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Abstract

There are many deﬁnitions of doping, but all of them suggest that doping is the illicit use of drugs with the aim to enhance sports performance and improve an athlete’s ability to win. Doping is fundamentally against the health of the athlete and the spirit of sports. While the harm to health argument appears straightforward, the ethical dimensions are both more ambiguous and more contested. In this research paper, key issues are discussed concerning the Prohibited List, Sports Entourage (Athlete Support Personnel), and Equality among athletes, as arguments to demonstrate the importance of the ethics aspects of anti-doping. First published by the International Olympic Committee (IOC) in 1967, the Prohibited List has been a continual source of controversy. Moreover, the responsibility of Sports Entourage for doping and anti-doping is unclear. Even with the 2015

World Anti-Doping Code, it is still not clear why athletes should be responsible for doctors’ or coaches’ mistakes. Finally, although doping rules and regulations are not perfect, they seem to better reach equality among athletes than do other rules. In conclusion, the ethics of doping, though not exhaustive of “the spirit of sports,” is an important pillar of anti-doping policy.

Introduction

In the book Both Sides Clean about doping from the perspective of people from Serbian culture, the journalist Marija Midzovic has opened up many questions, and, among them, the ethical ones are crucial. The modern worker is lagging behind expectations due to fatigue and exhaustion in the face of constant and ever-increasing demands for greater productivity. Unlike artists, sportspersons are not allowed limitless creativity. Unlike the world of business, sports cannot face the burnout phenomenon, in spite of what happens after every training session or performance (Midzovic 2009). There are numerous ways of addressing physical and mental overload, to renew energy and to ﬁll people with energy, in one word – performance enhancing substances (PES). The variety of PES, from Viagra to human growth hormone, is enormous and the results are often effective, though not necessarily legal. Athletes are one among few occupational populations that have no right to use them. The use of PES on the Prohibited list is considered unethical and punishable and is detrimental to athletes’ health and revokes the very idea of sports victory and fair competition. Yet the challenge of PES has seriously brought to question the norms of professional sports.

A Short History Of Doping And The Emergence Of Global Anti-Doping

It has been written many times that the history of doping is as old as sports itself. There is, however, not much evidence for the claim. Historically the problem of doping in modern sports was tackled ﬁrst by the International Olympic Committee (IOC), during the 1960s. An ofﬁcial deﬁnition of doping was ﬁrst given by the IOC in 1964, but a year earlier, the Council of Europe (CoE) established the following deﬁnition of doping: “The administering or use of substances in any form alien to the body or of physiological substances in abnormal amounts and with abnormal methods by healthy persons with the exclusive aim of attaining an artiﬁcial and unfair increase in performance in competition” (Bowers 1998).

The World Anti-Doping Agency (WADA) was established in 1999 as an international agency as a result of collaborations between international sports federations, the International Olympic Committee, and governments of the world. Its main task was to establish and monitor the World Anti-Doping Code, which is the core document that harmonizes anti-doping policies, rules, and regulations and attempts to ensure the standards are the same for all athletes all around the world.

The problem of coordinating nation states into international treaties is a signiﬁcant one. In the case of doping, UNESCO adopted a Convention against Doping in Sports, which was the ﬁrst time that governments around the world have agreed to apply the force of international law to anti-doping (UNESCO 2005). This is important because there are speciﬁc areas where only governments possess the means to take the ﬁght against doping forward.

Within the sports community, and indeed sports ethics (Moller 2009) and medical ethics scholarship (Savulescu et al. 2004), many have challenged the legitimacy of the World Anti-Doping Agency generally and the Prohibited List speciﬁcally. Their arguments range from the negative (such as criticizing in/consistency in policy and argument, the apparent arbitrariness of the doping list, the inadequacy of empirical literature, problems in performing doping controls, inconsistencies of penal actions, and so on) to the positive (such as the right of the athlete to self-determination in relation to their bodies, satisfying the desire of spectators for excellent results, doping to assist harm reduction in hazardous occupations, and so on). One additional ethical argument should be mentioned: the tolerability to PES in other spheres of life. Many doping substances are accepted in society as a means of eliminating problems related to activities at home and at work. The use of “the pill” has become an integral part of high-tech societies. It is an accepted part of the medicalization of everyday life. Were people really to say “no” to drugs on a widespread scale, life in many Western societies would be dramatically altered.

The use of doping substances has become an important part in some recreational sports, especially ﬁtness and bodybuilding (Christiansen 2010). One particular problem in these sports activities is the narrow gap between the permitted products, sports supplements, and doping steroids (Vernec et al. 2013). There is a small step between willingness from taking various nutritional supplements to transition to the doping substances. From a public health perspective, nutritional supplements may be seen as gateway substances (Hauw and McNamee 2014). In the world of aggressive marketing and Internet-driven (unveriﬁed) information, people become easy prey to consuming everything that appears to enhance their capacities.

It might be argued that the need to renew the basic humanistic values of life has never been greater, at a time when these values have never been harder to reach. In the summer of 2007, the scientiﬁc magazine Nature, induced by frequent doping scandals in sports such as the bicycle race Tour de France, asked whether we live in a transhuman era. Might it be the case that by the end of the twenty-ﬁrst century, the unenhanced body and mind might be increasingly rare? This challenging hypothesis sparked a great interest in the media and induced numerous controversies and discussions culminating in the question “might there be Olympics where all the competitors were doped?”

A central thrust of the argument of an editorial in Nature (2007) was that people in everyday life were increasingly drawing on the help of pharmacology to perform everyday functions such as remembering better, sleeping better, improving their BMI, concentrating longer and more intensely, and stimulating sexuality. Why ought these widely accepted pharmacological enhancements not extend also to the sphere of sports? Doping in sports stands in contrast almost as a paradox considering that sports are centrally about performance enhancement yet doping via PES is disallowed.

Nevertheless, a range of opponents have spoken out against the libertarianism that seems to fuel transhumanist (or as the loose group now self-identify: posthumanists). Bioconservative opponents have challenged the idea on philosophical, ethical, and political grounds. Religiously motivated scholars have challenged the hubris of claiming to transcend humanity. Philosophical scholarship in sports has largely been skeptical of these claims. At least one advocate of the arts, the famous Serbian actress Djurdjija Cvetic, has come out in opposition to such enhancement: “When you start doping it’s no longer a sports, and the participant is no longer an athlete. It would be as if someone else could come and play my role instead of me.”

Ought athletes be seen properly as exceptional cases to the ever-growing acceptance of pharmacological enhancement? It might be said that elite athletes are different from other people, a sort of almost divine creature, a positive “mistake” of nature, capable of extreme physical feats. Yet against a backdrop of pharmacological liberalism, their rejection of doping might appear messianic: their decision to stay “clean” could encourage other mortals who seem to lag behind in the pro-doping environment to stay clean as well. To those of us who face Olympian tasks in everyday life, the preservers of clean sports offer shaman-like puriﬁcation. Slogans such as “100 % ME” (UK Anti-Doping), “Play true” (World AntiDoping Agency), “For clean power” (National Anti-Doping Agency Germany), “Doping is not hockey” (International Ice Hockey Federation), and “Clean Game” (Federation of International Basketball Associations) are their bold, marketing-driven responses. Saints aside, why is it so difﬁcult to stay “clean?”

Conceptual Clarification/Definition

From the beginning of organized anti-doping policy development, the World Anti-Doping Code has treated ethics as a fundamental component of the rationale for the ﬁght against doping in sports. As it is written in the Code, “The spirit of sports is the celebration of the human spirit, body and mind, and is characterized by the following values: Ethics, fair play and honesty, Health, Excellence in performance, etc.” And later “Doping is fundamentally contrary to the spirit of sports” (WADC 2009, p. 14). Despite such bold proclamations, it seems that the majority of those actually involved in sports understand that doping substances are potentially enhancing sports performance and have health risks, but they do not frame doping so readily as an ethical issue. Frequently, the use of doping is cited by athletes (in private, of course) and members of the elite sports entourage as a matter of individual. They simply do not ask themselves the question, “Is doping against the ethics of sports?” which is seen more commonly as a pragmatic question.

The ethics of sports is important because, in ways both implicit and explicit, it impinges upon every athlete’s life. In relation to anti-doping, ethics (loosely characterized as the “spirit of sports”) along with performance enhancement and health risks, represent the three pillars of WADAs antidoping efforts. They are the three criteria by which a substance (or method) may be considered for inclusion on the Prohibited List. Any combination of two from the three is sufﬁcient for consideration by the Prohibited List committee. Notably, there has been considerable dispute as to whether “the spirit of sports” should be removed from those criteria, but the extant position from 2015 is that the status quo will remain. Equally noteworthy is the fact that Prohibited List Committee is comprised of scientists and includes no philosophers or ethicists who might interpret the spirit of sports criterion in a nuanced way (McNamee 2015).

Since it was accepted by the World AntiDoping Code, the ethics of anti-doping has become a legal instrument in some countries. Even though the anti-doping ﬁght is harmonized all over the world by the UNESCO convention as well as in certain national laws (e.g., France, Italy, Austria, Serbia), the demands on athlete’s lifestyles are so strong that anti-doping policy interferes in daily lives much more than most other sports regulations. Moreover, there is considerable overlap between law and ethical considerations in the World Anti-Doping Code, which makes the ethics of doping highly unusual within sports ethics. This may be because, philosophers aside, there is a considerable convergence of antidoping sentiment among administrators and athletes, and perhaps this is not the case with many other ethical issues on social and medical worlds.

For some scholars, there is surprise and frustration at the lack of legal challenges against doping in sports. Many sports politicians and policy makers were surprised at the speed with which the UNESCO Convention was brought together to globalize anti-doping policy and states parties’ support for it (WADA Media 2014). This was highly unusual for international accords on ethically contentious topics in the world of international politics. One suggestion for this accord was that the policy determinations reached were global, and without exception. Of course this must not be taken to mean that the Code is implemented in homogeneous fashion around the world. Indeed, differences of funding, scope, interpretation, application of doping control tests, analysis, storage of samples, and so on still represent serious challenges to the fairness of the policy as applied around the world.

Key Ethical Issues

The full range of ethical issues arising in antidoping is too numerous to survey here (McNamee and Moller 2011; McNamee 2014). Two issues are discussed from many that have direct bearing on the medical community: the Prohibited List and the Sports Entourage (sometimes referred to as “Athlete Support Personnel”).

The Prohibited List was activated by the IOC and its newborn Medical Commission in 1967. There are authors who chronologically divided the evolution of the List in four periods, each of which presents its own ethical problems (Botrè and Pavan 2009).

Phase I From The Origin Of The Modern Olympic Games To Establishing The Medical Commission Of IOC: Disagreement Between The IOC Medical Commission And International Federations

Everything started with the deaths of two cyclists, the Dane Knud Enemark Jensen, during the Rome 1960 Olympics games, and British champion, Tom Simpson, during the 1967 Tour de France. In the year 1967, the International Olympic Committee (IOC) set up the Medical Commission with the task to organize and supervise the ﬁght against doping in sports. The main ethical issue was to not allow the athlete to compete under the inﬂuence of drugs. At that time, the Medical Commission published its ﬁrst list of prohibited substances in sports with stimulants and narcotics, but without anabolics, hormones, etc. The IOC later developed a Medical Code in 2009 “to protect the health of athletes and to ensure respect for the ethical concepts implicit in Fair Play, the Olympic Spirit, and medical practice” that remains unchanged though compliance with it seems not to be monitored with particular rigor (Olympic Movement Medical Code 2009).

The ﬁrst anti-doping control tests were performed during the Winter Olympic games in Grenoble 1968, without any positive results, which are formally described as “adverse analytical ﬁndings.” Analytical methods have greatly improved since this time and have become increasingly sophisticated to cater for the high-tech advances in doping methods and substances. At the Mexico Olympic Games in 1968, 667 samples were analyzed (with one doping positive athlete), but during the 1972 Munich Games, 2,078 urine samples and 65 blood samples were analyzed, which led to seven disqualiﬁcations. So far so good, for the anti-doping regime. The ﬁrst ethical dilemmas arose, however, between the Modern Pentathlon Sports Federation and the IOC regarding 14 adverse ﬁndings involving sedatives. This disagreement ended with conﬂict between the IOC Medical Commission and International Federations. Ofﬁcials of the Modern

Pentathlon movement had asked “The list of forbidden drugs should be discussed with all the International Federations one year before the Games and published ofﬁcially by the IOC Medical Commission. Only in exceptional cases can a new drug be added to the accepted list, but that should be done in reasonable time before the Games” (Henne 2009). In that time nobody discussed the potential conﬂict of interest of International Federations, who did not take kindly to the image of their sports being tarnished by its association with doping practices. This conﬁrmed that the main scientiﬁc and ethical issues were at that time connected to the development and status of the Prohibited List, which even today is one of the main questions in the ﬁght against doping in sports.

Before the Olympic Games in Munich 1972, the IOC Medical Commission published what became known as the green booklet with antidoping rules and procedures. It set out procedures for doping controls, including privacy and anonymity in order to carry out the tests in a legally robust manner. The process has not changed so substantially and with the exception of the volume of urine (from 20 to 90 ml). What has changed greatly is the sophistication of the analytical methods to which the same is subjected. Testing occurred at major events, but not between them, allowing substantial periods of time when the athlete could beneﬁt by doping assisted training, allowing for greater workloads and quicker recovery from them.

Phase II From Anabolics To Hormones (1974–1992): Different Lists With Prohibited Substances Created Inconsistency And Misunderstanding

In the second period, the doping list included anabolic steroids (added in 1974), caffeine, betablockers (added in 1985), and diuretics (in 1986). Athletes had started to use doping substances more out of competition, since doping control started to be effective in competition. Many elite athletes had left the Pan American Games in 1983 at the start of anabolic steroid testing (Hoberman 1992). Later, some started to use clenbuterol (a b2 agonist), which was originally used in cattle breeding to increase the muscle mass of the animal to make it more proﬁtable as a commodity. This is just an example of what some athletes were ready to use in order to not be caught. b2 agonists were not detected in human athletes until 1992.

One of the most ethically controversial aspects of the IOC prohibited substance list is the phrase “and related substances.” The phrase is still retained in the 2015 version of the WADA Code. Clearly, it offers considerable latitude to antidoping personnel in their attempt to capture athletes who are doping with substances as yet unknown (speciﬁcally) to the anti-doping regime. The aim of the IOC Medical Commission is to prohibit all substances that are related by their pharmacologic actions or chemical structure to each class of prohibited substances, but according to many experts, this is not fair, since the Prohibited List is rendered potentially inﬁnite.

During this period, the Prohibited List of the IOC Medical Commission was not binding across all sports, and the substances that were banned varied greatly among them creating inconsistencies. Sports federations created their own lists of prohibited substances and established their own anti-doping rules. Interest in doping grew in North America, especially in 1988 because of the Dubin Commission inquiry in Canada, following the Ben Johnson scandal at the Seoul Olympic Games of 1988.

In consequence, many major sports organizations in the United States and Europe, including the National Collegiate Athletic Association (NCAA), the National Football League (NFL), the United States Olympic Committee (USOC), and Fédération Internationale de Football Association (FIFA) began extensive anti-doping programs. They have worked equally on education and testing, which is essential for understanding how anti-doping policies and practices should be organized. It is important that education is introduced from the early beginning in an anti-doping program of every sports federation, since the operation of strict liability means that athletes must be accountable for what is in their bodies, irrespective of how the substances get there. Yet many different lists with prohibited substances had created mismatches.

There was no harmonization, and each federation and country could punish an athlete very differently for what was, in effect, the same doping violation (e.g., the ban for phenylpropanolamine {stimulant in competition} varied between a public warning and a 2-year sanction). This made the situation where certain drugs could be banned in one country or under the rules of one federation, but not in others.

In 1987, speciﬁc anti-doping principles were added to the Olympic Charter, Rule 29. This clause articulated stricter obligations for athletes, the possibility of being banned for violations, and a clause explicitly stating that those nonathletes involved with doping cases (sports personnel) would also endure sanctions. The determination of what sanctions to be applied varied: some favored a lifetime ban after the ﬁrst offense, whereas others favored “balance and understanding,” enabling athletes to have a “second chance” after a temporary suspension, including Prince de Mérode, the Chair of the IOC Medical Commission (Henne 2009). This point has historic signiﬁcance, because it is the ﬁrst time that the sports entourage (Athlete Support Personnel) is mentioned speciﬁcally as a potential problem for anti-doping policy.

Phase III From New Substances On The List To Establishment Of WADA (1992–1999): Demands To Publish Complete Lists Of Prohibited Substances Valid For One Year

The third period follows the pharmaceutical industry’s development of new drugs, which led to the abuse of peptide hormones (erythropoietin, growth hormone, gonadotropins, etc.), which unintentionally became the platform for a new generation of sophisticated doping regimes. Just like anabolic steroids, so efﬁciently used for muscle regeneration in military contexts (Hoberman 1992) and then applied to sports, each of these hormones had therapeutic applications in general medicine. In 1988, blood doping was banned and the Prohibited List was supplemented with diuretics and beta-blockers. In 1989, peptide hormones were added. Since 1992, b2 agonists have been considered as doping agents.

In order to organize the system more scientifically, in 1994, the IOC and the International Federations signed an agreement to make a common list with prohibited substances that should be applied more generally. The crucial sentence “… and other related substances,” which allowed anti-doping personnel considerable ﬂexibility, remained. Since then, many experts in antidoping, as well as athletes, coaches, and so on, have been demanding the publishing of complete lists of prohibited substances valid for 1 year. This particular problem showed up during the Olympic Games in Atlanta 1996.

In the urine from ﬁve sportsmen from Russia and Lithuania, the product bromantan was detected. Bromantan is an immunostimulatory and antioxidative agent produced in the USSR for soldiers in order to shorten the time of biological recovery after an intense/prolonged physical effort. In the beginning of the competition, sportsmen that were proven to have used bromantan (two medalists, among others) were disqualiﬁed. Nevertheless, they were released afterwards because the agent was not on the list of prohibited substances. Clearly, it is a matter of dispute as to whether this should be the case. On the one hand, a legalistic perspective holds that doping substances and methods are deﬁned by the Prohibited List and if a product or method does not appear there, then it is unacceptable to hold them to account. Ethically, however, it was clear to everyone that this was indeed doping, and the clause “other related substances” was intended to cover this eventuality. The IOC Medical Commission subsequently added bromantan to the Prohibited List in January 1997, and during the following Classic Skiing World Championships, the Russian sportswoman Lubow Jegorowa, who won the 5 km classic style running competition, was disqualiﬁed in relation to its abuse. The total number of samples analyzed by the 23 IOC accredited labs in the years 1988–1992 almost doubled, increasing from 47,069 to 87,808 (Benzi 1994).

Phase IV: The Era Of WADA (1999– )

From January 1, 2004, the World Anti-Doping Agency (WADA) became the main coordinator of the global anti-doping system from the IOC Medical Commission. Being mandated by the World Anti-Doping Code, WADA has since been responsible for the preparation and publication of the Prohibited List. It is regularly updated and is valid from January 1 every year. Facilitating annual publications of the Prohibited List, amended by examples of banned substances, WADA partially fulﬁlls demands to publish the complete Prohibited List. Nevertheless, an open system exists that allows a rapid reaction if a new pharmacological substance is detected that athletes are using for doping purposes. For example, the American laboratory BALCO produced tetrahydrogestrinone (THG) and several track and ﬁeld athletes (e.g., world-class athletes Marion Jones, Dwayne Chambers, Tim Montgomery, Kelli White, John McEwen) had tested positive. The immediate reaction from WADA was to put THG on the Prohibited List. This fourth phase of anti-doping development is, however, feared by many as a step too far in the illicit search for the ultimate doping substances and methods. It is expected by some scholars that gene doping will develop as soon as gene therapy is available more widely. Many genetic scientists are less conﬁdent of this assertion.

In the 2005 Prohibited List published by the World Anti-Doping Agency (WADA), gene doping is deﬁned as the “non-therapeutic use of cells, genes, genetic elements, or modulation of gene expression, having the capacity to enhance athletic performance.” (WADA Prohibited List 2005). The possibility of gene doping and its detection raises a number of ethical issues. In addition to ethical issues that attend to all genetic medicine, relatively little is known about the use of genetic material in nontherapeutic populations. A relevant concern is whether some precautionary principle ought to apply here or whether this is too crude a policy response. Yet WADA has adopted a blanket ban on genetic manipulation of athletes’ bodies. Moreover, how anti-doping organizations are to test for such manipulation is disputed. Blood tests have been introduced in order to analyze hemoglobin-based oxygen carriers (HBOCs), recombinant human growth hormone (rGH), and homologous blood transfusion (BT). The fact is that a number of doping positive athletes were increased and that new methods helped to detect some new substances. The best examples could be the case of continuous erythropoietin receptor activator (CERA). As a new agent, CERA has been retested after Beijing Olympic Games and ﬁve new doping positive athletes have been found. Among them are Olympic gold medalist on 1,500 m, Rashid Ramzi, and silver medalist in cycling road race, Davide Rebellin. This raises further problems about retrospective justice and punishment. How long ought samples be stored? How can one assure the privacy and integrity of samples that are stored over extended time periods?

The World Anti-Doping Code states that a substance shall be included in the Prohibited List if WADA determines that the substance or method meets any two of the following three criteria:

4.3.1.1 Medical or other scientiﬁc evidence, pharmacological effect, or experience that the substance or method, alone or in combination with other substances or methods, has the potential to enhance or enhances sports performance

4.3.1.2 Medical or other scientiﬁc evidence, pharmacological effect, or experience that the use of the substance or method represents an actual or potential health risk to the athlete

4.3.1.3 WADA’s determination that the use of the substance or method violates the spirit of sports described in the introduction to the Code

It is clear that the latter two criteria moderate the ﬁrst; both have ethical signiﬁcance: harm to athletes’ health and contraventions of the spirit of sports. Critics have frequently queried why the particular harms represented by doping are justiﬁably singled out (Moller 2009; Savulescu et al 2004). Moreover, there has been considerable discussion as to whether the “spirit of sports” clause should be given normative power in antidoping governance given its conceptual vagueness (McNamee 2015).

In addition to the problems associated with the criteria for doping methods and substances and the list it produces, one of the most important is connected to the patterns of responsibility for doping. It might be thought that the person directly and predominantly responsible for doping rules violation was the athlete. But this would be a misconception. Elite athletes are now surrounded by a team of medico-scientiﬁc advisors, in addition to coaches and technical advisors. In antidoping circles, these were previously referred to as the “athlete entourage” but in the new Code are referred to as “Athlete Support Personnel.”

Charlie Francis gained notoriety as a pro-doping coach who had mentored Ben Johnson to his then astonishing world record in the Olympic 100 m ﬁnal in Seoul 1988. Before that the East Germans had a highly sophisticated state-sponsored doping system. In the former case, Johnson was thought to be incredulous for his defense, which seemed to be that he lacked competence in the decision-making and that Francis was the controlling mind. His defense was, unsurprisingly, unsuccessful. Some of the younger doped East German athletes might properly have made such a defense since their doping was utterly unknown to them. They had been duped into thinking that they were simply receiving nutritional and other licit sports medicine support.

Historical cases notwithstanding, there remain problems assigning responsibility for doping in contemporary doping and anti-doping. Sports physicians have been guilty of both active assistance but more contentiously they have also been guilty of negligence in their duty of care to their athletes. A catalog of mistakes made by medical doctors in sports has reopened the debate about the role of medical doctor in elite sports (Dikic et al 2013). In some cases, sports physicians involved in recent positive doping cases are insufﬁciently aware of the nuances of doping regulations and, most importantly, of the list of prohibited substances. Moreover, several team doctors are shown to have exercised poor judgment in relation to these matters with the consequence that athletes are punished, on the basis of strict liability, for doping offenses on the basis of the physicians’ failings.

Historically the most important case of doctor fault in relation to doping offenses was probably that of Andreea Raducan’s case in the Olympic Games in Sydney, when she was stripped of her gold medal after testing positive for pseudoephedrine, which was contained in Nurofen, a common over-the-counter antiinﬂammatory medicine. During the competition at the Olympic Games, she reported a headache, a running nose, and a feeling of congestion to Dr. Oana, who prescribed and issued her a Nurofen, an anti-inﬂammatory drug. Subsequently, however, she failed a doping control, testing positive for pseudoephedrine, and was stripped of her gold medal by the International Olympic Committee (IOC). Raducan said that she bore no responsibility for the anti-doping rule violation (ADRV), since the Nurofen pills were given to her by her team doctor with whom she had a relationship of trust and that the pills had not been performance enhancing. Nevertheless, the IOC anti-doping panel and later the Court of Arbitration for Sports (CAS) were implacable. Athletes have a duty to avoid the presence of such substances within their person. This is known as “strict liability.”

In such circumstances, athletes’ rights are jeopardized by a failure of the duty of care that sports physicians owe their athlete patients. It is true that the International Federation may punish the Athlete Support Personnel. What is clear, however, is that there is a signiﬁcant lack of consistency and coherence between different International Federations (IFs) and sometimes within the same IFs over time. It is true that WADA can take such cases to appeal at the Court of Arbitration for Sports; yet having one anti-doping authority challenge another (such as an IF) is hardly good news for anti-doping harmonization.

It is clear that patterns of responsibility need to be better distinguished. It is also fairly self-evident that intentional doping assistance offered by Athlete Support Personnel is more culpable than negligent; yet both will end in the, e.g., removal of the athlete from the competition in which he or she has competed. It is equally clear that in order to “prosecute” (both in the legal and nonlegal senses) antidoping policy with respect to Athlete Support Personnel, anti-doping authorities do not have the ﬁnancial or human resources to precisely delineate with conﬁdence the extent to which those personnel are morally or merely causally responsible for the doping offense. And here the standard of proof is going to be critical: is it satisfactory to use the standard of “preponderance of reasons” or reasonable doubt? If one is to ban a sports physician from working within a sports (irrespective of how this might be “policed”), is the weaker validity – the preponderance of reasons – sufﬁcient?

With respect to the World Anti-Doping Code, anti-doping governance fails to deﬁne with sufﬁcient clarity the role of medical doctors. There is a need for a new approach emphasizing urgent education and training of medical doctors in this domain, which should be considered prior to the revision of the next World Anti-Doping Code in 2015 in order to better regulate doctor’s conduct, especially in relation to professional errors, whether negligent or intentional.

Finally, this important ethical issue is regulated by New Code 2015 Article 21.2 Roles and Responsibilities of Athlete Support Personnel, not merely sports physicians. The Code stipulates that Athlete Support Personnel is required: (1) To be knowledgeable of and comply with all antidoping policies and rules adopted pursuant to the Code and which are applicable to them or the Athletes whom they support, (2) To cooperate with the Athlete Testing program, (3) To use his or her inﬂuence on Athlete values and behavior to foster anti-doping attitudes, (4) To disclose to his or her National Anti-Doping Organization and International Federation any decision by a non-Signatory ﬁnding that he or she committed an anti-doping rule violation within the previous 10 years, (5) To cooperate with Anti-Doping Organizations investigating anti-doping rule violations, (6) Athlete Support Personnel shall not Use or Possess any Prohibited Substance or Prohibited Method without valid justiﬁcation.

In new anti-doping rule violation stipulated by Article 2.10, the roles and responsibilities of the sports entourage are totally different as deﬁned by the new Code of 2015. It is now stipulated that athletes and other persons must not work with coaches, trainers, physicians, or other Athlete Support Personnel who are Ineligible or who have been (criminally) convicted because of an anti-doping rule violation. The list of associations which are prohibited includes obtaining training, strategy, technique, nutrition, or medical advice; obtaining therapy, treatment, or prescriptions; providing any bodily products for analysis; or allowing the Athlete Support Personnel to serve as an agent or representative. Prohibited association need not involve any form of compensation.

Perhaps the best example of this problem is the American Olympic winning sprinter Jones, who worked with the “wrong” trainer and the “wrong” physician, and she had even married to two athletes convicted of anti-doping rule violations. Circumstances, it seems, conspired to make almost inevitable her doping. If we are not responsible for contingency in our lives, then we cannot ignore the inﬂuence of Athlete Support Personnel for doping offenders in the sentencing of their offenses. Not only did Jones fall foul of WADA, who banned her for 4 years, she also served a 6-month prison sentence for lying to federal investigators. It is notable that her convictions and those of other athletes using the BALCO laboratories only came to light in a tax fraud investigation, not positive anti-doping control tests. Yet everything could have been prevented had Marion not been coached by Charlie Francis and that she had not been supplied with dietary supplements by Victor Conte, Director of the BALCO laboratory, who doped many athletes of her generation. Moreover, her ﬁrst husband had been doping positive and the second, Tim Montgomery, was stripped all race results, records, and medals and later arrested because of illegal trading with narcotics and money laundering in addition to his doping career as an elite sprinter. Marion Jones case is the best example how wrong Athlete Support Personnel – loosely connected elite sports science and medicine – can conspire to harm the athlete under the guise of optimizing performance enhancement and ﬁnancial gains.

The World Anti-Doping Code is important precisely because of this issue, since all of the countries on the world accept it, either by ratiﬁcation of UNESCO Convention and/or by integrating the Code into their national laws. The Code is one of those rare documents governing human conduct that is accepted by all nations. Perhaps there is no other sphere of human activity that has managed this kind of harmonization. It is for this reason, problems notwithstanding, that any deviation from the Code will lead only to skepticism and the opening of old problems of fairness, equality in contest preparation and competition, bias, and so on.

It is crucial that there is consistency in the way that every elite athlete in the sports world is subjected to sufﬁciently similar regulatory regime and punished appropriately. Every scientiﬁc conference on doping over the last decades has hosted muted discussions about whether athletes from this or that country are really being tested as rigorously as in others, or whether border ofﬁcials tip off federations or athletes when the doping control team arrive at a given airport. As the Lord Hewart remarked: “it is not merely of some importance but is of fundamental importance that justice should not only be done, but should manifestly and undoubtedly be seen to be done” (Hewart 1924). Thus, global support for the anti-doping regulatory framework is necessary if it succeeds in the face of never-ending suspicions.

Conclusion

Sports is socially meaningful and valuable cultural good. Though contested, doping is fundamentally against the spirit of sports. The IOC published the ﬁrst list of prohibited substances in 1967 and introduced anti-doping rules. After 47 years with the New Code 2015, anti-doping rules have been updated, and they are better, solving many important questions in order to protect the sports and foster pharmacological fairness among athletes. Despite pressures from many sources, the 2015 Code has retained the spirit of sports criterion in addition to the performance enhancement and health risks criteria that are applied to generate the Prohibited List that effectively deﬁnes doping as multiply realizable ADRVs (McNamee 2015). There are many ethical issues that orbit the problem of doping. This research paper has only focused on two, the genesis of the Prohibited List and the role of Athlete Support Personnel, that directly reveal the bioethical signiﬁcance of this global ethical problem.

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