Julian Savulescu | Sport and Society

Julian is a professor at the University of Oxford. He discusses the ethical issues that are raised by progress in science. He’s an expert on discussions around performance enhancers. 

This post gives you a taste of the kind of academic writing you could read if you attended the University of Oxford.  If there are words you or arguments you don’t understand then comment on the post so we can discuss this in more detail.

Dear Burnet News Club,

Thank you for your comments and questions. They are very thoughtful, and you have covered many of the major responses that I receive when I talk about this in Universities across the world. I will try and respond to them in the space that I have.

One thing to say upfront is that all of these arguments apply only to adults, under medical supervision and not to children under any circumstances. There are of course risks involved, as there are with many behaviours we allow adults to decide about for themselves, such as using drugs like alcohol and driving a car.  In these cases the risks should be reasonable and minimised as far as possible. In general, I believe the most effective way to minimise risk is by making the activity legal, educating the population and introducing good oversight. This is not occurring in sport at the moment.

Freedom and Choice

A couple of your comments touch on a topic which is one of the most important ideas in bioethics: we call it autonomy. Autonomy literally means “self-rule”. It means living your life according to your own values. Autonomy is the sense we have that people should be allowed to make decisions that affect their own bodies or their own lives, even if they are decisions others disagree with or we might even think are bad for them. Because we think people should have autonomy they can make these decisions for themselves.

Keyboard Geek expressed a strong view in favour of autonomy:

“I think that taking a drug is just another way to boost up yourself and win, so it should be allowed but not encouraged, as long as the athlete is aware of the consequences”

But Athena’s comment expressed concerns that many people share about taking autonomy too far:

“If all athletes are allowed to take drugs, more athletes will feel pressured to, even if they didn’t want to originally.”

Sometimes people can feel forced into decisions by someone else, or by a situation they are in. If someone says “Your money or your life”, and you choose to give them your money, although you did make a decision, we would not say that was your free or autonomous decision to give up your money. You would have been forced, or coerced.

So what about athletes? Is Athena right that they are not able to make a free decision because of the pressure they are under?

It is probably true that to consistently win in certain sports, you have to take performance enhancers. But in practical ethics, it is important to be consistent across relevantly similar practices.

Athletes are not restricted to training one hour a day, neither are they made to use inferior equipment. Athletes who want to win are under pressure to use the best sports equipment and to train for many hours. These are accepted kinds of coercion.

What makes coercion wrong is when it is harmful or removes a valuable option that the person can legitimately desire. Taking low levels or “physiological doses” of performance enhancing substances under medical supervision maximises the body’s potential. Taken correctly at a safe level, is not significantly harmful, no more at least than dangers athletes are allowed to face: full contact competition, arduous training or large amounts of caffeine.

In fact athletes are already losing the option to not take drugs. We know drugs are very widespread, more even than we thought a year ago: you have probably seen some of the major scandals recently. That means that athletes already have to face the question of whether they will take drugs to keep up, or risk their career.

But in this situation they have to not only decide to take drugs but they have to do it illegally, without supervision, and if they get caught they get punished, even though we know that we only catch a very small percent of people who dope.

Also, to go back to Keyboard Geek’s comment, because it is all secret, it is less clear  that athletes are aware of the consequences.

 

At the moment, we pretend that it is not happening. We stick our heads in the sand and encourage young people to take up athletics, pretending that they will not be under pressure to use drugs. Then when it is too late, they realise that many of their competitors are doping.

We need to face up to it so we can have a situation where athletes know the consequences, and where they are supervised by medical professionals, who are responsible for their health. Then people can decide if it is for them or not from the outset. Just by pretending there is no pressure to take drugs it does not mean there is not one.

 

This also applies to JK independences’ comment. It is not fair for some to take performance enhancing drugs but not others. But that is the situation we are already in, except for when people occasionally are caught they are harshly punished. I hope that legalising and monitoring their use will make it more fair than it is today. The drugs that are still illegal will be better resourced to stop cheaters. And other, safe, substances will be available to everyone, within safe limits.

 

What is an Enhancement?

A number of your comments ask about a very important distinction in doping in sport: which kinds of performance enhancements are OK and which are doping.

A previous head of the world anti-doping agency, Dick Pound said “You know it when you see it”

I do not think this is a good answer.

As independence8 said it leads to inconsistencies, “Beetroot isn’t considered illegal however it is performance enhancing as it enables your blood to carry more oxygen”

You can increase your ability to carry oxygen in your blood through a lot of methods. You can train in the high mountains. You can sleep in a tent which produces the same conditions as the high mountains. You can have blood transfusions taken and then put back in your body. And you can take a hormone called EPO. All of them produce the same effect of improving performance, without extra talent or effort. All of them cost money that not all athletes will have access to. And, I believe that for adults with appropriate medical supervision, a moderate use of all of these methods is safe enough. There are definitely dangers to using these methods to too high a degree or without supervision. That is why I think we should still have checks. But I think we should check for dangerous levels in athletes and not for the type of method they used. I think that this will be more successful as we can then test for changes made to the body not for a substance which can disappear in a few hours.

People feel that doping is immoral but that supplements like beetroot are not. But if a substance is proven safe, and it had the same effectiveness as Beetroot supplement, I do not think that it is morally worse to take the drug instead of taking a beetroot supplement. Likewise, to answer Sherlock’s point, I don’t think that it is morally better to change the climate of training to produce an advantage than it is to use another method. It might be preferable to the athlete for a number of reasons, and I would support that choice. But I don’t think we should force it on them.

JK Independence said that what is important is if it is “natural”, as beetroot is natural it should be OK. Many people share this belief. But it is also hard to pin down.

EPO, which is a drug famously used by the cyclist Lance Armstrong is a naturally occurring hormone, we all have it in our bodies. Blood doping involves using an individual’s own blood. Many drugs come from plants originally.  Caffeine was once banned but is now legal. It occurs naturally although not at levels that some athletes take today. Should the amount be limited as it is not natural? Some very dangerous drugs come from plants and might be called natural. A bike, a tennis racket, skis themselves are not natural. They are all ways of giving our bodies new abilities. I think this is a hard distinction to pin down, and I don’t think that it tracks important things.

What appears to be at the heart of why altitude training and hypoxic air tents are allowed to increase red blood cells, but EPO and blood doping are not, is that the former involve a natural delivery mechanism, whereas the latter involve “unnatural delivery”, often involving needles. This represents an institutionalised and inconsistent “needle phobia”. Athletes can be given vitamin supplements by injection. Injections, given by doctors, are not significantly harmful. It is the substance which is relevant, not the way it is given.

So what are the important questions to ask about whether something should be banned?  I think the important things are safety, and the spirit of sport. By the altering spirit of sport, I mean substantially altering the human ability that is being tested.

I think this is better than the current system because it will lead to a smaller amount of substances being banned. That means we can focus our limited funds on the important ones, the ones which are dangerous to the athlete or the sport, and on testing for the effects of drugs that take the body into dangerous places. And we can have a doctor who is openly responsible for the athlete’s safety.

I think it will also have an effect on whether athletes choose to obey the rules. At the moment, there is little respect. I can see why. One minute a drug is legal, and the next it is banned. The famous tennis player Maria Sharapova took the drug meldonium for many years and no one said she was cheating. Then the rule changed on January 1 this year and suddenly she was cheating and was banned.

If athletes know the rules are to protect them and to protect the essence of their sport,I think it will be easier to persuade athletes. Rules work best when most people agree with them and choose to follow them. If everyone disagrees with a rule and ignores it, it becomes very difficult to police it. And we agree with rules when we know the reason for it.

When your teacher asks you to be quiet in class it is because they want you to learn more effectively, and have the best education you can and therefore the best future you can. Not just because your teacher feels like you being quiet is somehow morally better but can’t say why. You might break the rule sometimes and then you will be punished. But for the most part you follow it, because it is a rule that has a good reason.

 

Testing Natural Ability

Following on to the question of natural substances, JK Independencesaid it would mean that we are not testing natural ability.

We like to think that sports are a test of natural ability. But we know that countries or teams who spend the most money tend to get the best results. This is not just because they buy more naturally talented players, or that rich countries somehow have the most naturally talented sports people. It is because spending money gives an athlete lots of advantages. For example, as we have seen they can spend long months in the mountains, gaining an advantage to their blood’s ability to carry oxygen. Or they can buy a hypoxic air tent to do the same. They can also have the best coaches, the best nutritionists, the best computers to analyse their data and so on. Or they have had expensive lessons since they were very young. There is areason why English skiers do not usually win, but it is not natural talent! They are not usually able to get enough skiing practice when they are very young because of where they live.

As I said before, I don’t think there is a moral difference between someone enhancing the natural talents through sleeping in the hypoxic air tent and taking EPO. And to go back to my previous point, pretending that we are testing natural ability is not the same as really doing so.

Finally, we might ask what is a level playing field. The genes you are born with are a lottery. Someone might have a slightly higher level of testosterone that someone else. Is that difference what you would call talent? Maybe it is just another kind of unfairness- the genetic lottery. There are lots of interesting questions about whatfairness and equality really look like.

 

Hard Work and Giving it Your All

JournalistWriter16 sums up what many people feel about dopers: that they are lazy and are taking a short cut to success.

I recommend Tyler Hamilton’s book, The Secret Race which is a very interesting read. He was a professional cyclist with Lance Armstrong who admitted to doping. He is very honest in his book. He does not agree with me about doping. But he does describe how it was to ride whilst taking banned substances. Of course the doping helps. But it helps athletes to train more, not to be more lazy. On one famous (doped) ride, he ground down 11 teeth through the pain of riding through a broken shoulder. In another episode recounted in the book, Lance Armstrong forced the whole team to ride an extra 5 hour training ride because he had eaten a piece of cake.

Doping can allow people to train harder, or to recover more quickly from injuries. It can give you a similar body make up to what others have naturally, or it can stop your body from losing things like red blood cells in a grueling race. If taking a drug meant you could sit on the sofa eating crisps and still win the race, I agree that drug should be banned. But if it means an athlete can recover more quickly from an injury, get off the sofa and go out training, I think that is something that, if it is safe, we should allow.

 

Summary

When I talk about drugs in sport, many people think that I am rejecting a system where no one takes drugs at all. If we could simply put any drugs or substances we wanted on a banned list, and know that very few athletes would take them, I would be happy with that system. The fact it is arbitrary would not matter if everyone followed the rules.

But that is not the situation we are in.  I am talking about trying to move on from the situation we are in where we know that a very large number of athletes are taking these drugs. And they are doing so illegally, without medical supervision and relatively few are getting caught. The people who don’t take them are at a serious disadvantage. The people who do get caught have their lives ruined for something a lot of other people are doing, and for something that the authorities know a lot of other people are doing. People go into the sport being told there are not drugs, but then when they have given their lives for the sport they realise this was a lie. So they face an impossible decision: to leave the sport because they are one of a few to follow the rules (one of Lance Armstrong’s teammates did this) or to take drugs, stay in the race, but risk getting caught.

People think that drugs that are not on the banned list are morally OK and drugs that are on the list are morally wrong. But I don’t think that is always correct. Meldonium didn’t become immoral on January 1 this year. Tennis was still an enjoyable and meaningful sport to watch last year. And Caffeine did not become morally OK when the authorities changed their minds. It is a decision that the authorities make. But right now, these decisions which they make but can’t realistically enforce are ruining the lives of young athletes.

So I am asking if there is a better way. And I think there is. I think we should not cling onto our list of banned substances for no reason. I think we should forget about things that don’t matter like whether we think substances are natural or unnatural and focus our resources on important things like safety. We should aim to have a set of rules that are reasonable and enforceable.

It might not be perfect, but I think it will be better.

 

 

Photo credit: Polly Borland

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