The Ethics of Using Performance-Enhancing Drugs 87 ery and on the prolonged arteriosclerosis, serious hypertension, a lowered sperm count in males, and de- velopment of masculine physical characteristics in women. The regular and ted to Coster- imate d not to be taking steroids at dosages so high that it would be illegal to administer open chas use of steroids is also asserted to produce such personality changes as increased aggressiveness and hostility. What is particularly frightening is that world-class athletes are reported them to human subjects in legitimate medical experiments. Some athletes are said to “stack” various forms of steroids along with other kinds of performance enhancers , such as human growth hormones, in attempts to find the most ef- fective combinations. Moreover , many, perhaps most, athletes who use steroids do so without medical supervision. Such athletes are likely to ignore claims that steroids have little effect on performance when such claims are based on studies that administer only low doses of the relevant drugs. in an ones gard ssist that een y to agh put Evaluating the Use of Steroids sime Various reasons are cited as justifications of the claim that competitive athletes ought not use performance-enhancing steroids. Among the most frequently cited are the following: (1) use of steroids to enhance performance is harmful to athletes, who need to be protected; (2) use of steroids to enhance perfor- mance by some athletes coerces others into using steroids; (3) use of steroids to enhance performance is unfair or a form of cheating; (4) use of steroids to enhance performance violates justifiable norms or ideals that ought to govern athletic competition; and (5) use of steroids demeans or cheapens achievement in sport, for example, by making home runs too common and too easy to hit in baseball. Let us examine each kind of justification in turn. ert es at Paternalism, Informed Consent, and the Use of Steroids Why shouldn't athletes be allowed to use performance-enhancing steroids? According to one argument, steroids, particularly at the high dosages believed necessary to enhance performance, can seriously harm those who use them. For example , according to the Mitchell Report, “Steroid users place themselves at risk for psychiatric problems, cardiovascular and liver damage, drastic changes to their reproductive systems, musculoskeletal injuries, and other problems? The report adds that “users of human growth hormone risk cancer, harm to reproductive health, cardiac and thyroid problems, and overgrowth of bone and connective tissue.”? Let us accept the factual claim that steroids as performance enhancers can be seriously harmful and consider whether poten- tial harm to the user justifies prohibiting their use. The principal criticism of prohibiting steroid use to protect athletes from their themselves is that it is unjustifiably paternalistic. Paternalistic interference 88 Chapter 4: Drugs, Genes, and Enhancing Performance in Spon prevents athletes from making decisions for themselves. After all, would any of spread paternalism was practiced, third parties could prohibit us from eating that our personal decisions about how to live our lives were too risky? If wide. foods that might be harmful, playing in sports that carried even slight risk of injury, or indulging in unhealthy lifestyles. Our lives would be monitored for our own good, of course. The difficulty is that we might not conceive of our The trouble with paternalism, then, is that it restricts human liberty. We may believe, with John Stuart Mill, the great nineteenth-century defender of hu- man freedom, "that the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant If each of us ought to be free to assume risks we think are worth taking, shouldn't athletes have the same freedom? In particular, if athletes prefer own good in the same way as the paternalist. rational decisions? wау. the gains in performance the use of steroids allegedly provides, along with the increased risk of harm, to the alternative of less risk and worse performance, performance, own what gives anyone else the right to interfere with their choice? After all, if we should not forbid smokers from risking their health by smoking, why should we prohibit track stars, baseball players, or weight lifters from taking risks with their health in pursuit of their goals? Although these antipaternalistic considerations have great force, we can- not yet dismiss paternalism as a justification for prohibiting steroids as perfor- mance enhancers. First we must consider some difficulties with this view. Even Mill acknowledged that the kind of antipaternalism articulated in his Harm Principle (the principle stating that the only justification for limiting liberty is to prevent harm to others) had limits. Mill excluded children and young peo- ple below the age of maturity as well as those, such as the mentally ill, who may require care from others. Moreover, Mill would surely exempt those who are misinformed or coerced from the immediate protection of the principle. To use one of his own examples, if you attempt to cross a bridge in the dark, not knowing that the bridge has been washed away by a flood, I do not violate the Harm Principle by preventing you from attempting the crossing until I have explained the situation to you.' In particular, before accepting the antipaternalistic argument, we need to decide whether athletes who use steroids to enhance performance really are making a free and informed choice. If behavior is not the result of free and informed choice, it is not really the action of a rational autonomous agent. If it is not informed, the person does not truly know what she is doing, but if the behavior is coerced, it is not what the agent wants to do in the first place. The Ethics of Using Performance-Enhancing Drugs 89 Is there reason to believe athletes who use steroids are either uninformed about the effects of the drug or are coerced or otherwise incompetent to make First, those below the age of consent can legitimately be prevented on pa- behavior, even if the children want to take their chances on getting hurt, so that parents can prevent children from engaging in potentially harmful prohibit the use of harmful performance enhancers by sports authorities can against possible benefits due to their youth. those who are less capable of accurately weighing risks and potential harms Moreover, elite athletes often are role models for younger athletes, who may strive to imitate their idols or hope to eventually achieve similar levels of performance-enhancing drugs to better their success. When elite athletes use their use may encourage minors, whose reasoning capabil- points out, even if steroid use by high school athletes is declining, as has been ities have not yet fully developed, to use them as well. As the Mitchell Report reported, and only 3 to 6 percent of such young people are using steroids, it such drugs. 1° Therefore, instead of trying to justify restrictions on the use of still would be the case that hundreds of thousands of young people are using performance-enhancing drugs by appealing to paternalism toward competent adult athletes, we can justify the restrictions with the claim that we must fulfill hend the short-term and long-term risks involved in steroid use, from them- our duty to protect younger athletes, who often cannot completely compre- selves. One point that could be raised here is that, although young athletes may be negatively influenced by the examples of athletes who use steroids and other illegal performance enhancers, they may also be dissuaded from using such substances by high-profile cases of those athletes caught and sanctioned for us- ing them. The fall from grace of American cycling icon Lance Armstrong, for example, provides a cautionary tale of how using illegal enhancers can destroy athlete's career and legacy. It could be argued that such examples serve to persuade young athletes that illegal performance enhancers should not be used in their pursuit of excellence and advancement in A second possible problem with the role model argument is that it is not sport. completely consistent with our practices in other areas. We don't prevent adults from consuming alcohol, for example, even though adult drinkers may serve as models for alcohol abuse by underage drinkers. Adults normally are not prohibited by law from being bad role models for young people. Why should we apply a double standard to athletes? The above points suggest that although we cannot ignore the effects of star adult athletes' steroid use on young peo- ple , the claim that prohibitions on competent athletes' use of performance an 90 91 of the argument. sent to skeptical pres- Chapter 4: Drugs, Genes, and Enhancing Performance in Sport less competent individuals is dubious. Such a consideration may factor into the enhancers can be justified solely on the basis of the need to protect younger, ultimate case against allowing steroid use, but it cannot bear the whole weight The Ethics of Using Performance-Enhancing Drugs steroids adequately informed about the serious potential side effects of these What about the requirement of informed consent? Are athletes who use writer concluded, "the onus is on the athlete to continue playing and to con- about the information available, but it is hard to believe that most adult us- drugs? Some athletes, particularly teenagers, may be uninformed or s subtle, makes the athlete vulnerable. It also takes away the athlete's ability to act things he or she would not otherwise consent to.... Coercion, however ers of steroids could be ignorant of the risks involved. Even if H. L. Mencken and choose freely with regard to informed consent.” 11 Although this point may not be without force in specific contexts, the use may not have been totally off the mark when he suggested it was impossible to go broke by underestimating the intelligence of the American people, it is it makes of the term "coercion” seems questionable. After all, no one literally is forced to become (or remain) a professional athlete or to participate at elite levels difficult to believe, in view of the amount of publicity devoted to the use of in amateur athletics. If we want to use "coercion” so broadly, are we also com- performance enhancers, that the majority of mature athletes could be unaware mitted, absurdly it seems, to saying that coaches coerce players into practicing or that steroid use can be dangerous. However, even if ignorance about the effects it more plausible to say that although there are pressures on athletes to achieve training hard? Do professors similarly coerce students into studying hard? Isn't peak physical condition, these no more amount to coercion than do the sures on law or medical students to study hard. Rather, the athletes (or the stu- dents) have reasons to try hard to achieve success; the pressures are self-imposed. n freely decide that the gains of steroid use outweigh the risks. Surely we are At best it is unclear whether top athletes are coerced into using steroids or not entitled to assume that professional athletes as a class are unable to give in- formed consent to steroid use unless we are willing to count similar pressures in other professions as forms of coercion as well. And if we use "coercion” that broadly, it becomes unclear who, if anybody, is left free. Sometimes, however, in particular contexts athletes may be victims of co- some of Lance Armstrong's teammates alleged that he pressured them to use illegal performance enhancers. With the power he ac- crued over time as seven-time Tour de France winner, such pressure could be perceived as coercion, as it seems that refusal to dope could have resulted in a cyclists dismissal from the team; specific overt or even implied threats do im- ply coercion. Apart from such specific situations, however , it appears doubtful that the athlete's general desire to be successful at his or her profession can by itself undermine the capacity for free choice. But is this conclusion too hasty? A critic might point out that even if the athlete's own internal desires for success do not rule out free choice, coercion from other competitors could be present. That is, even if we agree that inter- Coercion and Freedom in Sports nal pressures generated by the athletes are not coercive, we might suspect that What about the requirement of free choice? Are athletes really free to not use their competitors create external pressures that are. It is sometimes argued steroids? At least some analysts would argue that athletes are coerced into us- that even if some sophisticated athletes do give informed consent, their drug ing steroids. Consider professional sports. The professional athlete's livelihood use may force others into taking steroids as well. Athletes who would prefer may depend on performing at the highest level. Athletes who are not not to become users may believe that unless they take the drugs, they will not the best in the world may not be professionals for very long. Thus, as one be able to compete with those who do. Athletes may believe they are trapped because they are faced with a choice in which neither option is attractive. don't lake steroids and lose, or take them and remain competitive. ercion. For example, of steroids were widespread, antipaternalists still might argue that fostering informed choice through improved drug education is a better remedy than simple prohibition Accordingly, paternalism alone probably does not provide a strong enough justification for prohibiting competent athletes' use of harmful performance- enhancing drugs, although it does justify prohibiting those below the age of consent from using them. However, we should leave open the possibility that paternalism, when conjoined with other premises, may provide partial support for prohibition. For example, if steroid use by some people reasonably may be thought to threaten harm to others as well as to the users, and if it is less clear than suggested above that adult users give free consent to assuming the risk of use, then a limited kind of paternalism may play a supporting role in the prohibitionist argument. The argument for prohibiting steroids might then be similar to the argument for requiring automobile drivers to wear seatbelts: we may justifiably require automobile drivers to wear seatbelts because it is for their own protection, because the decision not to buckle up may not re- sult from thoughtful consideration of the dangers involved, and because of the high costs associated with collisions, which place a burden on the health care dias system as well as the taxpayers who support it. o visto que among 93 but only to prevent harm to others. nosni open the term "coercion." ing contribution. Note that the argument here is no longer that we should interfere with ter 4: Drugs, Genes, and Enhancing Performance in Sport but that we should interfere with them to prevent them from coercing others. athletes on paternalistic grounds-to prevent them from harming themselves Such an argument is in accord with Mill's Harm Principle: liberty is restricted The Ethics of Using Performance-Enhancing Drugs into using performance enhancers too? One reason for doubting they do is Do pressures generated by athletes who use drugs coerce other athletes Unethically Constrained Choice that it once again appears as if "coercion” is being used too broadly. One might The appeal to coercion as a justification for prohibiting the use of steroids is just as well say that students who study harder than others "coerce" their class 7 to the charge that it uses the notion of coercion far too broadly. Perhaps mates into studying harder in order to keep up or that athletes who practice the argument can be reconstructed or modified without unacceptably stretch- Whatever the proper definition of coercion, what seems to make coer- longer hours than others "coerce" their competitors into practicing longer hours as well. The problem with such claims is that all competitive pressure improperly interferes with the freedom of another. Thus, if we are reluctant to cion presumptively wrong is that it unduly, illegitimately, or in some other way becomes "coercive." As a result, the term "coercion” is deprived of any moral force. Indeed, if all the competitive behaviors that were "coercive" in this way harder than her competitors is coercing them, perhaps it is because we do not say that the student who studies harder than his peers or the athlete who trains think the student or the athlete is acting improperly to begin with. Both have a right to work harder, so their working harder does not coerce others to do have no reason to prohibit the behavior of the student or the athlete (and even have reason to encourage it because it leads to superior achievement). In fact, their hard work may be inspiring to others and thus make a positive social But consider another situation in which competitive pressures are im- posed improperly. Suppose you work in a firm where young employees com- e for promotions to higher levels. Up to a point, if some work harder than others, no ethical issue is involved, because it is not wrong and usually highly desirable for some workers to try to perform better than others. But now sup- pose that some workers work all the time, including weekends. Everyone feels the pressure to keep up, and soon all the workers give up their holidays and evenings for fear they will lose their jobs if they do not. In this situation it is more plausible to conclude that the workers are coerced or, if not “coerced.” then at least unjustifiably pressured into putting in many hours of overtime. Let us go further. Suppose some of the workers start taking stimulants- drugs having harmful side effects-so they can work even harder. Other defended. workers feel that to keep up they too must take the stimulants. They ask the But before any such argument can be made good, we need to consider employer to set limits on the amount of time they are expected to work be- whether steroid users do have a right to impose the choice of becoming a user cause they are being coerced into taking the stimulant to keep their jobs. on others. And even if they have such a right, would it be wrong for them In this example it is unclear whether the workers who take the stimulants to exercise it? Rather than engaging in a conceptual analysis of the notion of are behaving properly. Arguably, they are putting undue pressure on other "coercion," perhaps it will be more profitable to consider directly whether it is workers to risk harming themselves so they can keep their jobs. If so, the work- morally wrong for athletes who use steroids to place other athletes in a situ- ers taking the stimulants are violating the freedom of their fellow workers, and tion in which they must choose between becoming users themselves or be- their behavior may be regulated in the interests of protecting the freedom of all. Is the practice of steroid use in competitive sports like that of our last exam- oming competitively disadvantaged. be sed berabit isins be dition to our were put into a list, virtually no competitive behaviors would be left over that were not coercive. Critics might reply that there is a difference between weight training and extra studying, on one hand, and steroid use, on the other. As one writer has pointed out, “Steroids place regard for enhancement of athletic performance above regard for the health of the athletes themselves.” 12 Weight training should make athletes stronger and more resistant to injury; studying normally enhances the intellectual ability of students. But steroid use, even if it enhances athletic performance, also presents serious risk of harm to the user. These differences are important and suggest that the use of steroids does present athletes with a difficult choice. But is this enough to show that a user coerces other athletes into also becoming users? Much depends upon how we understand the term “coercion.” 13 If we understand coercion to mean im- posing difficult choices on others when we have no right to do so and if we assume the user has no right to impose the choice of using or not using on other athletes, then perhaps a strong form of the coercion argument can be pete ple ? Do users of dangerous performance-enhancing drugs behave improperly 94 95 withdraw." 14 Chapter 4: Drugs, Genes, and Enhancing Performance in Sport when they put pressure on others to keep up competitively? Some would "No!” As one writer has argued, "the ingestion of steroids for competitive into world class competition. ... If they find the costs excessive, they may to which athletes subject themselves to achieve success. No one is coerced sons cannot be distinguished from the other tortures, deprivations, and risks The Ethics of Using Performance-Enhancing Drugs Although such a rejoinder has force, it may not be decisive. Although steroid use is not strictly "coercive" because athletes can always withdraw from the competition, the choice of either using a potentially harmful drug or being consider the effects of elite athletes using steroids on impressionable young athletes as an added reinforcing factor (the "role model" argument is discussed noncompetitive may be unethical if it is imposed on others. Perhaps a pro- more fully in Chapter 8). Perhaps this presumption can be strengthened when conjoined with another argument of a different but not totally unrelated kind. hibition on steroids can be justified as a means of protecting athletes from being placed in a position in which they have to make such a choice. To the Fairness, Cheating, and the Use of Performance Enhancers extent that we think it is wrong or illegitimate to present athletes with such a Many of those who object to the use of performance-enhancing drugs in sport dilemma, then to that extent we will find the argument from coercion to have do so not (or not only) because they believe users coerce others into using reasons, if any, can be given for regarding the use of drugs such as steroids as these drugs but (also) because they believe that such use is cheating. What an unfair competitive practice? their opponents are doing more than claiming that users are breaking existing rules. For instance, many fans of Major League Baseball claim that players who used steroids and other performance enhancers before the explicit prohibition Of course, if the existing rules prohibit the use of such drugs, then their use is cheating. Those who secretly violate the rules take unfair advantage of those who don't. The interesting philosophical issue is whether sports organi- zations should adopt the rules prohibiting the use of performance-enhancing of their use prior to the 2004 season were cheating. 15 drugs in the first place, or if such rules already exist, they should be changed to allow the use of performance-enhancing drugs. Would allowing the use of performance-enhancing drugs be unfair even if such drugs were available to a point. Regardless of whether we want to apply the term “coercion" in such a context, we need to consider whether it is morally wrong to insist that ath. letes risk harming themselves to compete. If so, a prohibition on steroid use may be justified as a means of protecting athletes against having such a choice imposed upon them and protecting them from competitive pressures that, if unregulated, are far too likely to get out of hand. Such considerations may not satisfy those who think steroid use is per- missible. They would reply that athletes are not considered unethical if they engage in demanding training and thereby impose hard choices on other com- petitors. How can we justifiably condemn the users of performance-enhancing drugs for confronting competitors with difficult choices when we do not make the same judgment in similar situations? This rejoinder does need to be explored further, but it is far from deci- sive. Perhaps we can distinguish the risks inherent in stressful training pro- grams from those inherent in the use of steroids. As M. Andrew Holowchak remarked in a passage quoted earlier, we might distinguish between steroid use, which can be harmful, and training, which, if done properly, promotes conditioning and reduces the chances of injury. pro- Although we have not arrived at an uncontroversial justification for hibiting the use of steroids in organized athletic competition, we have discov- ered an argument that is well worth further examination. According to this argument, athletes who use steroids have no right to put other athletes in the position of either damaging their health or competing under a significant dis- all participants in a sport? Many of us share the feeling that use of performance enhancers provides an unfair advantage, but we need to ask whether there are good arguments to support this intuitive conclusion. We also need to consider just where the unfairness lies. Roger Gardner made a perceptive distinction when he asked whether steroid use was unfair to competitors because of the advantage it provides or was unfair to the game because it made success too easy. It will be useful to keep this distinction in mind as we explore the topic further in what follows. 16 One line of argument suggests an analogy with differences in the equip- ment available to competitors. For example, if one player in a golf tourna- ment used golf balls that went significantly farther than balls opponents used, even when struck with the same force, and the same ball was avail- able for others to use, the tournament arguably would be unfair. One player would be able to avoid one of the major challenges of golf not through skill but by using a superior product . Perhaps the use of steroids provides a sim- advantage. Whether it will survive the test of further critical discussion remains to be seen, but perhaps it is strong enough to create at least a presumption in favor of prohibiting steroids in athletic competition, especially when we also ilar unfair advantage.
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