Miah, A. (2008) Section Introduction: Ethical Considerations of Human Performance Optimisation. In Taylor, N.A.S., Groeller, H. & McLennan, P.L. ‘Physiological Bases of Human Performance During Work and Exercise, Elsevier.
At the beginning of the twenty-first century the ethics of performance are being pulled in two directions. The first of these embodies the spirit of the amateur athlete – itself an account of the broader social values ascribed to physical culture – which arose in the late nineteenth century and flourished in the early twentieth century (Hoberman 1992). The other beckons humanity towards a less familiar era, which is rooted in the democratisation of technology and where the human condition is treated as an unfinished biological entity.
These two eras are united by their mutual appreciation for performative excellence; the difficulty is that they differ in how they define and evaluate this term. For the former, technology compromises and overshadows the natural achievements of individuals, though at times allows for a more representative appraisal of ability. In this case, we might think of a shoe as a technology that eliminates the relative fragility of the ankle joint and foot structure, which has the effect of revealing which people can cover a given distance in the fastest time. However, even in this simple category, distinctions must be made about how different types of shoe optimise performance for quite different activities. Thus, a climber’s crampon also reveals specific kinds of skills that are deemed to be valuable to climbers. Without the technology, it would not be possible to test such specific skills. For the latter category, technology constitutes the natural athlete and it becomes all the more necessary to utilise as people approach their natural limits. On this view, one might consider what should be done to improve upon the relative strength of the ankle, as other physiological capacities are strengthened within an individual.
It is common within debates about the ethics of human performance optimisation to isolate specific social groupings through which to explore the problems it raises. Indeed, most notable in undertaking such isolationism is within elite sport. Yet, crucial to understanding these debates is the consideration of how the values that are deeemed to be at stake with regard to doping extend beyond sport or, more generally, how the values of sport are also constituted by broader social values. While it is convenient to discuss sports as separate from society and even identify examples that support this claim – for example, the legitimisation of violence – there are broader elements that cannot be so neatly described. These include the legitimate use of biomedical technology. The ethics of scientific research and medical practice is particularly complicated today, as a wider range of enhancement technologies is made available to people outside of sport, for use either in work or leisure (United States President's Council on Bioethics 2003). In this context, one might ask whether the rules of anti-doping will still be relevant in an era where non-athletes are modifying themselves through numerous forms of technology (Kayser, Mauron & Miah 2005, Savulescu 2004).
Over the last ten years, human enhancement technologies have begun to compromise the boundaries of health care. Moreover, the consumption of body modifications to fit lifestyle choices, rather than to resolve specific health needs, has grown considerably as a commercial market. One might include cosmetic dental work, surgical procedures, the ambiguous prescription of mind-altering pharmaceuticals, nanotechnology or even the development of science that promises the extension of life, such as biogerontology, as indications of this shift towards a biocultural model for understanding health (Morris 2000). Indeed, current parlance is to discuss the implications of 'NBIC' technologies, which comprise nanotechnology, biotechnology, information technology and cognitive science (Roco and Bainbridge 2002). One of the principal questions that confronts the ethics and administration of such technologies is not simply whether it is possible to make a conceptual distinction between therapy, non-therapy (which would seem to accommodate the notion of optimisation) and enhancement, but whether the moral distinctions between these terms will continue to matter; for they are already being transgressed.
A useful indication of how the performance cultures of work and exercise collide is the recent emergence of a genetic test for performance capacity (Genetic Technologies Limited 2004). This test has been criticised by a number of scientists but, nevertheless, has been made available despite the absence of certainty over its reliability and meaningfulness. While policy makers will undoubtedly offer formal guidance over the appropriate use of this technology, it is necessary to take into account that regulative frameworks do not determine the social significance of artifacts or the range of social meanings that might be ascribed to them. Indeed, Nelkin and Lindee (1995) offer this argument most eloquently when observing that the cultural significance and meanings attached to the concept of genes extends far beyond what responsible scientists would advocate.
The blurred boundaries between the two value systems outlined at the start of this introduction are made even more apparent by discussions about optimisation through nutrition. Indeed, the prospect of functional foods which are engineered to optimise the performative capacities of nutritional substances begs the question as to whether it will remain possible to make a meaningful distinction between doping technologies and technologies that optimise performance. The chapters in this section and others throughout this volume (eg. Chapter 8, Goldspink) imply a number of ethical questions that concern the distinction between optimisation and enhancement. For example, Goldspink (Chapter 8) undertakes the familiar scientific gesture of characterising the application of medical, therapeutic technologies to enhancement practices as a 'threat' to the meaning of sport and health care. Yet, he also recognises the difficulty of characterising therapy in the context of elite sport where, for instance, much of the scientific knowledge aims to enhance the recovery process when injured. In his case study on gene transfer, Goldspink notes that it will be very difficult to isolate a specific intervention as exclusively therapeutic. Once introduced, it might not be therapeutically sound (or possible) to switch off the genetic intervention that enabled the therapeutic effect. To this extent, while the World Anti-Doping Agency (2003) indicates that gene therapy will not be denied to athletes, it is difficult to foresee how this policy will be applied in any meaningful way. Indeed, it is likely that any therapeutic intervention using either nano- or genetic- technology would need to take place at the presymptomatic stage. Thus, even the therapeutic use of such technology involves the need to re-think such concepts as health, aging and disease.
So understood, the supposed threat from technologies that enhance performance is multi-faceted, but perhaps indistinguishable from the effects of technologies that optimise performance. It encompasses the possibly dehumanising effects of too much technology, the possibility of maintaining social justice, the prospect of harm, but also the value of preserving a competitive environment where individuals can expect minimal medical interference. It also involves the concern that the commercial model of medicine could compromise the care of professionals -- a worry that is often advanced in relation to elite sports where the decision of team physicians is compromised by coaches who are under pressure to make decisions that will optimise the likelihood of competitive success (Murray 1984).
A number of the chapters in this volume also draw attention to the complexity of engineering biology. They also remind us that characterising technology as distinct from biology is difficult. For instance, Noakes' Chapter on what is known about the performance effects of hyrdation explains how one might consider water as a technological artifact that is no less complex than, say, the science of performance genetics. Indeed, the salient point seems to involve our appreciation of the inter-relatedness of biological systems. While a systems-based theory of biological processes might not apply equally to all kinds of modifications – not all forms of performance modification are equally complex – the claim of complexity, from which ethical concerns about safety derive, seem central to the ethical resistance to enhancement.
These chapters also reinforce the need for ethical analyses to take into account the non-functional elements of performative culture. For instance, Chapter 34 indicates how some athletes use prohibited substances and methods to improve their aesthetic appearance, which most likely has no performance benefit. Indeed, recognising the athlete as a body located within a visual culture, rather than merely a performing body, is crucial to understanding the value system underpinning enhancement practices in work and exercise. They also raise a question about which people should be culpable for ethical transgressions in sport. Often, it seems that there is little sympathy for athletes who test positive for a prohibited substance. However, Chapter 36 indicates that the regulatory structure for nutritional supplements is inadequate, which limits an athlete's capacity to ensure they do not break the rules. This requires that responsibility for enabling an ethical culture is shared across a number of stakeholders.
Finally, one might suggest that one of the central values of elite performance practices, such as sport, music, or dance, is the demonstrable capacity to extend what is previously assumed about the limits of humanity. As such, if society expects individuals to break world records or extend creative genius, then technologies that transcend mere optimisation will become a necessity. In the near future, we might not see the engineering of pianists with six fingers on each hand, as depicted in the science fiction film GATACA (Nicol 1997) who are able to play divine new compositions. Nevertheless, it is pertinent to scrutinize the moral concern that arises from such a prospect as conceptually similar achievements are already undertaken via body modification.
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