Should Athletes Be Allowed to Use All Kinds of Performance-Enhancing Drugs? A Critical Note on Claudio M. Tamburrini

Journal of the Philosophy of Sport, 2009, 36, 88-98 2009 Human Kinetics, Inc. Should Athletes Be Allowed to Use All Kinds of Performance-Enhancing Drugs? A Critical Note on Claudio M. Tamburrini Thomas S. Petersen and Johannes K. Kristensen The Swedish-Argentinean philosopher Claudio M. Tamburrini has argued for the controversial claim that the ban on performance-enhancing drugs and methods for athletes should be lifted. 1 More generally he concludes that:... all kinds of performance-enhancing methods [and substances] should be allowed in professional sports (10: p. 216). To our surprise, no one has conducted a systematic investigation of Tamburrini s arguments in any book or international journal. Tamburrini s view is sometimes mentioned in books and articles on the ethics of doping and usually his view is stated as a controversial point of view not worth discussing. 2 However, we believe that his views are worth deeper investigation for at least three reasons. Firstly, it is intellectually unsatisfying simply to reject a controversial moral position without specifying the arguments in favor of the position and attempting to challenge them in a systematic manner. Secondly, since the use of doping is a widespread, although illegal, phenomenon within elite sports, it could very well be the case that many athletes (coaches and sports medics) can somehow sympathize with Tamburrini s view. Finally, if Tamburrini is right, society has a reason to radically change its current practice of testing and punishing athletes who use these drugs. The aim of this article is to challenge some of Tamburrini s arguments. First, in sections 2 4 we want to challenge his critique of some of the usual arguments presented in favor of a ban on doping. Secondly, in section 5, we want to challenge three positive arguments that Tamburrini presents in favor of lifting the ban. However, before entering into a critical discussion of these arguments, let us say a few words about doping. In what follows, we take the word doping to mean the use of substances or methods that are on the prohibition list of the World Anti-Doping Agency (WADA). 3 WADA came into existence in 1999 under the initiative of The International Olympic Committee (IOC) and as a response to the Festina doping scandal during Tour de France 1998. WADA is supported by most The authors <thomassp@ruc.dk> <jkjaer@ruc.dk> are with the Dept. of Philosophy and Science Studies, Roskilde University, Roskilde, Denmark. 88

On Tamburrini and Performance-Enhancing Drugs 89 national and international sports associations (e.g., IOC and FIFA) 4 and governmental organizations like the EU. 5 The Foundation Board of the agency consists of 36 people who represent IOC as well as public authorities. Its official aims are: (i) To protect the right of athletes to participate in doping-free sport; (ii) to promote health, fairness, and equality for all athletes; (iii) to promote and coordinate a worldwide fight against the use of doping; and (iv) to harmonize which substances athletes can permissibly use and what the sanctions for using doping or tampering with doping tests are. 6 On WADA s Prohibited List we find almost 300 substances and methods. For instance anabolic androgenic steroids, hormones like erythropoietin (EPO), methods like blood doping and intravenous infusions, stimulants like adrenaline, amphetamine, and cocaine, cannabinoids (e.g., marijuana), and alcohol in particular sports. 7 Harm and Anti-Paternalism A well-known and central argument in favor of banning doping is that these drugs will harm the athlete who uses them. Tamburrini begins his criticism of this kind of reasoning with the obvious observation that we generally accept that athletes expose themselves to harm (10: p. 202). Just think of sports as boxing, cycling, Formula 1, American football, and wrestling. We generally accept these sports even though the participants may sometimes be harmed. At least we do so after an effort is made to prevent harm from occurring, presumably because we believe that these sports, all things considered, benefit people (athletes as well as other persons who are somehow linked to these sports: relatives, coaches, judges etc.). But, the crucial question is: how much harm should society, governments, and sports organizations accept that athletes expose themselves and others to? In order to answer this question, Tamburrini s strategy is to argue by means of what he calls an antipaternalistic principle (10: pp. 202 204 and 11: pp. 38 50). Unfortunately, Tamburrini does not define this principle in any precise way. But from his use of it, the principle seems to amount to the following: Nobody should intervene in what individuals freely have chosen to do, unless the acts of these individuals do aggregate [sufficient] social harm [to others] (10: p. 204). 8 From this principle it follows that if athletes freely have chosen to take performanceenhancing drugs, they should be allowed to do so, no matter how harmful these drugs are to the athlete herself. Assuming of course, that the use of these drugs do not aggregate sufficient social harm to others. Add to this principle the condition that it is only under medical supervision that athletes should be allowed to take whatever drug they wish to (10: p. 207) In sum, on Tamburrini s view, if athletes voluntarily use drugs under medical supervision and the lifting of the ban will not aggregate a sufficient amount of harm to others, then the ban should be lifted. As we see it, there are several problems with this principle. First, the rationale behind this antipaternalistic principle is only made partly explicit in Tamburrini s writing. But the principle needs to be made explicit in order for us to be able to evaluate its plausibility. The reconstruction of the rationale and a short evaluation of it will be the subject of the following section. Secondly, as we shall see in section 4, Tamburrini s answers to the critiques of his antipaternalistic principle are also problematic.

90 Petersen and Kristensen Rationales for Anti-Paternalism: Libertarianism and Utilitarianism Tamburrini seems to endorse a rationale that is a hybrid between libertarianism and utilitarianism. 9 Let us explain. On a libertarian view people have a right to decide what to do with their own bodies as long as they do it voluntarily and as long as they do not harm or violate the rights of others. 10 This seems to fit well with the spirit of antipaternalism. This element of libertarianism is in the philosophical literature called the self-ownership thesis. 11 Hence, if some people are willing to compete in sports using unhealthy drugs, the state has no right to prevent them from doing so. Nor, of course, should the state prevent people from voluntarily forming a sports organization that bans the use of such drugs by its members. However, to the extent that WADA is a quasi-governmental organization recall that some of the members of the board represent public authorities and leading politicians and its rules are enforced by the state, libertarianism does have a bearing on the issue. But it seems to be the case that Tamburrini is not a full-blown libertarian. We can see this from the way he argues (i) that it should be illegal not to wear seatbelts when driving a car, (ii) that is should be illegal to sell recreational drugs even if some citizens really want to use, say, heroin or cocaine, and (iii) because of the reasons he use to support his claim that the ban on doping should be lifted (10: p. 204). Tamburrini, as we shall see, gives a partly utilitarian and partly libertarian reason for the legitimacy of such interventions and for the legitimacy of lifting the ban on doping: Both safety-belt regulations and the proscription of recreational drugs can be justified on grounds of the aggregate social harm they are expected to prevent. The vastness of these obnoxious effects then turns these banned patterns of behaviour into actions harmful to the whole social body. The regulations are therefore implemented to protect people other than those being coerced. This, however, is not the case with the ban on doping. Professional elite athletes are by definition few. The aggregate social harm that might follow from their doping use would therefore not be sufficiently large to justify the ban (10: p. 206) 12 This justification is partly utilitarian since one morally relevant factor is the aggregate harm in question. However, it should also now be clear that he is not a strict utilitarian, as he accepts that athletes or individuals have the right to do whatever they want to do including harming themselves as long as they do not harm others. So the utilitarian aim of maximizing welfare can be outweighed in such situations. The justification is partly libertarian exactly because of the athletes right to harm himself, while it is nonlibertarian as it is also the aggregate (and sufficiently large) amount of social harm that matters from a moral viewpoint. So, in other words, according to this hybrid view, harm to others should be prevented by the state or state-supported organizations if and only if the amount of harm is sufficiently large. But this implies that harm to others can be accepted if the harm is not sufficiently large. This is of course clearly nonlibertarian, as harming others is not acceptable at all. But remark that it is not necessarily nonutilitarian to accept a constraint on harm to others in certain situations, as harm to a person is morally right, according to utilitarians, if and only if it is the only way to maximize well-

On Tamburrini and Performance-Enhancing Drugs 91 being. In sum, Tamburrini s rationale for his antipaternalistic principle and his moral conclusion that the ban on doping should be lifted is that athletes should be allowed to harm themselves if they want to, provided that the amount of harm to others is not intolerably high. However, we should be reluctant to accept this hybrid between libertarianism and utilitarianism as a plausible rationale for lifting the ban on doping. To discuss these matters in full detail, however, would take us too far away from the present core issue of Tamburrini s arguments and deep into normative ethical theory. Nevertheless, we shall sketch out a few serious problems. We believe that there are at least two kinds of challenges to this view a moral and an empirical challenge. The moral problem is that it follows from the hybrid view that the state or others should not prevent athletes from harming themselves by using dangerous drugs or dangerous amounts of drugs if that is what athletes want to do. Another way to see this kind of problem is that according to Tamburrini s hybrid theory there seems to be no good reason to make it mandatory, at least if it is against the will of the athletes, to make them comply with various safety regulations which would protect them. An example could be the requirement that professional cyclists must wear helmets. The reason here is, we assume, that it would not generate a sufficient amount of social harm if professional cyclists did not wear helmets. However, it does not seem right that we should let individuals harm themselves severely (or expose themselves to the risk of severe harm) if this can be prevented by for instance making it obligatory to wear helmets at races like the Tour de France. Put differently, it does not seem obvious why harm prevention only matters form a moral point of view when the aggregate social harm has reached a so-called sufficient level (e.g., saving 1.000 lives a year) and not when it is under that level (e.g., saving 10 lives a year). Furthermore, how do we determine that the sufficient level of social harm has been reached? As for the empirical problem, Tamburrini s hybrid rationale rests on the empirical claim that it will not generate sufficient social harm if athletes could decide for themselves whatever performance-enhancing drugs they (under medical supervision) would want to use. But this, as we shall see in the next section, may not be true. Tamburrini on the Critique of Anti-Paternalism We will now turn to two of the critical objections to the antipaternalistic principle that Tamburrini deals with. a. Social Harm and Doping Besides accepting safety regulations for construction workers, Tamburrini accepts that it is morally right to restrict personal decisions in other situations: Wearing safety-belts when driving a car should be obligatory and the use of recreational drugs should be prohibited. The justification for intervention in these cases is that such restriction prevents a sufficient number of people from being harmed. He then claims that lifting the ban on doping would, very likely, not have such a negative social effect because the number of professional athletes by definition is few.

92 Petersen and Kristensen We see at least two problems with this claim. First of all, it may well be true that the number of professional athletes is small. But the number of people who use performance-enhancing drugs is way above the number of professional athletes. In Denmark, with a population of 5,3 million it is estimated that about 30.000 young men attending fitness centers make use of anabolic steroids (5% of the total number of individuals attending fitness centers), whereas the number of professional athletes using steroids is estimated to be fewer than 1%. 13 Lifting the ban on steroids could very well increase the number of nonprofessional users and increase the occurrence of the negative side effects of the use of steroids, which include depression, increased risk of developing heart disease, and irreversible organ damage. 14 According to representatives from the International Police Organization (Interpol), the actual market for selling illegal performance-enhancing drugs (especially anabolic steroids) is much larger than the actual market for narcotics. 15 This clearly indicates that the users of doping are not only elite athletes, but many others as well. In that case, a lift of the ban may very well have devastating social side effects. And if this is true, it would follow from Tamburrini s rationale that the ban, at least when it concerns anabolic steroids, should not be lifted. Secondly, Tamburrini s own estimation of the effects of allowing doping can be found in the following quotation: Thus without the ban and with medical research and supervision, the aggregate social harm of doping might after all end up at the same level as that caused be alcohol consumption (10: p. 207). However, if this estimation is right we believe that Tamburrini has given his opponents a very good argument against lifting the ban on doping. If it is true that lifting the ban will impose as much social harm in society as the consumption of alcohol, we should be very reluctant to lift the ban. The consumption of alcohol has had devastating side effects in many countries. Studies have shown that almost one fifth of the adult populations have a hazardous level of alcohol intake. 16 Furthermore, a range of social problems are linked to alcohol abuse (unemployment, divorce, health risks etc.). In the UK, for instance, there were 8.386 alcohol-related deaths in 2005. 17 It seems reasonable to believe that we should not accept side effects like these, just to give athletes easier access to performance-enhancing drugs. b. Coercion and Doping Tamburrini observes that an obvious charge against his position amounts to the following: the ban on doping is justified in order to secure the well-being of sports practitioners (10: p. 202) But as we already know, it follows from the libertarian part of Tamburrini s view that people, all else being equal, should decide for themselves what risks they want to expose themselves to. Following this line Tamburrini accepts, for instance, that we ought to have work safety regulations and he believes that the primary rationale for work safety regulations is to protect workers. Not in order to protect them from being harmed, but from being compelled by others (employers) to take risks they don t want to take (10: p. 203). If there were no regulations an employer could by not allowing safety equipment - coerce a worker into not wearing a helmet. Such regulation is consistent with antipaternalism (10: p. 203), as the moral factor that is violated if there is no work safety regulations is the self-ownership of the person, since the person is at risk of being coerced.

On Tamburrini and Performance-Enhancing Drugs 93 However, if Tamburrini accepts safety regulations when it comes to construction workers, then why shouldn t we accept regulation concerning athletes use of doping? After all, if workers can be coerced by employers when no regulations exist, why shouldn t this be true of athletes? Why presuppose that athletes belong to a special group of people that is less prone to give in to coercion by an employer or a coach? A relevant difference between elite athletes and e.g., construction workers could be that the former are in a better position to resist the pressure from their employers (coaches, sponsors, clubs, etc.), because elite athletes have more professional alternatives than a construction worker. This may of course be true of some celebrity athletes that are financially secured. But most elite athletes are not sport stars they rather want to become stars and to gain enough success to be secured financially. This fact alone could make them less immune to pressure. Secondly, why claim that the primary rationale for work safety regulations is to protect workers from being coerced? Why be so insensitive to harm and what about the social harm that could be the outcome if such regulations did not exist? A more obvious candidate as the primary rationale for work safety regulations is to prevent harm to or death of the workers. If an employer could save just one worker s life a year by deciding that his staff of 500 workers should wear helmets on construction sites, it is not at all obvious that the fear of coercion should be the primary rationale in favor of regulation. Tamburrini s Arguments in Favor of Lifting the Ban Beside his criticism of arguments in favor of a ban on performance-enhancing drugs, Tamburrini presents at least three positive arguments in favor of lifting the ban. We want to show that all these arguments are problematic. Lifting the Ban Will Erase Competitive Inferiority Tamburrini states: With no prohibition, no athlete will be in a situation of competitive inferiority, as all will have the opportunity to dope (10: p. 208). This argument in favor of lifting the ban on doping, on one interpretation, rests on a dubious empirical claim. To claim that no athlete will be in a competitive inferior situation if performance-enhancing drugs are not prohibited is first of all pure speculation, which is not supported by empirical studies. If the ban on performance-enhancing drugs is lifted, it might just as well increase the inequality between rich and poor athletes in their opportunity to compete, as it may be very expensive to buy these drugs even on a free and medically supervised market. Furthermore, it seems to be in conflict with what Tamburrini says elsewhere regarding teenage athletes. According to Tamburrini, teenagers should be prevented from using performance-enhancing drugs that might damage their health, as they lack the maturity to understand and estimate the severity of their decisions. 18 Many teenage athletes will then be in a situation of competitive inferiority if the ban were lifted for adults but maintained for persons under the age of 18. However, on another and, we guess, more fair interpretation it seems that the gist of this argument is the following: If we allow all athletes to dope except children under the age of 18 we then eliminate one source of unfair competitive inequality, namely the advantage that dopers get over rule-abiding nondopers. But

94 Petersen and Kristensen this version of the argument suffers from at least one shortcoming. Although it may be the case that a lift of the ban may eliminate some sources of competitive advantages, it may not be the case in all situations. Let s first illustrate where Tamburrini seems to be on the right track, and then turn to the shortcoming. As an example of the former we could take EPO a hormone that plays a significant role in the production of red blood cells that transfer oxygen to the muscles. If EPO were taken off the prohibited list, it could very well increase the equality between athletes when it comes to their opportunity to increase the volumes of their red blood cells. Presently, the access to a competitive high volume of red blood cells may seem unfair. Some are naturally endowed with a higher volume of red blood cells than the average person. 19 Accordingly, genetic luck plays a large role in determining whether you have a high volume of red blood cells. Others are socially endowed and can therefore afford to increase their number of red blood cells by using high altitude training, high altitude chambers that cost about $50.000, or hypoxic air machines and tents that cost about $7000. 20 Nevertheless, these methods are not on the Prohibition List. And even though EPO is on the Prohibition List it is used by some athletes who pay app. $30.000 on the black market for a year s supply of EPO. 21 If EPO could be sold on a regulated market, the price would drop to about $120 for a month s supply. Again, if EPO in safe doses were allowed this would correct for natural as well as financial inequalities. 22 Secondly however, this equalising effect of lifting the ban on EPO may not be true of other drugs or methods. As we have already hinted at, some drugs (e.g., growth hormone end probable gene doping) may be very expensive to use, and therefore out of reach for poor athletes. Furthermore, lifting the ban on these drugs will add to the inequality between athletes, because such drugs have effects that cannot, as it is the case with EPO, be gained by nonprohibited methods. In sum, lifting the ban on doping will eliminate the inequality concerning formal access to medical drugs between dopers and nondopers that we have in to day s world. And, as we have shown with EPO, lifting the ban on EPO seems to eliminate an inequality concerning access to have a high level of red blood cells, between rule-abiding nondopers. So in these situations Tamburrini has an important point, but just because lifting the ban on doping may have an equalising effect in the formal access to doping and probable will have a real equalising effect as our case with EPO shows, we cannot infer that the same is true of every of the many hundred drugs and methods that are on the prohibited list. Lifting the Ban Will Help Athletes in Perfecting Their Skills The second of Tamburrini s positive arguments for lifting the ban is formulated in what follows: The prohibition on doping puts arbitrary restraints on the further development of sports. Athletes are thus impeded from perfecting the skills specific to their discipline (10: p. 201). 23 It is not quite clear what Tamburrini s argument amounts to. However, if his claim is that the current ban on doping puts arbitrary limits on what kinds of drugs athletes may use and therefore restrains the development of a sport, he may well be right at least when it comes to some of the drugs or methods on the list. For instance, it seems arbitrary that the use of intravenous infusion of e.g., sugar is prohibited by WADA, as it is harmless and no more performance-enhancing than the oral intake of sugar. 24 However, prohibition

On Tamburrini and Performance-Enhancing Drugs 95 on doping needs not be arbitrary. If the rationale for prohibition is to prevent harm to athletes and others this would not be an arbitrary rationale as it seems obvious that harm, seen in isolation, is of no good. So if his claim is that prohibition on doping per se puts an arbitrary restraint on the development of sports he cannot be right. Banning some drugs may of course put limits on the development of sports in the sense that athletes will not jump as high or as long as they could if no drugs where prohibited. And if perfecting one s skills were valuable in itself, the argument might have had some pull. But the perfection of one s skills may do no good morally e.g., in the case of a serial-killer perfecting his skills. Furthermore, a value theory that prescribes noninstrumental value to perfecting one s skills does not fit well with Tamburrini s hybrid between utilitarianism and libertarianism, as these theories do not include perfecting one s skills as a noninstrumental value. Moreover, if it is morally plausible that the state regulates some of our action e.g., enforces speed-limits because of road safety then it does not seem convincing to claim that it is morally wrong per se to regulate the behavior of athletes. Lifting the Ban Will Improve Knowledge That Can Reduce Harm to Athletes Tamburrini here argues that: the ban on doping is responsible for our present lack of knowledge on the eventual harmful effects of doping. [...] Lifting the prohibition would then allow us to conduct research aimed at reducing harm provoked by actual unsupervised doping use. (10: p. 201). At first glance the argument makes good sense. If the use of drugs were not prohibited it would, all else being equal, be easier to test the effects of these drugs on athletes. More athletes would probably use drugs, thus making it easier to get access to a sufficient number of people to conduct research on. However, it is difficult to assess this argument as it is not sufficiently supported by empirical data. First of all, many of the drugs that are banned by WADA are in use and are constantly being tested within a medical setting. EPO (given to patients with blood anemia) and growth hormone (given to patients impeded in the growth process) are two examples. The same is true of the long-term effect of the use of doping among athletes from the former East-Germany. Secondly, it is possible and not prohibited to conduct research on the effect on drugs, even though the personal use of the drugs are prohibited. A ban on doping still allows us to conduct research on the eventual harmful effects of doping. Tamburrini may of course be right in his assertion that we at present lack knowledge about the harmful effects of doping, but wrong in his statement that this is due to the ban on doping. It may simply be due to lack of research within the field of sports medicine. Furthermore, it seems to be an open question whether sufficient knowledge about the harmful effect of doping can actually be gained from research made in a context were there is a ban on doping. If sufficient knowledge can be gained in such a context, then we do not need to lift the ban in order to gain that knowledge. In order to be convinced by Tamburrini s argument, he needs to supply us with data or references to data that can support his claim. Furthermore, athletes may not be willing to participate in such research as they haven t got the time or because they will not reveal what type of drugs they use, just as the will not reveal their secret training methods. Finally, at least when it comes to elite athletes, there is no reason to believe that athletes use of doping

96 Petersen and Kristensen has been unsupervised by doctors. For it is well-known that the names of many doctors have been connected to the use of prohibited drugs in sport. Conclusion Our aim has been to show that there are certain problems with Tamburrini s argumentation in favor of lifting the ban on doping. We have outlined and critically discussed his rationale for accepting his antipaternalistic viewpoint and challenged his answers to some of the most obvious objections to antipaternalism. We have argued that Tamburrini s positive defense for the view that athletes should be allowed to use all kinds of performance-enhancing drugs can be challenged in several ways. So, our inquiry provides good reasons for accepting a less liberal position than Tamburrini s; namely one according to which athletes should not be allowed to use all kinds of performance-enhancing drugs. 25 Notes 1. See Tamburrini, Claudio M. (2000a) and (2000b). 2. See e.g., Breivik (2005) p. 175 and Parry (2006) p. 3. Although the Danish social scientist Inge Kryger Pedersen has written an article in Danish that is devoted to a critique of Tamburrinis view see Pedersen (2004), our focus is primarily on other points of critique than those mentioned by Pedersen. 3. The Prohibited List 2007, WADA (2006) is available on www.wada-ama.org/en/ and so is World Anti-Doping Code (2003) in which the criteria for the Prohibited List is stated. 4. International Olympic Committee (IOC) and Fédération Internationale de Football Association (FIFA). 5. See www.wada-ama.org/en/ for all the organizations that has accepted WADA s list. 6. World Anti-Doping Code, WADA (2003). Especially pp. 1 3. 7. Alcohol is only prohibited in competitions and only for particular sports like archery and motorcycling, and only if the amount of alcohol in the blood exceeds a certain threshold see The Prohibited List, (2007), p. 10. 8. Compare also Tamburrini (2000 b), p. 44. 9. From personal communication we know that Tamburrini accepts this interpretation. 10. Libertarians vary according to what rights people have. However, if people have a right to do what they prefer to do as long as they do not harm others, then it seems likely that libertarianism is a part of Tamburrinis rationale for antipaternalism. 11. Peter Vallentyne, Origins of Left-libertarianism, (2007). The most prominent defender of the self-ownership thesis is Robert Nozick (1974). 12. Our italization. 13. www.antidoping.dk (in Danish) 14. Maravelias, C. et al., Adverse Effects of Anabolic Steroids in Athletes, Toxicology Letters, 2005, vol. 138(3): 167 75. 15. New York Times, October 1, (2006). 16. Sunders, J.B., et al., Alcohol consumption and related problems among primary health care patients, Addiction, Vol. 88 (3), 349 62, (1993).

On Tamburrini and Performance-Enhancing Drugs 97 17. http://www.statistics.gov.uk/cci/nugget.asp?id=1091. 18. Note that this does not fit well with a libertarian justification for antipaternalism. 19. An example of this is the Finish skier Eero Mäntyranta who won two gold medals and a silver medal at the Olympics in Innsbruck 1964. After his career was over, scientists found out that Mäntyranta, due to a rare genetic mutation, had 20% more red blood cells than that the average athlete. See www.olympic.org/uk/athletes/profiles/bio_uk.asp?par_i_id=78697. Obviously, Mäntyranta was not being unfair in benefiting from his rare genetic potential. But, arguably, one would have eliminated an unfair natural advantages on Mäntyranta s part had one made other athletes able to compete on equal terms through their use of substances making up for their genetic disadvantage. 20. See Savulescu, Foddy and Clayton Why we should allow performance enhancing drugs in sport. Admittedly, the argument could run the other way here as well, i.e., rather than allowing EPO to compensate for the fact that some, but not others, can afford high altitude training, one might see the unfair unequal access to such training methods as a reason to prohibit high altitude training instead. 21. We have this information from the Danish journalist Christian Weide Larsen (personal communication) who has interviewed Danish athletes who have used EPO to perform and restore better. 22. Savulescu, Foddy and Clayton (2004) p. 6. Here we appeal to a concern for fair competition, which we believe favor permitting a certain performance-enhancing substance. By doing so we render ourselves open to the suggestion that this favors forbidding other performanceenhancing substances, e.g., those that amplify unfair genetic advantages or are extremely expensive and would not be used, if banned, because the use of them is very easy to detect. However, we do not think such cases are very common and in any case, it is not true of the use of performance-enhancers as such. 23. As an anonymous referee has mentioned, Tamburrini here seems to misinterpret the aim of many sports organizations. We agree, since not all sports organizations would claim that the goal of sport is the perfection of talent but instead claim that a fair and healthy competition is what primarily matters. However, although Tamburrinis view is out of touch with reality, we discuss it as one of the many different normative goals of sport that are discussed in the literature. 24. The use of intravenous infusion can make an athlete recover faster and thereby make the athlete feel less muscle pain after a major achievement. 25. For proposals that are liberal in nature, but less liberal than Tamburrini s proposal, see e.g., Petersen, T.S. & Lippert-Rasmussen K. (2007) and Savulescu et al. (2004). Acknowledgments We would like to thank Claudio M. Tamburrini for his swift response and detailed comment on the first draft of this article. Also thanks to two anonymous referees, Jesper Ryberg, Pelle G. Hansen, Frey Klem Thomsen and Jakob v. H. Holtermann for valuable comments on an earlier version of this article. References 1. Breivik, G. Sport, gene doping and ethics. In Genetic Technology and Sport. C. Tamburrini & T. Tännsjö, 2005, pp. 165 177. 2. Maravelias, C. et al. Adverse Effects of Anabolic Steroids in Athletes. Toxicology Letters, 138(3), 2005, 167 175. 3. Mill, J.S. On Liberty and other essays. Oxford University Press, 2008.

98 Petersen and Kristensen 4. Nozick, Robert. Anarchy, State and Utopia. Basic Books, 1977. 5. Parry, S.J. Doping in the UK: Alain and Dwain, Rio and Greg Not Guilty. Sport in Society, 9(2), 2006, 269 296. 6. Pedersen, I.K. Doping promotes a different game than sport (in Danish), www. idrottsforum.ord/artikler, 1999. 7. Petersen, T.S., and Lippert-Rasmussen, K. Prohibiting Drugs in Sports: An Enhanced Proposal. In New Ways in Applied Ethics, J. Ryberg, T.S. Petersen, and C. Wolf (Eds.)., Palgrave Macmillan, 2007, pp. 237 260. 8. Savulescu, J., Foddy, B., and Clayton, M. Why we should allow performance enhancing drugs in sport. British Journal of Sports Medicine, 38, 2004, 666 670. 9. Sunders, J.B. et al. Alcohol consumption and related problems among primary health care patients. Addiction (Abingdon, England), 88(3), 1993, 349 362. 10. Tamburrini, Claudio M. What s Wrong with Doping? In Values in Sport: Elitism, Nationalism, Gender equality and the Scientific Manufacture of Winners, T. Tännsjö and C. Tamburrini (Eds.)., Spon Press, 2000a, pp. 206 218. 11. Tamburrini, Claudio M.: The Hand of God? Essays in the philosophy of sport, Acta Universitatis Gothoburgensis, no. 11, 2000b. 12. Tamburrini, C., and Tännsjö, T. (Eds.). Genetic Technology and Sport. Routhledge, 2005. 13. Vallentyre, Peter. Origins of Left-libertarianism. Palgrave Macmillan, 2007. 14. World Anti-Doping Agency. Montreal: World Anti-Doping Code, 2003. 15. World Anti-Doping Agency. The Prohibited List 2007, Montreal, 2006. 16. www.antidoping.dk (in Danish)