Transwomen in elite sport: scientific and ethical considerations.

The inclusion of elite transwomen athletes in sport is controversial. The recent International Olympic Committee (IOC) (2015) guidelines allow transwomen to compete in the women's division if (amongst other things) their testosterone is held below 10 nmol/L. This is significantly higher than that of cis-women. Science demonstrates that high testosterone and other male physiology provides a performance advantage in sport suggesting that transwomen retain some of that advantage. To determine whether the advantage is unfair necessitates an ethical analysis of the principles of inclusion and fairness. Particularly important is whether the advantage held by transwomen is a tolerable or intolerable unfairness. We conclude that the advantage to transwomen afforded by the IOC guidelines is an intolerable unfairness. This does not mean transwomen should be excluded from elite sport but that the existing male/female categories in sport should be abandoned in favour of a more nuanced approach satisfying both inclusion and fairness.

Transcranial electrical stimulation for human enhancement and the risk of inequality: Prohibition or compensation?

Non-invasive brain stimulation is used to modulate brain excitation and inhibition and to improve cognitive functioning. The effectiveness of the enhancement due to transcranial direct current stimulation (tDCS) is still controversial, but the technique seems to have large potential for improvement and more specific applications. In particular, it has recently been used by athletes, both beginners and professionals. This paper analyses the ethical issues related to tDCS enhancement, which depend on its specific features: ease of use, immediate effect, non-detectability and great variability of effects. If tDCS were to become widespread, there could be some potential side effects, especially the rise of inequality in many selective competitive contexts. I discuss two possible scenarios to counter this effect: that of prohibition and that of compensation, each supported by reasons and arguments that seem plausible and worthy of consideration. In conclusion, I show why I think the scenario of compensation is the preferable one.

Ethics, genetic testing, and athletic talent: children's best interests, and the right to an open (athletic) future.

In this paper we discuss the ethics of genetics-based talent identification programs in sports. We discuss the validity and reliability of the tests and the claims made by direct to consumer companies, before presenting a range of ethical issues concerning child-parent/guardian relations raised by these tests, which we frame in terms of parental/guardian duties, children's rights, and best interests. We argue that greater ethical emphasis needs to be put on the parental decision on the wellbeing on the child going forward, not on ex post justifications on the basis of good and bad consequences. Best interests decisions made by a third party seem to comprise both subjective and objective elements, but only a holistic approach can do justice to these questions by addressing the wellbeing of the child in a temporal manner and taking into account the child's perspective on its wellbeing. Such decisions must address wider questions of what a good (sports)parent ought do to help the child flourish and how to balance the future-adult focus necessary to nurture talent with the wellbeing of the child in the present. We conclude that current genetic tests for "talent" do not predict aptitude or success to any significant degree and are therefore only marginally pertinent for talent identification. Claims that go beyond current science are culpable and attempt to exploit widespread but naïve perceptions of the efficacy of genetics information to predict athletic futures. Sports physicians and health care professionals involved in sport medicine should therefore discourage the use of these tests.

Ethical Aspects of Human Genome Research in Sports-A Narrative Review.

Human genome research in sports raises complex ethical considerations regarding the intersection of genetics and athletic performance. Pursuing genetic enhancements must uphold fairness, equality, and respect for human dignity. This narrative review explores the ethical dimensions of human genome research in sports, its potential implications on athletes, and the integrity of sports. As a narrative review, this study synthesizes the existing literature and expert insights to examine the ethical aspects of human genome research in sports. This study extensively examined the current literature on genetics, sports performance, ethical concerns, human rights, and legal regulations within the European context. The literature was searched using the SPORTDiscus, Scopus, Google Scholar, and PubMed databases. Exploring human genome research in sports reveals significant ethical implications, including potential genetic discrimination, impacts on human rights, and creating a genetic underclass of athletes. There are also definite benefits surrounding genetic testing. In conclusion, this review contends that integrating ethical considerations into developing and applying genetic technologies in sports is crucial to upholding fundamental principles of fairness, equality, and respect for human dignity. It stresses the importance of open and inclusive dialogue about the potential consequences of genetic advancements on athletic performance, future generations, and the integrity of sports.

Sports medicine and ethics.

Physicians working in the world of competitive sports face unique ethical challenges, many of which center around conflicts of interest. Team-employed physicians have obligations to act in the club's best interest while caring for the individual athlete. As such, they must balance issues like protecting versus sharing health information, as well as issues regarding autonomous informed consent versus paternalistic decision making in determining whether an athlete may compete safely. Moreover, the physician has to deal with an athlete's decisions about performance enhancement and return to play, pursuit of which may not be in the athlete's long-term best interests but may benefit the athlete and team in the short term. These difficult tasks are complicated by the lack of evidence-based standards in a field influenced by the lure of financial gains for multiple parties involved. In this article, we review ethical issues in sports medicine with specific attention paid to American professional football.

Therapeutic bodily assistive devices and paralympic athlete expectations in winter sport.

OBJECTIVE: To ascertain the impact of therapeutic bodily assistive devices that enable beyond-the-normal body abilities on sport in general and the Paralympics and Olympics in particular. DESIGN: Cross-sectional survey. SETTING: Online. PARTICIPANTS: Members of the National Council on Rehabilitation Education (United States). Distribution of online survey link to membership. ASSESSMENT OF RISK FACTORS: The survey used a combination of 37 simple yes or no, Likert scale, and opinion rating scale questions. This article is based on 4 of the 37 questions that focus on the impact of therapeutic enhancements on various aspects of sport. MAIN OUTCOME MEASURES: Whether respondents felt that there is an impact of therapeutic bodily assistive devices that enable beyond-the-normal body abilities on the participation of people with disabilities in sport of all levels and the self-identity of athletes with disabilities. Secondary outcome measure was what the respondents felt the impact may be. RESULTS: The respondents indicated that therapeutic bodily assistive devices, which enable beyond-the-normal body abilities, will have an impact on participation of people with disabilities in sport at all levels and on the self-identity of athletes with disabilities. CONCLUSIONS: Given the result that the respondents felt that therapeutic enhancements will impact various aspects of sport, it may be prudent to initiate a broader discourse around therapeutic enhancement and to revise codes of ethics so that they give guidance on this topic.

Human genetic variation: new challenges and opportunities for doping control.

Sport celebrates differences in competitors that lead to the often razor-thin margins between victory and defeat. The source of this variation is the interaction between the environment in which the athletes develop and compete and their genetic make-up. However, a darker side of sports may also be genetically influenced: some anti-doping tests are affected by the athlete's genotype. Genetic variation is an issue that anti-doping authorities must address as more is learned about the interaction between genotype and the responses to prohibited practices. To differentiate between naturally occurring deviations in indirect blood and urine markers from those potentially caused by doping, the "biological-passport" program uses intra-individual variability rather than population values to establish an athlete's expected physiological range. The next step in "personalized" doping control may be the inclusion of genetic data, both for the purposes of documenting an athlete's responses to doping agents and doping-control assays as well facilitating athlete and sample identification. Such applications could benefit "clean" athletes but will come at the expense of risks to privacy. This article reviews the instances where genetics has intersected with doping control, and briefly discusses the potential role, and ethical implications, of genotyping in the struggle to eliminate illicit ergogenic practices.

The fair use of lower-limb running prostheses: A Delphi study.

The purpose of this paper is to investigate the role of lower-limb running prostheses and stakeholders' perceptions of fairness in relation to their use in competitive disability sport. A Delphi study was conducted over three rounds to solicit expert opinion in a developing area of knowledge. High levels of consensus were obtained. The findings suggest that the prosthesis is defined as a piece of sporting equipment to restore athletes' function to enable them to take part in disability sport. In addition, the panel determined that the development of this technology should be considered to be integral to the sport's ethos. Crucially, prostheses technology should be monitored and have limits placed upon it to ensure fairness for both participants and stakeholders.

[Bodily excellence and education: ambiguities of performance]. / Excellence corporelle et éducation: les ambiguïtés de la performance.

The notion of excellence contains an ambivalence: to aim at the "good" and/or to aim at the "best". This ambivalence exists particularly in the physical effort and in the history of bodily practices, shared between gymnastics, physical education and sports. In the second part of the XXth century, the notion of performance became "worship of performance", "infinite perfectibility". In this context, high level sports became the human improvement laboratory, thanks to the sophistication of its technical means and the its practices intensity. However this "high" questions: about physical and psychological consequences of intensive practices ; about doping and its medical and ethical perspectives; about the increasing precociousness and the potential exploitation of the baby champions. It questions about the nature of familial, social, economical norms transmitted by education: about articulation between constraint and self-government. This is the question about the "price" of excellence. In this sense it appears that the excellence of champion spreads out the margins of an ethics which would be meant to be regulating and universal, indeed this excellence is perhaps, in the same capacity as genius is and in spite of the attachment of sports to a "ethics of the rule", un-ethical.

The logic of categorisation in sport.

The aim of this paper is to examine the basis of eligibility rules in sport by exhibiting the logic of categorisation, with its associated ethical problems. We shall be concerned mainly with pre-competition categories - age, sex, weight and dis/ability - because they are directly relevant to sports performance and are relatively stable inequalities. We shall prefer to use the term "categorisation", although we mean by it just what others might mean by classification, to refer to divisions, classes, groups, etc. The paper argues that we have categories only because we consider it desirable to offer some groups protected status in order to enable and promote inclusion and fairness. This desirability condition determines eligibility. Only then do issues arise of which sub-categories we should have, and how they are to be policed. There will always be categories in sport, as a minimum to protect athletes based on age groupings, from children to veterans. But since every categorisation brings its own problems, we need to ensure that we keep them balanced, so that sport can strive for maximum inclusion of different kinds of athletes, and maximum fairness. This requires us to step back from the many particular debates in order to rethink the logic of the whole categorisation process.

Classification in sport: A question of fairness.

Competitor classification schemes have been a part of sport since its origins. Eligibility criteria have developed towards inclusion and increasing diversity. The pool of competitors has expanded from the ancient Olympic Games, eligible only to free Greek men, via nineteenth-century English sport favouring primarily the upper class of so-called gentlemen amateurs, to the current global and diverse pool of men, women, children, and able-bodied as well as disabled persons. Hence, the challenge of sound classification schemes has increased. This article examines the principles of fair classification of athletes. With the help of normative theory as well as practical examples, a fair equality of opportunity principle for sport (FEOPs) is formulated. It is demonstrated how sound classification schemes combine the normative backing from FEOPs with relevant scientific insights. Current classification challenges and possibilities for change are discussed. It is suggested that in several sports, biological sex classes can be abandoned, and that in some sports, sex classes can be replaced by body size classes. It is argued, too, that sports in which body height exerts a significant and systematic impact on performance should classify accordingly. In the final part, classification is discussed in light of new techno-scientific possibilities, among them the possibility of innovative performance-enhancing prosthetics.

The construction of categories in sport: Unfair advantages, equality of opportunity and strict attainability.

On 8 September 2020, the Swiss Federal Supreme Sport dismissed the double appeal by Caster Semenya against the decision of the Court for Arbitration of Sport to uphold the World Athletics regulations restricting testosterone levels in female runners. On 24 February 2021, Semenya appealed to the European Court of Human Rights. This is the most recent episode of an international legal case which was ignited at the 2009 Berlin World Track Championship, when Semenya was 18 years old. Semenya's case has generated an intricate web of questions for classification in sport that are yet to be resolved. In this paper we aim to disentangle them. We proceed as follows: we describe the problem of binary classification related to Semenya's case and introduce the concept of property advantage, and the fair equality of opportunity principle. We compare Semenya's case with Eero Mantyranta's case and fail to identify a way according to which the two cases could justifiably be treated differently. We then discuss three possible ways to organize sport categories based on the combination of Loland's fair equality of opportunity principle and our strict attainability criterion, and outline the implications of each alternative for international sports law regulation. Finally, we summarize and outline the legacy of Semenya for the construction of categories in sport.

Integrating transwomen athletes into elite competition: The case of elite archery and shooting.

The inclusion of transwomen into elite female sport has been brought into question recently with World Rugby banning transwomen from the elite female competition, aiming to prioritise safety over fairness and inclusion, citing the size, force and power-producing advantages conferred to transwomen. The same question is being asked of all Olympic sports including non-contact sports such as archery and shooting. As both these Olympic sports are the polar opposite to the contact sport of rugby in terms of the need to consider the safety of athletes, the IF of both archery and shooting should consider the other elements when deciding the integration of trans individuals in their sports. Studies on non-athletic transwomen have reported muscle mass and strength loss in the range of 5-10% after 1 year of their transition, with these differences no longer apparent after 2 years. Therefore, based on the current scientific literature, it would be justified for meaningful competition and to prioritise fairness, that transwomen be permitted to compete in elite archery after 2 years of GAT. Similarly, it would be justified in terms of shooting to prioritise inclusion and allow transwomen after 1 year of GAT given that the only negligible advantage that transwomen may have is superior visuospatial coordination. The impact of this considered integration of transwomen in elite sports such as archery and shooting could be monitored and lessons learned for other sports, especially where there are no safety concerns from contact with an opponent.

Fairness, technology and the ethics of Paralympic sport classification.

Fairness in sport is a widely shared meritocratic norm. Its application is usually restricted to equality of opportunity to compete for victory. Paralympic sports lay down a further challenge in that equality of opportunity must be shaped by considerations of fairness, evidenced by the development of discrete competition categories to construct fair and meaningful contests. In this article, we extend these philosophical ideas to consider how Fair Equality of Opportunity might operate in the context of Paralympic sports classification. We articulate three conceptions of fairness relevant to these sports: (i) background fairness; (ii) procedural fairness; and (iii) stakes fairness. We critically review the International Paralympic Committee's Policy on Sport Equipment in relation to the first two conceptions and argue that greater clarification, theorization and rule modification is required if physical prowess, as opposed to equipment technology, is to be assured as the dominant determinant of Paralympic athletic success.

Gene doping.

Gene doping is the misuse of gene therapy to enhance athletic performance. It has recently been recognised as a potential threat and subsequently been prohibited by the World Anti-Doping Agency. Despite concerns with safety and efficacy of gene therapy, the technology is progressing steadily. Many of the genes/proteins which are involved in determining key components of athletic performance have been identified. Naturally occurring mutations in humans as well as gene-transfer experiments in adult animals have shown that altered expression of these genes does indeed affect physical performance. For athletes, however, the gains in performance must be weighed against the health risks associated with the gene-transfer process, whereas the detection of such practices will provide new challenges for the anti-doping authorities.