Sport Medicine Ethics (2005, Stockholm)


Sport Medicine Ethics, Stockholm,May 2005-05-24

Christian Munthe Sport, Med and HC

HC goods -    securing certain lev of health (prevention, restoration, ailment) -    in a just way

SM goods – secure health conducive to athletic performance -    beyond HC lev ofhealth and goals, also enhancmenet not approach reqt of justive

dual influences of SM -    ethos of trad med (life and qual, autonomy, justice) -    ethos of sports (supreme performance and excellence), autonomy, fairness

Rationing HC -    HC: need paramount (and prognosis); prov for worse off upto a level; contested ideas about relevance of numbers;l contested ides about relevance of merit/desert -    SM: unclear about what is paramount; resource not limted by same funds; numbers probc; merit desert can work both ways (sports injuries, self inflicted, heroes benefit soc)

Conested procedures – 4 args (doping, etc)

1.    SM should adapt to ethos of HC (either prob: goals different; or: reason for revising 2.    HC adapt to ethos of Sports (excellence, fairness): either: prob: rules and goals of sport arbitrary from medical view, or: recom for breaking SM out of HC 3.    Sports should adapt to ethos of HC (but: safety or justice arg) 4.    HC should adapt to ethos of SM (safet, justice) Either: probc, due to dit; radical revision of HC

Remarks: -    what ethos is relevant for ethos of SM? -    ‘place’ of SM? -    Basic prob for ethos based ethics – virtue sport philosophy, or communitarian theories of justice -    Challenge for medical ethics – sm/sport -    There is no archimedian point -    Inquiries into concrete, partic issues needed

Claudio Tamburini

No difference view – between med everything and sport med ethics – latter only more specific applic of normative framework in med ethics generally – NOT TRUE – eg. Autonomy/privacy function/meaning in different way in sport – sport med more paternalistic – eg. Training technique – athletes are not protected -, must subit to rules, - testing = privacynot same – no difference view obviously wrong

But should they be different? – yes: athletes are not sick – wrong to giv medicine for sick – Lyjungqvist = doping is medicine – ‘athletes are healthy’ – thus athletes are not patients – not general rights of HC system  - what’s wrong w athletes using med (prov not state funded) – athlete are patients – meaning of patient – suffer from pathology – too narrow – today healthy people give treatment – not clear where to draw t line – healthy people already consume – WHO – well-being – dependence of medical prof for (non(athlete – exposure to effect of medicine makes vulnerable and this vuln indicates patient status , regardless of whether customer – athlete? – are patients – conclusion: recog as patient

ME: ethos of medicine is that absence of proof does not mean absence of reasonable expectation or evidence; cannot refer to WHO for support for an ethical view same for anti doping code

Anders Sandberg

Health consumerism – what are enhancement treatments? – alcohol caffeine, etc – st johns wort – ginseng – positive psych – beta blockers (musicians) – growth hormone – since it is an enhanceent(?) – IGF – improved elasticity – cognitive enhancement – social (prozac -= leadership) – acceptance is complex =- is morphological freedom a right? – functional food yes, GM less, but dfferes in culture – Japan 50%, would consider, 66% would for … therapy – Thaliand, India, yes, if adv – WHO – health as optimal but function relation to ones own cgoals – conclusion: doping and enhancement  - performance artists: how they change their body

ME: only medical intervention reqd ; modafinial, global GM same?

Question&A

JS: by allowing enhancement, implies coercion

MMc: autonomy – inc vulnerability = higher standard SH: sm goal fro physiocan as not ‘excelelnt’, but goal of employer – make sure team wins CL: health definition tooo wide – who – boorse – too narrow Tomas (athlete): paternalism – we let athlete do unhealthy things, so not too paternalistic – wada: not prov risk to health – Is pressure on autonomy so freat for an athlete? CT: as patient more exposed to med prof – athlete can choose not to expose themselves JP: beta-blockers not analogous – art and creaft

REF: MIGUEL NICOLELI – NEUROSCIENCE, CHIPS IN ARMS, MAGNETIC

Susan Sherwin

Should we welcome/resign/resist – social polic y or indiv choice? – Francoise Bayliss/ - oppose – to pursue GE = research prog – sports req different kinds of body type – enthusiasm for GE = popular reductionism – avoid enthusiasm welcome – also reject 2nd (resign) – beleief in efficacy will lead to demand (!) – resigned acceptance is self-fulfilling- reject inevitability – opt for resistance – social policy, not indiv choice – indiv choice: autonomy as informed choice – prog grants to challenge rights based – for some implices reduced autonomy – must include right to refuse – but in sport not possible – broader implic for young athletes – most likely to be applied in adolesecenc, this is bad time – cannot claim ‘iformned’ – challenge indiv – reject trad economy defences – reject indiv autonomy and personhood and supplement w relational theory – persns as partially contested by social relations – liberal theorie treat self-hood as indiv, relations -= selfhood as ongoing project – wht are t proceses by which a person holds certain prefers – fem theory – irrationality based on consensus (irrational to resist conformity – become irrational NOT to select enhancement – excellence as GM conveys something to those who are genetically deficitine – new expctation for improvement – entrenches legitimacy of comp (social Darwinism) – precautionaryu princip0le needed – excellence is not GM, but social programes – less sexy perhaps

ME: what else shouldn’t we have done based on this model?

Sarah Teeztsel

Adam Moore – unexamined life..open to inspection – proivacy and tech – gene doping – uise of legl gene theory for sport not acceptable – banning just -    drug testing in sport (Canada report) – invasion of privacy - acknowleged

Nick Bostrom

(w Toby Ord) – good or bad – double epistemic prob – 1. radical disagreement about conseqs, 2. Eval of consqs: even if we know what would happen, diffi to say whether, on balance, is good orbad – double epistemic chance of only major reform – eg implic of abolishing slavery, rely on stat and subj intuitions judgement – biases – ‘status quo’ bias – doc by exptl economits – defined as inapprop or irrational pref for state, just because it is XX – ‘mug’ experiment – choc bar or nice mug – predict that 50% would get what they wantede, but 90% choose to return item – ‘endowment’ effect – place value on something just because given to us – irrational? – but status quo bias clear explanation in bioethics, definition of judgmeent for this

how elminate bias? – hypothetical enhancement of cognitve (eg. Memory) – conseq: should we think enhancenment would have good/bad oconseqs? – oft doubts about this (fear of unknown) – how adjudicate between opposing views – ask counter intuitive: what if did opposite? – decrease human cognitive capacity – clearer agreement that bad – those who also bad must judge why ‘current’ level is optimal – burden of proof is on those who make these claims – seems implausible that isat peak – reversal test –doesn’t say is wrong, but that burden of proof on ‘status quo’ – cognitive enhancement: arg from ‘evol adaptation’ reg ratio of heart size to body size – w cognitive enhancements, arg doesn’t work, since eg enviro different now than was previously (ie now cognitive society, previously physical soc);  - if human cog cap corresponded w brain size, then might be good – preventing costs to bigger brain – now less – now less – what evol optimises, so inclusive fitness, but human sep side undermine this – eg. Intell – 2. Arg from transition costs: (do not sxXX, kust because implies t difficult – cost to great - - 3. Arg from risk – but this works both ways – riskness doesn’t imply anything specific -  cognitive benefits enormous – 4. Arg from ‘persons affecting’ – consier not likely to effect – 2nd reason of reversal – imagine – double reversal – more powerful heuristic – as takes into account these other args – toxin in water, reduce cog, intro therapy to water – then toxin removes, then cog enahncenemts above optimal (double reversal test) – reverswal and double reversal best comforts to status quo bias – it extent bias – must interpolate  2 versions of status quo – can take into account genesis choices , deontological considerations, and social policy – intuition about ‘natural ‘ prevalent in bioethics – natural = good – intuition about natural more properly about ‘status quo’

Mike McNamee Slippery Slope

Half-baked HN – witnessin convergence of system – no human or postmodern consition – but convergenet – views of transhumanism not clear – ‘transcend limits’ of HN is wrong – ‘features? Is more approp – reduce vulnerability to human – posthuman? – use to enahncene H choices – no need to shed HN, but augment – in favour: facilitate 2 aims: use technology to improve Hs – transhumanism: ‘ideal blue print’ – personhood: if indep of species, then moral status maintained – arg: 2 types of being|: human and posthuman – Buchanan et al: found on category of H – no longer common H – expand inequalities – genetically deficient – autonomy as RRATIONAL CHOICE THEORY – DEMOcratic technology is naïve and idealistic – surely coomerce will govern – in elite sport prevalent – double blind: poor pay for pleasure of envy – for other transhuman 0 engineer resistance – what is idal type? – criteria of THN – affront to morality – eg. HR, tranhusmanist might be beyond human – why moved by approach of ‘solidarity’ – life span: agening as a creapping evil – woody allen: ‘immortal not by doing great deeds, but by not dying’ – burden of proof should be on transhumanist – transhumanist has no limits and thi is a prob – eg. Bod transplant – burden of proof is on ‘us’ – t human is ‘repugnant (Kass) – proof of transhumanist (HE!) – misuse of drugs for sport enhancement – genetic enhancement – approach to therapy first and subjective normalise these – Kant’s ‘dove’ – preconditions of dyling – should celebrate human vulnerability

For NB : does arg depend on stable conseqs? Different versions of autonomy

Jared Diamond – h not changed much in thouse years, but h can find new ways of re-working hu  limits – intell  (rather acculating of cuilture allows more effective development )

Kate fox book – ‘what do we want, gradual chance, when do we want it, in due course’

NB: Asian disease prob –

600 will die without intervention

A  - 200 saved 75% B – 1/3 600 saved, 2/3 0 saved 28%

C 400 die 22% D 1/3 0 die, 2/3 600 die %78%

A and C are same

B and D are same People overweigh losses in decision making

JS: satuat quo not irrational -    if neither v good nor v bad, then not irrational -    - if chose for 150 age, but might me 40 yr, stick w 80 -    in absence of giving people choice to change, giv opp to do that o    if has rich, then prob not whether conformist – cosmetic surgery entrenches norms

Jim Parry –

Supplements – rusedski – defence – supplement – is suppleenmt controlled Different between an orange or taking vitamin pill – ME: an orange is more (still don’t really know what foos is) – foods are unknown ssubstances

Soren Holm -    new drugs – social position  - should not expect sports doctors to prov good advice -    no reason to beloieve that no ban would lead to open safer doping

should not pressure people finto taking big risks

sociall construction of rules – and arbitrariness of rules

MMc: autotelicity – have own rules