The Dangers & Ethical Considerations of Performance Enhancements

To begin to understand the ethical considerations and potential dangers of artificial enhancement of blood oxygen carrying capacity, it is first necessary to frame our question. In doing so, we can ask ourselves the reverse question: “Does allowing an athlete who hails from a high-altitude region to compete against other athletes constitute an unfair advantage or an unethical situation?” Perhaps this seems somewhat silly; of course it isn’t unethical to allow a competitor from a mountainous region, and in fact it seems that it would be unethical to disallow competition. Similarly, it does not seem to constitute an unfair advantage to hail from a hometown above the tree line – competitors, after all, cannot control where they are born.

It is also important to distinguish our three concerns – what, after all, constitutes fairness, ethicality, and harmfulness? Let us briefly briefly state our frame of reference for each of these:

1. Fairness constitutes a fundamental availability of access; an ideally fair enhancement would be equally available to all competitors. While this is often a practical impossibility, a fair enhancement would be optimally accessible.

2. Ethicality constitutes specific societal considerations as to the nature of a treatment; they must be socially acceptable, recognized, and widely used among the relevant population. As cultures vary around the world, society in this sense denotes the governing body that oversees the competition; usually this is mutually agreed-upon by member nations of the competitions.

3. Harmfulness is a much easier metric as it can typically be quantified. Any treatment which provokes a negative acute or chronic response within the body should be considered harmful. Furthermore, any treatment which has a net negative impact on society would also be considered harmful.

Which of these considerations, should they be violated, constitute banning from competition? As stewards of both present and future athletes (as well as being caretakers of the inevitable future in which athletes retire from sport), oversight committees should strive to prevent any performance enhancement, or indeed any potential situation arising from competition, from causing any undue, unnecessary, and avoidable harm. As such, any treatment which could be reasonably constituted as harmful, as determined by a series of accredited and independent set of researchers, should be banned from competition. Thus, while it could certainly be argued that living in high altitudes could cause serious respiratory problems in the general population, athletes are much less likely to see these effects. Furthermore, regardless of any potential individual harm due to homologous transfusions, of which there are many, they should be banned by the simple fact that they provide a net negative influence on society; using donor blood that would otherwise be donated to a blood bank strains already continually in-demand supplies.

Additionally, competitions must inherently be kept competitive; while many have argued that  universal approval of performance enhancements would promote universal adoption, thus negating any unfair competitive advantage, universal adoption is necessarily possible, especially in international competitions (let alone the potential health issues that this may cause). Thus oversight committees should strive to ban any enhancement which is reasonably unfair. Again, there is some judgement inherent; while it could be concluded that it is unfair to allow high-altitude training given that countries like the Seychelles do not have native access to mountain ranges, but such a thing would seem to go to far. After all, Switzerland is a perennial contender in the America’s Cup, an oceanic sailing event, despite being entirely land locked. EPO stimulants, in addition to likely being harmful to the body, would constitute an unfair advantage, as availability is not widespread.

Lastly, we arrive at the question of ethicality, the most nuanced of the three categories. It would be, for example, entirely unethical to poison a competitor prior to competition; however, this is also an unfair and harmful competitive advantage. In fact, most situations of ethicality are covered by the previously stated cases for banning. The only major category is deception – using (approved) performance enhancements while not disclosing them. While this may not feel right to some, there is nothing inherently unfair, or harmful about deception, and thus, it is not a cause for banning. Thus, with the stringent requirement that it is safe and performed properly, there would be no issue with autologous blood doping, a more unethical form of RBC enhancement: athletes all over the world have equal access to their own blood, and treatment centers are almost universal widespread with the capability of performing these operations. The issue, of course, is what levels of transfusion could be considered safe, an issue that would need to be researched and overseen.