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.

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.

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.

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.

Medical arguments for and against the liberalization of doping / Argumentos médicos a favor y en contra de la liberalización del dopaje

The use of doping has been banned for almost a century due to the risk involved to the athlete's health. Since then, the criterion of prohibiting substances has been reinforced to improve performance, becoming a rarely controversial issue nowadays. However, opinions defending the liberalization of doping has been sometimes given based on various arguments. One of the most common is the impossibility of completely eradicating doping and that this can be safe, from the point of view of health, if it is done by qualified doctors. This paper presents the arguments against the liberalization of doping from a medical point of view, contemplating various aspects. Those related to the use of substances such as: lack of clear criteria for inclusion in the list of prohibited substances and the unclear margin between the use of medication for treatment and for doping. Arguments related to health protection such as: the risk of sport for the athlete, the healthy sport, doping substances have few health risks, the use of medications, allow genetic doping because it is inevitable, risks of self-medication or use of medication without a prescription. Arguments related to sports performance such as: Doping products do not improve performance, doping is comparable to other performance improvement techniques, match genetic differences among athletes. And other arguments such as: prohibition favours doping, the control of doping increases the risks of doping itself, the high cost of anti-doping fight or the few anti-doping resources. The proposal for liberalization of doping under medical control is analyzed and discussed as well as the effects of liberalization on children and adolescents. At the end the medical ethical aspects related to doping are presented to conclude with the opposition of the medical profession against doping and its liberalization

El dopaje está prohibido desde hace casi un siglo debido al riesgo que implica para la salud del deportista. Desde entonces, el criterio de prohibición de sustancias se ha reforzado para mejorar el rendimiento, convirtiéndose en un tema poco controvertido en la actualidad. Sin embargo, a veces se han emitido opiniones en defensa de la liberalización del dopaje basadas en diversos argumentos. Uno de los más habituales es la imposibilidad de erradicar por completo el dopaje y que éste puede ser seguro, desde el punto de vista de la salud, si lo practica médicos titulados. Este artículo presenta los argumentos en contra de la liberalización del dopaje desde el punto de vista médico, contemplando diversos aspectos. Los relacionados con el uso de sustancias tales como: falta de criterios claros para su inclusión en la lista de sustancias prohibidas y el margen poco claro entre el uso de medicamentos para tratamiento y dopaje. Argumentos relacionados con la protección de la salud como: el riesgo del deporte para el deportista, el deporte sano, las sustancias dopantes tienen pocos riesgos para la salud, el uso de medicamentos, permitir el dopaje genético porque es inevitable, los riesgos de automedicación o uso de medicación sin prescripción. Argumentos relacionados con el rendimiento deportivo tales como: los productos antidopaje no mejoran el rendimiento, el dopaje es comparable a otras técnicas de mejora del rendimiento, diferencias genéticas entre los deportistas. Y otros argumentos como: la prohibición favorece el dopaje, el control del dopaje aumenta los riesgos del dopaje, el alto coste de la lucha antidopaje o los escasos recursos antidopaje. Se analiza y discute la propuesta de liberalización del dopaje bajo control médico y los efectos de la liberalización en niños y adolescentes. Al final se presentan los aspectos éticos médicos relacionados con el dopaje para concluir con la oposición de la profesión médica al dopaje y su liberalización

The Landscape of the "Spirit of Sport" : A Systematic Review.

The World Anti-Doping Agency (WADA) sets out a detailed description of what its own conception of the "spirit of sport" as employed in the World Anti-Doping Code (WADC) entails. However, controversies as to the significance and meaning to be ascribed to the term abound in the literature. In order to unravel the core of the debates and to move discussions forward, the authors aimed at reviewing understandings of the spirit of sport in the conceptual literature. The main databases were searched using relevant keywords. After the inclusion and exclusion criteria were applied, eighteen publications were included in the review. The most striking result to emerge from the data is the multivalence of the concept of spirit of sport. Our thematic analysis generated the contestability of the spirit of sport as the predominant theme in the conceptual literature. There is a need for empirical research to generate data about perspectives on the spirit of sport from other stakeholders especially those of the athletes themselves.

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.

Trastornos de bipolares y comorbilidades - consideraciones éticas en deportes / Bipolar disorders and comorbid conditions - Ethical considerations in sports

Introducción: El objetivo de la intervención farmacológica es el resultado terapéutico: máxima eficacia con mínimos efectos adversos. Esto resulta difícil a la hora de tratar el trastorno bipolar, debido a las comorbilidades y/o fármacos complementarios necesarios para abordar los efectos adversos. La polifarmacia racional óptima puede maximizar el resultado terapéutico, aunque podría crear cuestiones éticas en los deportes competitivos. El Código Mundial Antidopaje (WADC) y la Lista de Sustancias Prohibidas de la Agencia Mundial Antidopaje, publicada anualmente, tienen como objetivo disuadir y sancionar a los atletas que utilicen agentes para mejorar el rendimiento, y promover un marco de igualdad para todos los competidores. Este documento presenta tres ejemplos hipotéticos (TDAH/temblor secundario al litio/dolor) en los que la contravención no deliberada de la Lista de Sustancias Prohibidas derivaría en descalificación por violación de la norma antidopaje sin aprobación de las Exenciones por Uso Terapéutico (TUEs). Método: Análisis de caso hipotético con revisión de la literatura. Resultados: TDAH Comórbido: la Lista de Sustancias Prohibidas excluye los psicoestimulantes (metilfenidato/anfetaminas) en la competición (S6) pero permite guanfacina/atomoxetina. En los casos en que los psicoestimulantes constituyeran un tratamiento eficaz para el TDAH en los atletas con trastorno bipolar, a diferencia de guanfacina/atomoxetina, estos pacientes-atletas deberán presentar TUEs, junto con la certificación y documentación de respaldo del clínico. Temblor secundario al Litio: a menudo se prescriben beta-bloqueantes para controlar el temblor secundario al litio, pero que no están autorizados para deportes específicos (P2). En caso de que los fármacos alternativos (primidona) resulten ineficaces, serán necesarias las TUEs. Dolor: el manejo del dolor crónico es difícil en atletas, ya que los analgésicos narcóticos (S7) y cannabinoides (S8) están prohibidos en la competición. Cuando el dolor comórbido no se controla con fármacos autorizados, son necesarias las TUEs. Conclusión: Los pacientes-atletas con trastorno bipolar y comorbilidades precisan enfoques holísticos, con reconocimiento tanto del WADC como de la Lista de Sustancias Prohibidas. Los atletas deberían realizar un listado de todos los fármacos incluyendo diagnósticos/obtener TUEs/verificar el estado de la medicación propuesta (prohibido/restringido/permitido) con las Federaciones Internacionales adecuadas y/u Organizaciones Olímpicas. Los clínicos deberán ser conocedores de estas cuestiones a la hora de tratar a los pacientes-atletas

Introduction: The goal of pharmacologic intervention is therapeutic outcome: maximal efficacy with minimal adverse effects. In treating bipolar disorder, this may be complicated by comorbidities and/or adjunctive medications required to address adverse effects. Optimal rational polypharmacy may maximize therapeutic outcome yet could create ethical issues in competitive sports. The World Anti-Doping Code (WADC) and yearly published World Anti-Doping Agency Prohibited List are intended to deter and sanction athletes using performance-enhancing agents while promoting an even playing field for all competitors. This paper presents three hypothetical examples (ADHD/lithium-tremor/pain) wherein unintended Prohibited List contravention would result in doping violation disqualifications without approved Therapeutic Use Exemptions (TUEs). Method: Hypothetical case analyses with literature review. Results: Comorbid ADHD: the Prohibited List precludes psychostimulants (methylphenidate/amphetamines) in competition (S6) but permits guanfacine/atomoxetine. When psychostimulants effectively treat ADHD in athletes with bipolar disorder but guanfacine/atomoxetine do not, these patient-athletes, with clinician’s certification and supportive documentation, should file TUEs. Lithium-tremor: beta-blockers are frequently prescribed to control lithium-tremor but are not permitted for specific sports (P2). If alternatives (primidone) are ineffective, TUEs are indicated. Pain: chronic pain management is difficult in athletes as narcotic analgesics (S7) and cannabinoids (S8) are prohibited in competition. When comorbid pain is not controlled with approved medications, TUEs are required. Conclusion: Patient-athletes with bipolar disorder and comorbidities require holistic approaches with appreciation of both the WADC and Prohibited List. Athletes should list all medications with diagnoses/obtain TUEs/verify proposed medication status (banned/restricted/permitted) with appropriate International Federations and/or Olympic organizations. Clinicians should be cognizant of these issues when treating patient-athletes

Antidoping program: an important factor in the promotion and protection of the integrity of sport and athlete's health.

Using performance-enhancing drugs concerns not only elite Olympic and Paralympic Games' athletes but also amateur athletes, who are making increasing use of substances and/or methods. Furthermore, a new frontier reached by the doping is the use of genes. World Anti-Doping Agency expressly prohibited the participation in competitive sports by the athlete in case of taking banned substances to treat disease in the event that the above assumption implies an excessive improvement of performance. This study aims to analyze and show the doping control as an essential part of the antidoping program to promote and protect the integrity of sport and athlete's health. Testing is carried out in accordance with the World Anti-Doping Code (WADC) and several international standards (ISs). The ISs were developed for laboratories, testing, the prohibited list, and for therapeutic use exemptions. It seems that the 2009 version of the WADC obliges all the healthcare professionals not to assist athletes engaged in doping behaviours; they can be removed from working with athletes. Many people do not know doping's dangerous effects on health. It is necessary, therefore, to implement the knowledge on this issue through public and sports institutions information and awareness campaigns. For this reason, local institutions and the National Olympic Committee shall give tools, in particular economic, to carry out the work of education, training, and control.

The Use of Stimulant Medication to Treat Attention-Deficit/Hyperactivity Disorder in Elite Athletes: A Performance and Health Perspective.

The use of stimulants as a treatment for attention-deficit/hyperactivity disorder (ADHD) among elite athletes is a controversial area with some arguing that stimulant use should not be permitted because it offers an advantage to athletes (fair play perspective). Guided by an integrated model of athletic performance, we address common concerns raised about stimulant use in sports from our perspective, which we coined the "performance and health perspective," highlighting relevant research and pointing to gaps in empirical research that should be addressed before bans on use of stimulants for athletes with ADHD are considered. The current article posits that a stimulant ban for athletes with ADHD does not necessarily facilitate fair play, ensure safety, or align with existing policies of large governing bodies. Instead, we recommend that stimulant medication be allowed in high-level sport, following proper diagnosis by a trained professional and a cardiac assessment to confirm no underlying heart conditions. Athletes with ADHD approved to use stimulant medication should be monitored by a health care professional, physically reevaluated and reassessed for ADHD as clinically appropriate and as indicated by relevant sports governing bodies. This performance and health perspective is consistent with that of multiple sport governing bodies who offer therapeutic use.

Ethics of Regulating Competition for Women with Hyperandrogenism.

The International Association for Athletics Federations (IAAF) has been granted 2 years to submit further evidence showing a correlation between higher levels of testosterone and a competitive advantage. This article first presents the case of Caster Semenya, which triggered the drafting by IAAF of the regulations on eligibility of female athletes to compete in the female category in 2011. Then the IAAF regulations are critically analyzed from a scientific and ethical point of view. Finally, the Court of Arbitration for Sport decision to suspend the regulations pending further evidence provided by IAAF, and what this means for the future of sports, is discussed.

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.

Considerations in the Use of Stimulants in Sport.

Medication treatment of adult athletes with attention-deficit/hyperactivity disorder (ADHD) is controversial. Some articles and guidelines support the use of stimulant medications in this population, while others advise against it. We believe that the important issues regarding the use of stimulant medications in athletes include the likelihood of performance enhancement, poor inter-rater reliability of ADHD diagnosis in relation to therapeutic use, policies of sport-governing bodies, psychiatric treatment of mental illness, and dangerous consequences of use. We review the literature on these five issues and conclude by discussing the ethical principle of fairness, and suggest some proposals regarding the use of stimulants by athletes that balance these five issues and fairness. Our ultimate recommendation is that stimulants should not be used by high-level adult athletes.

Women with hyperandrogenism in elite sports: scientific and ethical rationales for regulating.

The recent implementation by some major sports-governing bodies of policies governing eligibility of females with hyperandrogenism to compete in women's sports has raised a lot of attention and is still a controversial issue. This short article addresses two main subjects of controversy: the existing scientific basis supporting performance enhancing of high blood T levels in elite female athletes, and the ethical rationale and considerations about these policies. Given the recently published data about both innate and acquired hyperandrogenic conditions and their prevalence in elite female sports, we claim that the high level of androgens are per se performance enhancing. Regulating women with clinical and biological hyperandrogenism is an invitation to criticism because biological parameters of sex are not neatly divided into only two categories in the real world. It is, however, the responsibility of the sports-governing bodies to do their best to guarantee a level playing field to all athletes. In order not cloud the discussions about the policies on hyperandrogenism in sports, issues of sports eligibility and therapeutic options should always be considered and explained separately, even if they may overlap. Finally, some proposals for refining the existing policies are made in the present article.