Performance enhancing drugs in youth sport provide a teaching moment for ethical reasoning

"An ethical man knows what to do. A moral man does it." Youth sport is an ethical reasoning laboratory that we really should take advantage of more often.

The phrase performance enhancing drugs (PEDs) triggers a flood of negative associations with most people. In sport it paints a sordid picture of blood transfusions, steroid injections, or other practices that clearly exist on the windy side of ethical behavior. PED use in sport creates an artificial advantage for one competitor over others; thus, challenging our most basic expectation of sport, which is to offer a fair competitive experience. This explains why international sport organizations have mechanisms to police the illicit use of a long list of substances considered performance enhancers, and why the average sport fan calls out PED use for what it is, cheating.

But a small number of people believe that PEDs should be legal and that athletes should be free to make their own decisions about whether to use them or not. This view is not widespread, especially among sport practitioners, but the fact that this view exists at all illustrates that the ethical frameworks used to understand PED use are not universal. In countries where drug use in general is becoming less of a criminal offense and more of a public health or freedom of choice issue, isn't it reasonable to expect that PED use in sport will also become less of an issue in the future?

The public's perception of doping in sport is shaped by the way testing and reporting are done. Since doping control is only conducted at upper level competitions only elite athletes are tested. Consequently athletes who test positive are already in a select group of high performers and the perception is that doping is a problem exclusive to elite level sport. This is almost surely not the case but there is no real way of knowing since testing is not done at lower levels. Testing on a larger scale though would be both impractical and prohibitively expensive. This is why PED use goes unnoticed outside the elite level.

Elite level doping occurs on the underside of sport. Since success at the pinnacle of one's sport can be quite lucrative there is a lot at stake for athletes who add PEDs to the dark side of their training regimen. Success at the developmental level, however, is short lived and the rewards amount to nowhere near those at the elite level, so the risks apply more to the physical health and moral foundation of the athletes involved rather than suspension from participation or loss of income. 

Common PEDs used in developmental sport fall into a few general categories

Stimulants are used primarily during competition. Their effect is almost immediate but not long lasting. This includes well known energy drinks such as Red Bull and Monster, both of which are high in caffeine. Amphetamines, such as Adderall (used to treat attention and hyperactivity) are also used.

Bronchodilators like Albuterol, Formoterol, and Terbutaline are used to treat asthma. Proper use allows asthma sufferers to breathe normally. In sport the 'off label' use offers temporary increased lung function. Doses are delivered through the use of inhalers. Exercise induced asthma (EIA) is more common amongst athletes than the general population and is found in endurance athletes (cycling, cross-country skiing) more often than in other kinds of sport. In the UK a study found that 70% of the British national swimming squad had some form of asthma compared to the nationwide average of less than 10%. In swimming there is speculation that chlorine may be the cause of the condition; in other sports EIA is thought to be triggered by cool or dry air. Still, the ubiquitous presence of inhalers at youth sport competitions makes one wonder if they are all necessary.

Anabolic steroids and their precursors are used to build muscle mass. Their use is perhaps the most troubling of all performance enhancement methods. This is because of the health risks involved and the fact that they are illegal, which makes acquiring them a much more serious matter than merely misusing an asthma prescription or drinking an unhealthy amount of caffeine.

Anabolic steroids are synthetic versions of testosterone, which is used to medically treat hormone deficiencies. Steroid precursors such as androstenedione ("andro") and dehydroepiandrosterone (DHEA) can be converted to testosterone in the body. Possession and use of these substances is illegal without a prescription in most countries. There are limited health benefits associated with these drugs such as increased strength or endurance but due to health risks caused by their use they were banned in the United States in 1990. 

Steroids and precursors, whether legal or not in a particular country, are banned for use in sport. Unfortunately there is a dark side of the sport community that not only strives to concoct versions of these drugs that are not covered in the 1990 Anabolic Steroids Control Act but which are undetectable by current testing protocols.

Creatine also helps to build muscle mass but is currently not on the WADA banned list. It is considered a nutritional supplement rather than a drug and is available over-the-counter in most countries. Creatine exists in a somewhat grey area as a performance enhancer. It has a small effect on performance but using it effectively depends more on a proper training regimen than on the substance itself. Many athletes use it to aid in recovery. Youth sport training is not intense enough to really need recovery strategies so creatine use at the developmental level doesn’t make much sense.

Ethical considerations of using PEDs in youth sport

Commenting on the ethical considerations involved in young athletes using performance enhancing substances is tricky because it's almost never the athlete who is making the decision to use enhancers or not: It is the athletes' parents or coach. This changes as athletes get older but the foundation for ethical reasoning is laid early in a child's life and the moral direction this foundation provides doesn't change suddenly when a child becomes a young adult and begins making such decisions himself. A sound foundation in ethical reasoning and examples of moral action provide the framework for the future.

PED use in youth sport offers one of the purest examples of an opportunity to teach ethical reasoning and offer an example of moral action. We often don't get this chance in real life because along with making the 'right' decision comes the possibility of getting caught and punished for making the 'wrong' decision. In sport this doesn't happen. Until athletes reach higher levels of performance where testing is mandated by international governing bodies there is almost no possibility of punishment for PED use. Without testing how would anyone know?

“The ethical man knows what to do. A moral man does it.”

The point is whenever a decision is encouraged by the avoidance of punishment we don't know the basis of the decision. Was it guided by sound ethical reasoning resulting in moral action? Or was it guided by the threat of punishment? If you say that the result is the same and that we shouldn't really care you might be right if we're talking about things like paying taxes or stopping at red lights. These are both moral actions but we don't really care why people do them as long as they do them. We benefit when they do them and suffer if they don't. But if you're talking about shaping the moral behavior of our children it's a different matter. We want them to arrive at the right decision for the right reason.

Youth sport offers a different scenario because the threat of punishment for PED use is not present. Why is the young athlete using the inhaler now? Why are so many Red Bulls in their travel kit? As coaches and parents we can inadvertently cripple the development of ethical reasoning by encouraging PED use.

Once on an old TV show one of the characters said (paraphrasing), "An ethical man knows what to do. A moral man does it." Ethical reasoning is not difficult and can be learned fairly easily but youngsters need examples of moral action. When we don't take the opportunities available in youth sport to shape the future we are not fully appreciating the value of the youth sport experience.