Every once in a while I dust off my old road bike and head out onto the North Downs to take in a few hills. Panting up a short sharp rise is about as close to elite athleticism as I get—and it is not unusual for me to get off and push. It is from these foothills that I look across to the distant Himalaya of Olympic sports. Draw a veil over the grubby politics, forget about the ticketing problems—I only got three in the end, for the men’s volleyball—inure yourself to the corporate takeover: the heart of the matter surely lies in that look upwards—here is a kind of human excellence at its fullest reach, perhaps the one excellence that in these egalitarian times we are permitted to contemplate without misgiving. This is what a human being at full stretch is capable of.
Which brings me by a circuitous route to the doping problem—if that high Himalayan light is the glory of the Olympics, then by most accounts doping is its nadir. The 2012 Olympics allegedly had the biggest anti-doping operation in the history of the games. The Belarusian Nadzeya Ostapchuk lost her gold in the shot put after testing positive for metenolone. And this is but the visible tip of an iceberg of suspicion about the scale of illegal enhancement in elite sport.

On the face of it the argument against doping looks straightforward. What we revere in Olympians is their extraordinary combination of native talent and self-discipline, not the genius of chemists. We want to see humans in competition, not laboratories. Also, if doping is against the rules and athletes dope, then they are cheating and the Olympics is not in the business of honouring cheats. Attractive as these arguments may be there are problems with them. Take coffee. Whenever I head out into the hills I kick off with a double espresso. Caffeine is not against the doping regulations and yet it can deliver a massive twenty per cent increase in time to exhaustion. The use of the hormone Erythropoietin (EPO) to stimulate the growth of red blood cells is against the rules. Living way above sea level, or using altitude or hypoxic training, which is not, has the same effect. It can be difficult to see a morally significant distinction between them. And as for the cheating argument, well if enhancement is permitted, it is no longer cheating. The moral question is whether the rules are good ones.

A strong argument against the use of doping stems from the health risks it presents to athletes. The clandestine use of unregulated drugs, taken without proper medical supervision can be lethal. EPO can significantly increase blood viscosity and has been linked to premature death among elite cyclists. Appeal to risks however can cut many ways. Many elite sports involve accepting personal risks and this is surely linked to their appeal—courage is a sporting virtue. Besides, if the risk presented by doping is the real issue, arguably a more effective way of managing it is legalisation, ensuring proper regulation and supervision. The argument from risk alone does not look convincing. Banning doping also seeks to protect those athletes who wish to compete ‘clean’ and who seek to resist competitive pressures to expose themselves to the risks associated with doping. The argument is compelling but the big difficulty is that the current ban does not seem to have been successful here.

To turn the argument the other way, those who seek to lift the ban on doping often rely on the argument from consequences. Legalise it and the harms are far easier to manage. You also level the playing field—forgive the metaphor. Everyone has access to the same enhancement technologies. Just as everyone can have an espresso before an event, “unfair” advantages are largely eradicated and the competition returns its focus to that elusive inherent something that the games seek to celebrate. I am not sure though that the argument from consequences holds. Given the intensity of the desire to win, if relatively safe enhancing drugs are legalised, surely athletes will continue to look to riskier unlawful drugs in search of further competitive advantage, merely shifting—oh those sporting metaphors—the goalposts.

There are no easy answers here. Perhaps the ghost of a helpful approach can be found in Aristotle and virtue ethics. If the goal or telos of a sport is the development and expression of certain human excellences and the virtues necessary to acquire them, then perhaps we should ask of any enhancement not only whether it is sufficiently safe—and the safety of the drugs has to be a critical factor—but whether it tends to the expression or the effacement of those excellences. Enhancements need not be biochemical. As Julian Savulescu points out, the development of large head tennis rackets increased serving power to the detriment of rallies. Power began to dominate among the various excellences of tennis. In response, the pressure of the balls was lowered and the game came back into balance. In the absence of a bright moral line between lawful and unlawful enhancements perhaps it is worth remembering what it is that sports seek to celebrate and to consider our arguments about enhancement in their light. Who knows, reflection on those excellences might also just give pause for thought to the money men—and women—and to the politicians.

(The BMA’s Ethics Committee debated the issue following a preliminary discussion between Professor Julian Savulescu and Dr John William Devine on doping in sport to which these thoughts are indebted. They debate the issues in far more detail and with far greater nuance than me in an Oxford debate here. In 2002 the BMA’s Board of Science published a report Drugs in Sport: the Pressure to Perform that explored the use of anabolic androgenic steroids and their associated risks.

Julian Sheather is ethics manager, BMA. The views he expresses in his blog posts are entirely his own.