“Key reading and a central reference point for anyone who intends to enter the realm of sport bioethics”

Matija Mato Škerbić
Department of Croatian Studies, University of Zagreb, Croatia

Bioethics of sport was included in the Routledge Handbook of the Philosophy of Sport (McNamee & Morgan, 2015) among other sub-disciplines like aesthetics, ethics, epistemology etc., and by this somehow ‘officially acknowledged’ as a specific branch of philosophy of sport. Silvia Camporesi’s and Mike McNamee’s Bioethics, Genetics and Sport seems to be just the book that the sub-discipline needed at this stage: capturing prior research and accomplishments in this regard and leaning on it, determining its specific thematic scope, establishing the proper methodology, and finally extracting and dealing with some of the most heavy and exemplary cases which are putting in question our understandings and explanations of sport, threatening the very integrity of sport.

In the Routledge Handbook, Camporesi presented bioethics of sport as a five topic field: doping, genetics, gender, paralympism and disability, and sports medicine (pp. 81-97), which is in accordance with the previous thematic spectrum presented especially in different editions of bioethics encyclopaedia (T. H. Murray, 1995; A. J. Schneider, 2004, 2014; A. Miah, 2016). In Bioethics, Genetics and Sport the spectrum is a bit broader with inclusion of several specific issues in sport like (new) informed consent, sports categorisation, biological race, and hyperandrogenism.

The book is divided into two parts with five chapters in each. First part is titled ‘Genetics, Sports Medicine and Sports Science’ and is focused on the growing field of genetic science research and technology, its practical and possible influence and implications in sports, but also in sports medicine and sport sciences.

In the first chapter the authors are introducing readers to key concepts and methodology in genetics and genetic bases of sport performance. In doing so, they are pointing to different chapters in the book where they address issues further and more specifically, with the explicit attitude not to deal with science fiction or ‘long-term scientific guesswork’ (p. 188), but only with the realistic scenarios in bioethics of sport.

The second chapter offers a discussion on the limited role of genetic testing in training optimization and for injury prevention in the cases of sudden cardiac death, concussion and brain injuries, sickle-cell anaemia trait, and Achilles tendinopathies and anterior crucial ligament injuries. Also, it raises ethical discussions on paternalism and policies which can be led by particular interests or intentions.

Genetic testing for talent identification and development is discussed in the third chapter. The authors go from the clear stance against irresponsible direct-to-consumer (DTC) marketing of genetic testing and the fact that there is no scientific evidence “for the predictive value of genetic profiling in sports performance” (p. 45), just to focus on the ethical issues of the role, duties and responsibility of parents on the one hand, and children’s rights in both genetics testing and child-parent relationship on the other.

In the fourth chapter, the authors are problematising the role of the Athlome-Project and Athlome-Consortium in the delicate issue of biobanking in sport. After pointing to the epistemological problems of presumed objectivity and the context of the data, they are presenting and developing six models of new informed consent as the most appropriate solution. Namely: blanket consent, open, broad, meta/tiered, dynamic, and waived consent (pp. 62-67).

In the fifth chapter, the authors are discussing gene transfer, gene enhancement and gene doping, thereby “distinguishing science from science fiction”. In order to do that, they are challenging the view that gene transfer to enhance athletic performance is an innovation ‘that enhances the capacity to express sports-related skills’ (Miah), setting it against against the view which considers it as just another form of doping (WADA, Vlahovich), pointing to the limits of genetics due to human (genetic) complexity.

The second part of the book titled ‘Enhancement, Therapy, and the Ethical Construction of Categories in Sport’ and deals with different issues in therapy, enhancement, identity and normality, and implications of various critical concepts in regulations of sports policy and practice.

A detailed analysis of the cases of Caster Semenya and Dutee Chand and the discussion on issues of the hyperandrogenism regulations in sports takes place in the eighth chapter.

Chapter six is ‘the hinge of the book’ (p. 112). Starting with Hoberman’s 1992 research on East German sports medicine, the authors raise a wide range of issues and positions regarding the problem of enhancement, doping and the spirit of sport. The huge differences between the goals of medicine and sports medicines, as well as the perception of the therapy/enhancement distinction, and ‘an ‘abnormal’ entity and the goals’ of the latter, leads them to point out the urgency and importance of anti-doping, as well as therapeutic usage exemption (TUE) regulations in sports.

The seventh chapter challenges ‘ethics of translational research’ with ‘ethics of sports enhancement’ scenarios in a case study on legitimacy of gene transfer to raise the tolerance to pain. In that regard, among others, they bring the interesting case of Lionel Messi, asking ‘how one of the greatest football (soccer) players ever, benefitted precisely from this kind of intervention’, and conclude that such transfers ‘compromises an element essential to the activity itself’ (p. 126).

A detailed analysis of the cases of Caster Semenya and Dutee Chand and the discussion on issues of the hyperandrogenism regulations in sports takes place in the eighth chapter. In dealing with such cases, the authors point out the need for ‘a broader reflection on the value and the meaning of sport’ because ‘IAAF and IOC regulations are permeated by outdated discourses of a binary switch of sex determination (i.e. male or female) and by the quest for a clear and precisely measurable dividing line where there is none.’ (p. 144)

Chapter nine puts an interesting light on the problem of disability and categorisation in sport. Going from the essential question of what is disability, the authors reveal ‘social’ and ‘medical’ models of understanding disability as inadequate, and go along with the International Classification of Functioning, Disability and Health (ICF) or ‘bio-psycho-social’ model, which recognises that disability ‘cannot be simply equated with impairment, as disability is more than a medically conceived health issue’. (p. 154) Then, through detailed analysis of two paralympians, Oscar Pistorius and Markus Rehm, they confront congenital and acquired disabilities, as well as the value of technology used and the decision-making process of IAAF and IPC of whether they should be allowed to compete in ‘standard’ competitions. In such decisions, ‘simple reduction of complex questions to scientific or biomechanical answers’ (p. 166) is not enough, because they require a multidisciplinary approach, and normative discussions on fairness and the value of technology in sport.

In the final chapter, the authors alerts about and argue against the re-inscription of the concept of ‘human race’ which is ‘covertly hidden’ in the recent discussions about the genetic basis of sports performance.

At the very end of the book, authors include a glossary with explanations for the most important specialised terms used in the book. This is very helpful, even necessary addition for bringing the book to a larger audience that doesn’t necessarily know and understand medicine and natural sciences terminology, or was educated in this area. Also, bioethics by itself attracts a wide range of scholars and other interested parties to deal with the problems in interdisciplinary settings, so it is crucial that they understand and use the terms precisely and properly.

Camporesi and McNamee successfully show how empirical and natural sciences should go along with humanities and social sciences in the research and considerations of sports related topics.

Summa summarum, Camporesi’s and McNamee’s book provides the range of the most relevant issues in and for contemporary sports, their critical and precise examination with many plausible solutions and anticipations gathers an impressive amount of previous research in the field, and thus, by connecting ‘yesterday’ with ‘today’, sets the proper ground for ‘tomorrow’. Unsurprisingly, it seems that Bioethics, Genetics and Sport has instantly become key reading and a central reference point for anyone who intends to enter the realm of sport bioethics. Moreover, in the last decade, the authors of the book has done a tremendous work, and have become a leading sport-bioethicists, as well as promoters of the field. This book is a sort of catalog cum melting pot of years of scientific endeavours, combining hardworking ethics with the highest-level quality, and deep love and care for sports. At the same time, it is also a confirmation of their status as the foremost authorities in the field.

Furthermore, interdisciplinarity, multidisciplinarity, and transdisciplinarity that captures the methodological efforts of bioethics, and is a joint tendency in all of its understandings developed in the bioethics spectra around the globe – from ‘(new) medical ethics’ (Kennedy Institute), ‘global’ or ‘bridge-building’ (Van Rensselaer Potter), to ‘European’ (Fritz Jahr) – is accomplished in a superb way. Camporesi and McNamee successfully show how empirical and natural sciences should go along with humanities and social sciences in the research and considerations of sports related topics. It is enrichment of both – empirically gathered data and research receive deep philosophical and ethical reflection, while philosophical/ethical considerations and claims get the empirical evidence.

However, since I’ve been educated and raised in another philosophical and bioethical tradition, I will put a critical note in this regard and ask for a small extension in future editions of this book. Namely, since the authors explicitly claim already in the title that they are combining bioethics and sport with the accent on genetics, it seems to me that it would be useful if they would provide a definition or understanding of the kind of bioethics that they build on. It seems that they are speaking only from the ‘new-medical-bio-ethics’ position, not taking into account other, different traditions. Here, I mostly miss ‘European Bioethics’, bioethics that are rooted in the long and rich European philosophical tradition; I am referring to Van Rensselaer Potter and Fritz Jahr, who coined the word bioethics in 1971 (Potter) and even in 1926 (Jahr), as well as their broad understanding of bioethics. Of course, this remark does not interfere with the content or the quality of the book, but does point to several new directions and perspectives for future research. In this regard, I salute the inclusion of the work of Hans Jonas in the discussion.

My second minor point of criticism goes towards a certain lack of homogeneity and consistency. The book appears to me as more like an edited volume, with ten separate and specific research articles brought together under the common umbrella of bioethics, albeit written by the same authors. Each chapter seems like a stand-alone text, with a specific introduction, discussion and conclusion(s), despite the fact that authors are pointing at the other parts of the book that are connected.

However, these minor criticisms notwithstanding, I believe that with Bioethics, Genetics and Sport we have one of those books that we will refer to as classics or capital works in the philosophy of sport.

Copyright © Matija Mato Škerbić 2019