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Bioethics Forum - Paralympics 2.0

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Friday, June 6, 2008

Mind-Altering Drugs and the Problem Child Claudia Meininger Gold, Boston Globe “If we can listen differently to parents of young children who have ‘behavior problems,’ we can intervene early, before there is even a question of medication, and may be able to change these developing brains.”

Paralympics 2.0 BY ANDY MIAH Oscar Pistorius was right all along, at least for now. He was right to appeal the ruling from the International Association of Athletics Federations that forbade him from competing alongside Olympians in Beijing for one simple reason: he is an Olympian. Pistorius is the South-African-born, double below-the-knee amputee who has spent the last year campaigning for his right to compete as an Olympic athlete rather than as a Paralympian in Beijing later this year. The Beijing Games would be the first Olympics where such integration has taken place. His initial request to the IAAF was turned

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down, but last week his appeal to the Court of Arbitration for Sport was upheld. The dispute over his entitlement centers on the particular properties of his Cheetah Flex-Foot, a device that has been in use by athletes since 1997. To date, Pistorius’s career has been extraordinary. In Athens 2004, he won Olympic Gold in the 100-meter and 200-meter events, and he is currently the Paralympian world-record-holder for 100, 200, and 400-meter events. Over the years, his times have slowly crept down, and

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they are now at a point where they rival those of able-bodied athletes. This has been noticed by the international athletic community. In 2007, the IAAF introduced an amendment to its rules, requiring that any device used by an athlete must not provide an advantage over other athletes who do not have

COMMENTATORS

NICHOLAS AGAR NANCY BERLINGER DANIEL CALLAHAN TOD CHAMBERS ELLEN WRIGHT CLAYTON

the device. This is one of the key sticking points in the legal entanglement that the IAAF and Pistorius have encountered. The Court of Arbitration found that this rule appeared to have been introduced with Pistorius in mind and so considered the appeal both on grounds of technical advantage and on discriminatory grounds. Nevertheless, the evidence focused on the biomechanical and physiological measures: Is Pistorius’s stride length longer? Does he have less of a build-up of lactate acid within his legs?

CARL COLEMAN REBECCA COOK MARY CROWLEY BRIETTA CLARK ALICE DREGER CARL ELLIOTT ADRIANE FUGH-BERMAN MICHELE GOODWIN DIANE E. HOFFMANN SANDRA H. JOHNSON CAROL LEVINE HILDE LINDEMANN THOMAS H. MURRAY WENDY E. PARMET KELLY C. PIKE JULIAN SAVULESCU ROBERT L. SCHWARTZ

Does his VO2 consumption differ? The burden of proof rested with the IAAF to show that, on the balance of probability, such an advantage exists. To this end, the court concluded that there was no evidence to support the claim that the Flex-Foot provides an advantage over able-bodied athletes. In any case, the IAAF has intimated that Pistorius should remain focused on the Paralympics rather than the Olympics. Why? The Paralympics is the product of a particular era of disability rights activism. Yet its separation from the Olympics is morally suspect, and the new era of bionic prosthetic devices will make an important contribution to revealing this dubious segregation. This is not to diminish the social significance of the Paralympics. It continues to make an important contribution to the visibility of disability rights that far extends the value of what happens on the competition field. However, in deciding Pistorius’ future and others like him who will follow – and they will follow – we must distinguish between

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Cash for Kidneys? Scheme Won't Work Art Caplan, MSNBC “A default donation plan could bring a boost in organs for transplant without creating the headaches, fears and misdistribution of a financial market.”

the merit of the Paralympic movement and the logic of sports contests. Despite the weak evidence, the objection to letting Pistorius compete in the Olympics is that he has a particular type of unfair advantage that is objectionable partly because it transforms the activity into something else. Pistorius’s prosthetic legs, according to this view, transform the activity of running in such a way that it does not make sense to compare his performance with that of people running on home-grown legs, so to speak. This view leads some critics to throw up their hands and declare that we must create a new category of bionic athletic competitions, to ensure we are not racing apples with oranges. The problem with this argument is that we already have this

'Blade Runner' ruling subverts nature of sport Art Caplan, MSNBC “It may be fascinating to see who can go the fastest on rocket-powered legs or throw a heavy weight the farthest using performance-enhancing drugs, or genetically engineered muscles. But what you have then is an exhibition or a show, not a sport.” A Phony 'War on Science' Michael Gerson, Washington Post “In their talk of a Republican war on science, liberals may be blinding themselves to a very different kind of modern war in which their own ideals are deeply implicated: a war on equality.” It’s Not Immoral to Want to be Immortal Arthur Caplan, MSNBC “Despite a lot of hand-wringing and finger-pointing, it is not obvious that wanting to live a lot longer is evil or immoral.” Science Is Leading Us to More Answers, but It's Also Misleading Us David A. Shaywitz, Washington Post “Consumers of scientific information must balance the hope we place in global biology with the skepticism this field has surely earned.” Taking the Scary out of Breast Cancer Stats Carol Tavris and Avrum Bluming, LA Times “The media understand how deeply women fear breast cancer, and the result is that

3/7/08 12:54


Bioethics Forum - Paralympics 2.0

http://www.bioethicsforum.org/Court-of-Arbitration-for-Sport...

(Center for Genetics and Society)

contest; it is called the Paralympic Games.

Blogborygmi (Nicholas Genes)

In any case, what if the legs are providing an advantage over other competitors? Does

Envisioning 2.0 (Fard Johnmar) Global Bioethics Blog (Stuart Rennie) Health Care Organizational Ethics (Jim Sabin)

this make it unfair? Even within the category of able-bodied sport, there are vast differences of technological enablement at work and these are only likely to grow. To this end, maintaining fairness is increasingly a conviction of faith, rather than a condition that can be achieved within elite sports competition. Moreover, each individual athlete will become more strategic in finding their technology of choice in what has already become a contest of technology and biology.

Medical Futility (Thaddeus Pope)

In any case, as I intimated earlier, deciding whether Pistorius should compete as an

Neuroethics & Law Blog (Adam Kolber)

exposing the injustice of segregation should be our primary moral concern and its

Not Dead Yet (various)

we should be asking is not whether Paralympians should compete at the Olympics, but

patriciaEbauer.com (Patricia E. Bauer)

that justifies the separation of these two sets of competitions.

Secondhand Smoke (Wesley J. Smith) Sufficient Scruples (Kevin T. Keith) Women’s Bioethics Blog (various) Anxiety, Addiction and Depression Treatments (Patrick Coffee) What is Bioethics Forum?

Olympian or a Paralympian is not just a problem of apples and oranges. Rather, significance far exceeds that of ensuring fairness to able-bodied athletes. The question why they are separate in the first place. There is nothing within the Olympic Charter

The Olympic ideals of “excellence,” “fair play” and “celebrating humanity” apply in equal measure to both Paralympic and Olympic games. Moreover, a quick glance at the enabled to capture the attention of international audiences in the way that is enjoyed by the Olympic Games. Allowing Paralympians to compete as Olympians would advance the cause of disabled athletes by at least fifty years. It would also reinforce the value of physical difference within a society that has steadily aspired to increasingly narrow ideals of physical and aesthetic ideals. We cannot assume, however, that the emerging era of the bionic athlete will work out well for disabled people. While new technologies might provide modifications that will be available to these athletes that can reconstitute the boundaries of comparison even

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Dollars to Doughnuts Diagnosis Albert Fuchs, LA Times “Insurance doesn't make routine care affordable; it makes it more expensive by adding a middleman.” Tainted Medicine Jerome P. Kassirer, LA Times “Disclosure of financial ties may give a scientist or researcher a clean conscience, but that doesn't erase the possibility of a conflict.” Children's health can't be left to faith alone Arthur Caplan, MSNBC “Parents do not have the right to watch a child wither away while they pray.”

operational budget of the next few games shows that the Paralympics have not been

exceed the capabilities of so-called able-bodied athletes, subsequent innovations might

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every study that seems to find a link between some new risk factor and the disease makes headlines everywhere.”

further. Consider the prospect of stronger tendons, the use of laser eye surgery, and even elective surgical interventions designed to strengthen the body. Even today, it’s not clear what’s best for Pistorius. For instance, if he makes it to the Olympic finals this year and comes last, will he – and should he – value this more than breaking the Paralympic world record and winning Paralympic golds? This is no easy trade-off. Some years in the future, this issue will rear its head again when able-bodied athletes become synthetically enhanced to such a degree as to make them, once again, competitive against the hard prosthesis that Pistorius enjoys. We thought the ethics of doping was difficult? It’s all about to get much more complicated. However, there will be one crucial difference between how the world of sport treats this bionic future compared with that of performance-enhancing drugs. I doubt very much that we’ll hear the rhetoric of futuristic “freak shows” and so on when discussing how prosthetic devices change the capacities of people with disabilities. This common, though unreasonable assault on doped athletes has been advanced from various critics of

Transplant List Numbers Raise Doubts Arthur Caplan, MSNBC “The American people have a right to expect absolute honesty about the number of people waiting for a transplant at any time.” An Epidemic No One Wants to Talk About Robert E. Fullilove et al., Washington Post “Simply put, we will never rid the United States of HIV and other STDs if our only weapon is medical treatment.” Making Cells Like Computers Erik Parens, Boston Globe “Conceivably, we are on the verge of installing synthetic genomes in bacterial cells to create products we want. But we are still a long, long way from doing what most people mean by ‘synthesizing life.’” Miracle Workers? David Rieff, New York Times Magazine “Even today, the oldest of all relations between patient and physician — that of supplicant to shaman — continues to exert its authority.”

doping practices, including Wildor Hollmann, president of the World Federation of Sports Physicians in 1984 and recently departed World Anti-Doping Agency President 1

Dick Pound (2004). I wonder how they will characterize the athletes of this new era of bionic prostheses. 1

. J. Hoberman, Testosterone Dreams: Rejuvenation, Aphrodisia, Doping (University

of California Press, 2006), p. 192; R. Pound, “An Olympian Test of Our Morality,” Financial Times (London), August 9, 2004, p. 17. Comment on this essay. Comments are sent to the forum moderator. Select responses may be posted.

Overselling Overmedication Judith Warner, NYTimes.com “Most of the critics decrying the over-medicalization of the American mind rest their arguments upon the bedrock assumption that people who have nothing wrong with them are being medicated for largely fictitious concerns.” Ads Spur Urge for Drugs David Lazarus, LA Times “DTC advertising has turned prescription drugs into just another gotta-have-it consumer product.”

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Paralympics 2.0