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Boosting Performance at the Paralympics

By Michael Cook

Up to one-third of Paralympians in London may have harmed themselves to boost blood flow.

“To strive, to seek, to find, and not to yield”. If this line from Lord Tennyson expresses the essence of the Olympic spirit, then the Paralympics are possibly even more “Olympic” than the big ticket events.

The former captain of Scotland’s Scottish wheelchair basketball team said that the London Paralympic Games “will only add to the perception that there aren’t Paralympic athletes and able-bodied athletes – there are just athletes”.One problematic consequence is that some Paralympians are going to cheat.

Everyone knows that some Olympians cheat. Lance Armstrong, once hailed as the greatest cyclist in history, departed from cycling forever in disgrace this year. He forfeited everything he won since August 1998 – including seven consecutive Tours de France and a bronze in the 2000 Olympics – after declining to defend himself against doping charges.

Drug doping is banned not only because it gives competitors who use drugs an unfair advantage, but also because it can be dangerous. But cheating by athletes disabled by spinal cord injuries can be so dangerous that it puts Lance Armstrong’s activities in the shade.

In a practice called boosting, athletes subject their body to extreme pain to raise their blood pressure and heart beat. This improves their performance because more blood reaches their muscles. In able-bodied athletes blood pressure rises spontaneously to cope with a challenge, but not in athletes with spinal injuries. So players do things like sitting on sharp objects, strangulating testicles, clamping urinary catheters to distend the bladder or even breaking their toes with a hammer. They can’t feel the pain, but their bodies do react. The technical term for it is “induced autonomic dysreflexia”.

Boosting is extremely dangerous. A sudden explosion of blood pressure could burst blood vessels in the eye, cause a stroke or even death.

How many athletes engage in boosting? A survey at the Beijing Olympics found that 17% admitted that they had done it. Dr Andrei Krassioukov, a professor of medicine at the University of British Columbia and a specialist in spinal injuries, believes that the figure at the London Games would be more like 30%, but no one knows for sure. “What’s going to happen one day is that someone is going to have a stroke right on the court and then they are going to have to talk about it,” Krassioukov said.

Boosting is a disturbing reality, but it is a helpful counterpoint in thinking about whether “abled” athletes should be allowed to take performance-enhancing drugs, as some libertarian bio­ethicists contend. They have three main arguments.

Drugs may be dangerous, but if athletes understand the risks it violates their autonomy to ban them. This assumes that athletes will always act in their own interests.

What boosting shows is that the desire to win can be so strong that it clouds rational judgement. Even the doyen of libertarianism, John Stuart Mill, thought that autonomy had limits. One could not sell himself into slavery, for instance. Isn’t self-mutilation similar?

Sport is all about reaching the limits of human performance, and drugs allow athletes to get there. But the very existence of the Paralympics suggests that sports are more about the virtues required to win – tenacity and grit – than the physical achievement. That’s ultimately what we admire in the winners. Drugs and boosting can give more strength, but not more courage.

Finally, bioethicists say that legalising performance-enhancing drugs would level the playing field because the sporting world would no longer be divided between honest suckers and winning cheats. But the ghastly, almost unthinkable, practice of boosting suggests that as long as there are rules there will be cheating. (Remember the intellectually disabled Spanish basketball gold medallists at the Sydney Olympics, who weren’t disabled at all and were stripped of their medals?)

Sport is all about playing within rules. The notion of a perfectly level playing field in sport is as fanciful as a perfectly functioning market in economics.

Ultimately, boosting is unethical not just because it gives an unfair advantage but because it is a form of self-harm or mutilation. Violating a body, even a disabled body, diminishes the person’s dignity by treating him merely as an object. Thankfully, the practice has been banned by the International Paralympics Committee since 1994.

Michael Cook is editor of the on-line bioethics newsletter BioEdge.