Ethical Issues of PEDs

Surveying the Ethics Field

In considering the rights and wrongs of PED use, we at once encounter a threshold question, one that has received very little treatment. Exactly why is using PEDs "wrong"?--which is really to ask is it wrong?

In the witch-hunt fervor sweeping the land right now, asking such a question openly is sort of like asking the shade of Joe McCarthy if communism is really so bad after all. But consider that if the answer to a question is "self-evident", there should be no pain in supplying it, and no disagreement once it is supplied. That is by no means the case here.

As with all else to do with PEDs, sane, qualified voices are hard to pick out from the screaming cacophony of viewpoints which almost all boil down to "in my opinion", with no qualifier about why that opinion should be taken with any more weight than that of a poodle trimmer. Professional medical ethicists--yes, such folk do exist--have spent years both in the trenches of medical care and in the contemplation of the scope and meaning of ethics. They are trained thinkers on the topic. That doesn't make them oracles, invariably delivering truth and wisdom, but it does put them light years ahead of the lads down at the Dew Drop Inn as plausible sources of food for thought.

An excellent overview of the nature of the issues in performance-enhancement ethics can be found in a 1997 article "Fooling Mother Nature: An Ethical Analysis of and Recommendations for Oversight of Human-Performance Enhancements in the Armed Forces" by Dr. Evan G. Derenzo and Richard Szafranski; as the title makes clear, the context is military, but the principles are sufficiently general to apply to sports (which is often cited in the article). Here are some lightly edited (for brevity) extracts:

Vade mecum in hand, we can now turn to specific arguments on PEDs in sports.

Some Statements of the Issues

A Quick Demolition Derby

Let's look in on Norman Fost. Who is he? He was awarded an A.B. by Princeton, an M.D. by Yale, and an M.P.H. (Master of Public Health) by Harvard; he is not only a practicing pediatrician (and Professor of Pediatrics at the University of Wisconsin) but also a widely recognized expert in medical ethics, being Director of the Program in Medical Ethics at the University of Wisconsin and Chairman of the Hospital Ethics Committee; he heads the Child Protection Team, and is a former Chairman of the American Academy of Pediatrics Committee on Bioethics. Last year he received the William G. Bartholome Award for Excellence in Ethics from the American Academy of Pediatrics. Or, in shorter form, he is a practicing physician who is highly expert in medical ethics. Now let's see what Dr. Fost has to say about some of these matters.

In an online article from the American Medical Association Journal of Ethics, "Steroid Hysteria: Unpacking the Claims", Dr. Fost focusses on the ethical aspects of PED use. The essence of his position is embodied in this statement:

Dr. Fost then analyzes and demolishes a number of commonly made claims about PED use; while I strenuously recommend the entire article, which is short enough (and non-technical enough) that you can easily read it all, here is a summary of his points using mostly his own words (more on each point later):

Fost's #1 addresses the "coherence" issue. His #2 is the "harm and coercion" issue, and #3 addresses its implied basis. At #4 is the "moral-boundary" question. Point #6 is really pragmatic rather than ethical, as Fost notes; so is point #5, though it is distantly related to coherence. His #7 is the "normative" issue.

Another Derby

Another place one can look is in the book Sports Ethics: An Anthology, in particular at Chapter 17, "Good Competition and Drug-Enhanced Performance" by Robert L. Simon (p. 175 et seq), Chapter 18, "Enhancing Performance in Sports: What is Morally Permissible?" by Laura Morgan (p. 182 et seq), and Chapter 19, "Sports and Drugs: Are the Current Bans Justified?" by Michael Lavin (p. 188 et seq, no online preview available). I will not here try to tease out each of those essays' points (in part because the online versions are only partial, except for Morgan's). But even what one can see on line is certainly thought-provoking.

By and large, those essays deal with the same themes Fost presents. Morgan, reviewing anti-use arguments, after rightly dismissing as hopelessly weak The Usual Suspects, tries--in her quest to mimic politicians and invent a justification for what one wants to do anyway--to adduce an argument based not on implied coercion for personal benefit (which argument she, like everyone else, has already discounted as specious) but on implied coercion to be a "worthy opponent", in effect to be all that you can be for the sheer glory of the sport. She seems to be trying to translate the "harm and coercion" line to a "coherence" line, but it just doesn't take. How or why implied coercion to achieve "worthiness" is in any morally qualitative or quantitative way different from implied coercion to achieve personal benefit exceeds my capacity to understand. Ipse dixit, I suppose.

And Yet Another

Dr. Charles E. Yesalis, one of the nation's best-known experts on steroids in sports (and, as also noted elsewhere on this site, no apologist for steroids), in the book Anabolic Steroids in Sport and Exercise, which he edited, sets forth what looks like what George Mitchell later regurgitated in his so-called "Report":

My point in setting forth what must seem like a lot of repetitious material is to emphasize just that: the repetitiousness. By that, I mean I want it to be clear that the question of what the issues are is not something that will produce as many answers as there are experts to give those answers. The ethical points at issue are quite well established.

Some Analysis of the Issues

They are, I think, best labelled in the more general form in which Derenzo and Szafranski laid them out.

Harm and Coercion

First, the necessary basis, that PEDs are a substantial risk is, as Dr. Fost noted, itself something of a wet squib. As Dr. Yesalis himself notes,

Mind, the falseness of that assumption is really a practical matter, not an ethical one per se. But it in effect makes the ethical issue of harm largely go away. PEDs are by no means guaranteed harmless; indeed, there may be long-term harms of which we do not yet know. But they are not simply poisons, or anything close to it. They are powerful medications that, under proper medical supervision, are probably about as safe as any other medication.

But put that aside: it remains so that every player who participates in any physical sport undergoes risk of bodily injury, and often very great risk (consider boxing or football). If people want to play those sports, they take on those risks; if they don't want to take on those risks, they don't play those sports. To make a po-face claim that in our never-ending battle for Truth, Justice, and the American Way we must do everything possible to remove as much risk of harm as possible from the game is to make milk spout from the nostrils. Checked outfield padding lately? The rules on batting helmets?

Also keep in mind that the coercive force exists largely because steroids are banned--so that using them is not a universal opportunity, for when something is banned, many will avoid it, for a variety of reasons. Consider conventional exercise, which is an augmentation method that is available to all: many top athletes exercise strenuously, some mind-bogglingly so. Do their regimens "coerce" their peers to like regimens? Do all athletes in a given sport exercise about as much as the most rigorous exercisers do? Let's not be silly.

Again, Dr. Yesalis gives essentially the same reasoning as Dr. Fost:

That's the long and the short of this ethical issue: if drug use is a characteristic of full participation in a sport, in the same way that exercise or the everyday risks of performing in the sport are characteristic, then that's that: it's part of the risk package involved in playing that sport. Play the sport, take the risk; avoid the risk, avoid the sport. It's that simple.

To especially select performance-enhancing drugs as an element of the game that will not be allowed when they bring some benefit (which we know that for baseball they don't, but we'll assume it for the argument, because in many sports they do), unless they are more or less poisonous (that is to say, a highly probable risk of major harm), is arbitrary and silly. One might as well argue that tackling be eliminated from football, because exactly the same arguments apply pro and con: football, tackling; no tackling, no football. There are only so many ways to state this simple, clear, overarching truth. And obviously, from the quotations above, serious thinkers on the issue agree.

Boundaries

The "Boundaries" argument focus on "natural" versus "unnatural" properties. The thrust of the position is that PEDs should be banned because they are "unnatural" aids to performance, the implication being that sports are otherwise pristine Greek exhibitions of pure natural bodily endowments.

This is another milk-out-the-nose fountain. Do we ban eyeglasses, contact lenses, or Lasik surgery for ballplayers? Do we ban ice packs for pitchers arms? Do we ban cleats? Or, closer to target, do we ban carb loading or high-calorie diets or the Atkins plan? Can a man with a sore throat take a cough drop? Can a man with a headache take a Tylenol? Do we regulate the amount of exercise they can do? Only 10 squats a day? Maybe no exercise at all other than actual play? Well, obviously one could string this sort of foolishness out forever, but the very reason it is foolishness is that it reflects the inherent foolishness of the "unnaturalness" theory of prohibition. As Dr. Yesalis says:

Not to mention compound bows for archery--but what's the point of going on? You get it or you don't.

Coherence

Coherence arguments address whether an action is consistent with our idea of the "essence" of a given sport. What I guess is the guts of the position was set forth by Dr. Thomas Murray, president of the Hastings Center, an ethics institute, and Dr. Don Catlin, who operates the Olympic drug-testing lab at UCLA, when they wrote that drug testing in the Olympics seeks to--

Sounds swell, doesn't it? Who could argue with "beautiful and admirable"? Um, perhaps someone with an IQ bigger than his hat size?

As Dr. Fost pointed out in the quotations above, sports are games, invented by humans, with arbitrary rules that are constantly changing. When the American swimmer Janet Evans won a gold medal in the 1988 Olympics in Seoul, she wore a so-called "slime suit", a greasy swimsuit that had been developed in secret, which slashed her time. At that same Olympics, the Canadian sprinter Ben Johnson was stripped of his gold medal because he had failed a test for steroids. Evans won praise for using an unnatural assist, Johnson was vilified for using an unnatural assist. Drugs are chemicals that change the body, but so are special training diets; so is Lasik surgery; so, for that matter, is Gatorade.

In what way does the ability of an athlete to perform his or her sport at a better level somehow destroy what is "beautiful and admirable" about that sport? The only sane answer possible is the presumption that though what he or she did was the sport at a higher level, the "beauty" is tainted by the thought that he or she was not entirely unaided in the performance. Oh, dear.

This is, in reality, only the "boundaries" argument in a new clown suit. If athlete A has Lasik surgery while athlete B takes steroids, in what way has the body enhancement man A underwent, which with no effort on his part raised his ability to perform in his sport, remained "beautiful and admirable" while the enhancement of man B (who has to continually work hard at taking advantage of it) destroyed "beauty"? Really, folks, this is just insanity.

James Bakalar, associate editor of the Harvard Mental Health Letter, put it this way:

Let that be the punch line on this one: When you analyze this, it doesn't work out too clearly.

Normative Systems

This, of course, is where it all really comes from. It is our centuries-old Puritan heritage, the heritage that famously redlined when "recreational drugs" became faddy. Thereafter, anything that could be deemed a "drug" got swept up by the riptide, including PEDs, which have nothing to do with psychic recreation.

Hark back: the American Medical Association, the Food and Drug Administration, the Drug Enforcement Agency, the National Institute on Drug Abuse--all those, and many other experts besides, strenuously opposed adding steroids to the controlled-substances lists, and told the Congress so as forcefully as they could to its collective face during the hearings on the subject. But no: "normative systems" triumphed against medical, criminological, and jurisprudential expertise.

Of course, no one will stand up and say "I'm against steroids because I don't like people having fun, and drugs help people have fun, and steroids are drugs." Even diehard Puritans might choke on that pseudo-syllogism. But such folk come from a tradition that does not allow them to ever be wrong. So, they instead stand up and say "kids will do steroids because pro athletes do." They forget or look away from the evidence that the lads are doing it for reasons older than baseball, or even than the human race.

The Crux

Morgan (cited farther above) has put into sharp focus what is perhaps the ethical crux: in a free and moral society, as a matter of basic principle we do not prohibit things unless there is a manifest nontrivial risk of harm from it to someone who is not knowingly and willingly accepting that risk. Or, as Morgan puts it,

Besides which, as a practical matter, every time we do try to "protect people from themselves", as with Prohibition, we not only breach the basic tenets of a free society but also inevitably wake up with a splitting headache the next decade.

And finally, to argue that PEDs are immoral because they are banned is such a true classic textbook example of circular reasoning that it obviously needs no further comment.

Ethics Summary

The ethical questions are plain, simple, and pretty much universally agreed on. Among ethics experts--but not the press, the public, or the Congress--so by and large are the answers. In sum:

• PEDs are not "health risks" to any greater extent than the average prescription medication of any sort; that is especially true if users have reasonable medical advice and oversight in their use, but it seems true even when they are used "cowboy style". There can be no honest ethical issue of "harm".

• Risks--often of a serious nature--are inherent in all physical sports. If, in a particular sport, PEDs are a significant aid to better performance, then they, and whatever risks they may or may not represent, become an inherent part of that sport, just as are its other risks. Individuals can pursue a sport if they are willing to accept all its risks; if they are not, they are free to avoid that sport, as many avoid, say, boxing or football. No one is "coerced" into playing any given sport, nor does anyone have an inherent right to demand that the nature of a sport be significantly modified--say as by converting regulation football to a game of touch football--just so he or she can play it at a risk level acceptable to him or her.

• There is nothing "unnatural" about PEDs because there is, in reality, nothing that is pure or "natural" about any sport, sports being wholly of human devising. Even in the purest imaginable competition--say, just throwing a weight--training, learning, and coaching will materially advantage one competitor over another. Why are those "natural" and PEDs "unnatural"? If the argument is that they are "unnatural" because they cause changes in the athlete's body, then the whole edifice collapses under the weight of its absurdity, because training, diet, and such universally accepted aids as Lasik surgery, aspirin for headaches, ice packs for limbs, "Tommy John surgery"--and a like laundry list that anyone can readily extend--also cause athletically significant changes in athletes' bodies.

• If there is an unfairness about PED use, it is that owing to their tabu status, they are not equally available to any who might want them. Those who are willing to risk detection or opprobrium can obtain whatever advantage they may or may not confer in a given sport, while those equally interested but cowed by the regulatory and acceptability climate are denied whatever those gains might or might not be. Athletes cannot make choices on the merits as they perceive them.

There is simply no plausible case, ethical or practical, to be made for prohibiting PED use, not in law, not in sports-organization codes. The strong tendency to regulate or ban arises largely from old instincts, not reason, which makes discussion on the issues difficult, for it has been famously said that reason will never get someone out of a position that reason never got them into in the first place.

It is supposed to be a basic tenet of any society daring to call itself "free" that it is not to regulate conduct that is not risky to those not willingly accepting the risk, whether that is oneself or others; many would say that it ought not even to regulate conduct that is risky unless that risk is material.

The rest of what it seems to me appropriate to say on these matters I have put on the main PEDs page here under "Conclusions".