DOCTORAL SCHOOL BIOMEDICAL SCIENCES Ethical Aspects of Doping and Anti-Doping In Search of an Alternative Policy Bengt Kayser Promoters: Dissertation presented in partial Prof. Jan Tolleneer fulfillment of the requirements for the Prof. Andreas De Block degree of Doctor in Kinesiology May 2018 KU Leuven Biomedical Sciences Group Faculty of Movement and Rehabilitation Sciences Department of Movement Sciences Ethical Aspects of Doping and Anti-Doping In Search of an Alternative Policy Bengt KAYSER Jury: Prof. Jan Tolleneer, promoter Prof. Andreas De Block, promoter Prof. Johan Lefevre, chair Prof. Mart Buekers Prof. Letizia Paoli Prof. Paul Schotsmans Dissertation presented in partial Prof. Michael McNamee fulfillment of the requirements for (Swansea University) the degree of Doctor in Kinesiology May 2018 © 2018 KU Leuven – Faculty of Movement and Rehabilitation Sciences Uitgegeven in eigen beheer, Bengt Kayser, Tervuursevest 101, 3001 Leuven, Belgie. Alle rechten voorbehouden. Niets uit deze uitgave mag worden vermenigvuldigd en/of openbaar gemaakt worden door middel van druk, fotokopie, microfilm, elektronisch of op welke andere wijze ook zonder voorafgaande schriftelijke toestemming van de uitgever. All rights reserved. No part of the publication may be reproduced in any form by print, photoprint, microfilm, electronic or any other means without written permission from the publisher. Front cover ’Finish Line’, featuring Lance Armstrong, by the artist Robert Hurst. Acrylic on canvas, 16" x 24", 2001. www.adamnfineartist.com (with permission). Back cover ’Untitled (Krystufek after Steen Møller Rasmussen)’, by the artist Claus Carstensen. Acrylic on canvas, 200 x 150 cm, 2001. Photo: Anders Sune Berg. www.clauscarstensen.com (with permission). See the Postscriptum for explanations for the front and backcovers. Typeset with a modified KU Leuven Arenberg Doctoral School PhD dissertation LaTex class (https://github.com/wannesm/adsphd). Printed by Procopia NV, Ambachtenlaan 29, 3001 Heverlee, Belgium. Preface Bengt Kayser i PREFACE iii This thesis would not have been possible without an appropriate mix of conditions, including some luck. The possibility of a sabbatical offered to me by the University of Lausanne, even though I had only just arrived there after having spent more than 20 years at the University of Geneva, provided the first incentive. Rector Dominique Arlettaz suggested that I take a sabbatical leave sooner rather than later so that the University of Lausanne would profit more from what I would bring back, and I thank him for the opportunity. Discussions with my life companion Barbara then spawned the idea to do something with my (and our) work on doping and anti-doping. A chance meeting in 2009 with Jan Tolleneer at the occasion of a two-day meeting on human enhancement at the Brocher Foundation on the shores of Lake Geneva resulted in an invitation from him to participate in a workshop he had organised at the University of Leuven. This was followed by an invitation for a contribution to a volume, co-edited by Jan Tolleneer, Pieter Bonte & Sigrid Sterckx1. It was at the occasion of that Leuven workshop that I learned about the interfaculty workgroup on ethics in sport at the KULeuven, bringing together colleagues from the Faculty of Movement Sciences and Rehabilitation Sciences, the Faculty of Medicine and the Institute of Philosophy. It all seemed to fit, and I therefore approached Jan Tolleneer with the idea of coming to Leuven for a sabbatical and to aggregate my work on doping and anti-doping in the form of a doctoral thesis. Jan reacted enthusiastically and proposed asking Andreas De Block to be co-promotor, which to my pleasure Andreas accepted. The University of Leuven then agreed to offer me an adapted PhD program, given my previous research background, for which I am grateful. I especially thank Jan and Andreas very warmly for their willingness to accompany me on my endeavour; I learned a lot from working with them. It must have been somewhat strange to supervise an older student like me, but they dealt with it in a loving way. I am also very grateful for the stimulating environment that was provided to me at the KULeuven during my sabbatical there in 2016. I heartily thank my colleagues at the historical Hollands College, where as a fellow, I was provided with a wonderful office in the intelectually stimulating environment of the Metaforum, a multidisciplinary initiative of the KULeuven to foster thinking and communicating on important societal questions and developments. The encounters at Metaforum, both formal and informal, were rich, eye-opening and often entertaining. 1Tolleneer J, Sterckx S & Bonte P (2013) Athletic Enhancement, Human Nature and Ethics. Springer Science & Business Media. http://doi.org/10.1007/978-94-007-5101-9 iv PREFACE I also thank the University of Lausanne for the logistics necessary for a six-month leave, an essential ingredient for all of this. Special thanks go to the members of the thesis jury. I am very grateful for their willingness to share their expertise in their critical appraisal of the present thesis. And last but not least, I thank my beloved life companion, Barbara, and my children Remco and Emma, for their love and for coping with an often absent (-minded) husband and father. Saas-Fee, May 2018. Abstract v ABSTRACT vii The use of certain technologies, especially of specific pharmacological means, with the aim of improving performance, is forbidden in competitive sport. This practice, called doping, is repressed by increasingly strong anti-doping measures, which are overseen by the World Anti-Doping Agency (WADA). Even if these anti-doping developments essentially concern elite competitive sport, they influence society in general. Some agents present doping as a major societal problem, and the dealing with it is therefore considered a political priority. In several countries, the principles of anti-doping in elite sport are now applied outside of competitive sport, such as in the realm of fitness centres, and calls for further extension of regulations are regularly heard. Increasingly specific legislation has been introduced, in some countries in the form of criminal law that is also applicable to non-athletes. These developments have spawned academic interest, and doping inside and outside elite sport, as well as the anti-doping efforts aimed at eradicating this practice, have become the subject of an active field of scholarly study. There is considerable overlap with two other important societal and scientific debates, one on the regulation of psychoactive drug use and one on overall human enhancement, i.e. the use of technology to improve human performance in general. Regarding sport, two diametrically opposed discourses can be found in the scholarly, but also lay, literature. Today’s most vocal discourse is that of a zero tolerance approach, enforced in elite competitive sport by surveillance, repression and punishment. On the other hand, an opposing discourse can also be heard that finds anti-doping illogical and calls for the liberalisation of doping. These opposing positions would seem to have their limitations. Past experience with prohibition has shown that a zero-tolerance stance using stringent repression to curb a forbidden behaviour may lead to important (unintended) side effects, while there is insufficient public and political support for the total liberalisation of currently forbidden substances. The general aim of this thesis is to contribute to the discussion on doping and anti-doping, and to sketch the outlines of an alternative way of dealing with doping inside and outside of sport. After a short introduction (Chapter 1) that sketches the historical background of the main issues, an analysis of modern anti-doping in elite sport is presented, highlighting some paradoxes and weaknesses at the basis of today’s anti-doping policies (Chapter 2). Chapter 3 provides an analysis of the argument that allowing doping would merely result in a uniform shift of the playing field at the cost of greater health risks. It is shown that this is unlikely to be the case and a counterargument in favour of allowing some regulated forms of doping, because potentially leading to a more dynamic playing field, is then presented. Chapter 4 provides a perspective accounting for some of the side effects of modern anti-doping, also from a legal perspective. It highlights some of these side-effects and shows that anti-doping viii ABSTRACT comes at a considerable cost to the individual athlete and the community. Chapter 5 then introduces the idea of using a harm reduction approach in the realm of doping in sport. First the principle of harm reduction is explained, building upon the evidence base in the field of recreational substance use. This is followed by a first attempt of applying its principles to doping practices in sport. Chapter 6 then takes the reasoning of the preceding chapter further by completing it with a specific analysis of the ethical implications of such a harm reduction approach for doping, concluding that such an approach can be defended. Chapter 7 finally provides a general discussion that ends with some conclusions and perspectives. The overarching conclusion of the thesis is that there is no society-wide solution to the problem of doping. Therefore practical ways of dealing with its presence aimed at containing its potential risks may represent preferable policy alternatives as compared to today’s runaway effects of globalisation of anti-doping efforts, all while promising to enrich the spectacle of modern elite sport. Samenvatting ix SAMENVATTING xi Het gebruik van sommige technologieën, en speciaal het gebruik van specifieke farmaceutische middelen, met het doel om de prestatie te verbeteren, is verboden in de competitiesport. Deze praktijk, doping genaamd, wordt onderdrukt met toenemend sterke anti-doping maatregelen, onder de auspiciën van de World Anti-Doping Association (WADA). De maatregelen, in principe bedoeld voor de top van de competitiesport, hebben ook effecten voor de algemene samenleving.