7.15 - Ethics of performance-enhancing substances

Biological benefits and risks

A performance-enhancing substance can change a biological process in a way that improves a sporting performance, but its effects depend on the substance, the athlete and the event.

Two examples show why the biology matters.

The muscle-size and strength effect is supported by controlled research, including a trial in adult men published by Bhasin and colleagues in 1996. That finding establishes a possible benefit under the studied conditions; it does not establish safety for all athletes or a benefit in every event. Primary trial abstract. The health summaries above are supported by the US Anti-Doping Agency's substance information and EPO explanation, checked 15 October 2026.

Avoid treating all substances as equally effective or equally dangerous. A risk is a possibility with a probability and severity, not a claim that every user experiences the outcome. Conversely, an athlete who has no immediate symptoms has not demonstrated absence of long-term harm. These distinctions allow health arguments to use evidence without exaggeration.

Fairness and the purpose of sport

A fairness argument asks what a competition is intended to compare and whether competitors have a fair opportunity to succeed under its agreed conditions.

One position opposes prohibited enhancement because athletes enter a competition expecting the same rules to apply to everyone. Secret steroid use may increase muscle strength while competitors follow a restriction against it. The objection concerns both the resulting advantage and the deception: competitors, spectators and sponsors may have been misled about how a result was achieved. Athletes who keep the agreement may lose places, income or recognition.

A different position challenges the boundary between accepted and prohibited advantages. Athletes already differ in inherited characteristics, coaching, nutrition and access to facilities. Supporters of a more permissive policy can argue that an artificial aid is not wrong merely because it is artificial, and that sport already accepts many interventions that improve performance. This is a challenge to how the rule is justified; it does not show that secretly breaking the existing rule is fair.

The counterargument is that accepting some inequalities does not require accepting every additional inequality. A governing body might aim to compare trained biological abilities while excluding particular hazardous forms of enhancement. Others might define sporting excellence differently. State the purpose being defended rather than assuming that the word “natural” settles the issue.

Access matters under either position. If an effective substance and its medical monitoring are expensive, permission may increase the advantage of wealthy teams. Equal formal permission is therefore different from equal practical opportunity. A proposed shared-access system would need evidence that it could reduce that inequality; it would not remove health risks by definition.

Health, choice and coercion

An athlete's freedom to choose can conflict with protecting that athlete and other competitors from harm.

A welfare-based position supports restrictions when likely harms outweigh benefits. For example, an endurance advantage from EPO may be outweighed by the severity of clotting or stroke. Harm can extend beyond the user: families may provide care, and a team culture may encourage younger athletes to imitate dangerous behaviour. This argument needs evidence about both the probability and severity of harm, rather than the unsupported assertion that all enhancement is fatal.

An autonomy-based position gives weight to an informed adult's right to decide what risks to accept. Competitive sport already involves injury risks. A supporter of a more permissive policy may argue that consistent regulation, independent information and medical oversight could respect adult choice and reduce harms associated with hidden use. This is a proposed policy benefit, not evidence that oversight can make a substance harmless. Uncertain or irreversible effects make fully informed consent more difficult, especially for young athletes.