo testing. The International Association of Athletics Federations (IAAF) estimates that only 10-15% of participating athletes are tested in each major competition.

Undetectability: 

Undetectability EPO and growth hormone are natural chemicals in the body

Enhancement in Sport: 

Enhancement in Sport Obvious what the advantage is Irresistible Prohibition will fail – alcohol, drugs, prostitution Ritalin, nicotine and caffeine in exams Value skepticism wrong

Enhancement in Sport: 

Enhancement in Sport Against the spirit of sport? Spirit of sport Test of ability/talent in a rule governed activity Change the spirit Human race vs animal race Musicians and beta blockers Human spirit To be better To lead better lives

Respect the Natural: 

Respect the Natural Nature – machines for reproduction and reproductive survival What is so special about that? Image of God Should not alter what God has given us But what about those who do not believe in that God

Enhancement and the Human Spirit: 

Enhancement and the Human Spirit Enhancement does not necessarily involve cheating or failing to respect the spirit of fair competition If there is a spirit of humanity or human activity, whatever it is, some enhancements are compatible with this

Ethos of Sport: 

Ethos of Sport Test of natural/genetic/biological variation (naturalistic) Plus environmental enhancement of biological High tech training Plus a human component of direct biological modification

Unfair?: 

Unfair? Nature is random and inegalitarian. Applies to diseases EPO Capacity of blood to carry oxygen The starkest example is the Finnish skier Eero Maentyranta. In 1964, he won 3 gold medals. Subsequently it was found he had a genetic mutation that meant that he “naturally” had 40-50% more red blood cells than average. Physiology: Safe level of 50% 5% have a natural level higher than 50%

Prevalence: 

Prevalence In 1998, the Festina team was expelled from the Tour de France after trainer Willy Voet was caught with 400 vials of performance-enhancing drugs The following year, the World Anti-Doping Agency (WADA) was established as a result of the scandal. However, EPO is extremely hard to detect and its use has continued. Italy’s Olympic anti-doping director observed in 2003 that the amount of EPO sold in Italy outweighed the amount needed for sick people by a factor of six.

What Matters: 

What Matters What matters is the level, not its origin Natural – pregnancy, haemorrhage, disease Altitude training Autoinfusion Hypoxic air machine Enhancement corrects natural inequality in haematocrit More fair

Unfair: Two tier World?: 

Unfair: Two tier World? The enhanced vs unenhanced Happened in evolution neanderthal Happens now: US vs Bangladesh environ – economics tech knowledge Response is not to prevent or lower dev but make it more avail Make global enhancement possible

Just for Rich?: 

Just for Rich? The cost of a hypoxic air machine and tent is around US$7000. Epogen costs the athlete about US$122 per month. Biological enhancement may be cheaper

Social justice: 

Social justice Is an objection to enhancement just as it is an objection to maximally pursuing our interests in other ways, e.g private health care, private education It is not an objection special to enhancement Applies to training

Safety: 

Safety Only basic objection Taking GH and EPO to a certain level is safe (eg EPO at 50%) Concentrate on testing for that level, not whether exogenous or endogenous Far from harming athletes, paradoxically such a proposal may protect our athletes. There would be more rigorous and regular evaluation of athlete’s health and fitness to perform. Moreover, the current incentive is to develop undetectable drugs, with little concern for safety. If safe performance enhancement drugs were permitted, there would be greater pressure to develop safe drugs.

Safety: 

Safety For many athletes, sport is not safe enough without drugs. Between 1985 and 1995, at least 121 U.S. athletes collapsed and died directly after or during a training session or competition – most often because they had hypertrophic cardiomyopathy or heart malformations. The relatively high incidence of sudden cardiac death in young athletes has prompted the American Heart Association to recommend that all athletes undergo cardiac screening before being allowed to train or compete.

Test health not drugs: 

Test health not drugs In 1998, the president of the International Olympic Committee, Juan-Antonio Samaranch, suggested that athletes be allowed to use non-harmful performance-enhancing drugs Caffeine is now allowed in the olympics

Performance Enhancement in Sport: 

Performance Enhancement in Sport Performance enhancement is not against the spirit of sport; it is the spirit of sport. To choose to be better is to be human. Welfare should be paramount. But taking drugs is not necessarily cheating. The legalization of drugs in sport may be fairer and safer There is nothing wrong with an enhanced competition

Limits: 

Limits Safety Nature of activity Webbed feet or flippers in swimming Natural webbing Our choice

Advantages: 

Advantages Clearer conception of the nature of the activity and consistency Environmental enhancement vs Biological Swimming skins Cf biological alteration of skin Body Shaving

Advantages: 

Advantages Health of the athlete Require independent body that tests health of athletes and educates them Different as today Sports medicine doctors are committed to performance Independent bodies test for performance enhancement Coaches have strong incentive to enhance performance

Advantages: 

Advantages Reduces harm of social construction of sport At least makes options safer and so better Can’t choose to be an unenhanced athlete but Not clear you can choose that now The nature of sport is arbitrary Reducing freedom is a perilous way of improving people’s choices To be truly free we will make you unfree Other ways of improving option set Reward the unenhanced Respect, prize money Reduces cheating

Examples: 

Examples Food (e.g. glutamine), Caffeine, salbutamol already permitted Safe so tolerated Salbutamol would be a nightmare to regulate How would we prove someone did not have mild asthma Beta blockers, Growth hormone, EPO – yes Steroids - no

“Talent Prediction” ACTN3: 

“Talent Prediction” ACTN3 AUD$110 Australian company Genetic Technologies will test a cheek swab for the R577X variant of the ACTN3 gene. protein alpha-actinin-3, which helps to produce the fast-twitch muscles used in sprint and power sports. R577X variant is a common version of this gene which produces less of this protein. People with this variant therefore will grow less fast-twitch muscle tissue in their body.

ACTN3: 

ACTN3 no copies of the R577X variant gene - sprints and power sports such as judo. two copies of this gene - long-distance or endurance sports. one copy of each variant will be positioned between these two extremes.

Reason : 

Reason Knowledge is power Selection of activity if performance is desired

Objections: 

Objections Skepticism about predictive value and abuse Unfair But already employ talent selection Closing child’s future Punish child for parents’ faults Social construction of harm

The Future: 

The Future Will it be better or just disease-free? We need to shift our frame of reference from health to life enhancement What matters is how we live Technology can now improve that

Two options: 

Two options Intervention Treating disease Preventing disease Supraprevention of disease Protection of well-being Enhancement of well-being State of nature - no treatment or prevention of disease, no technological enhancement To be human is to strive to be better There is nothing intrinsically wrong with performance enhancement in sport The limits are up to us to choose

Reference: 

Reference J Savulescu, B Foddy, and M Clayton Why we should allow performance enhancing drugs in sport Br. J. Sports Med., Dec 2004; 38: 666 - 670.