“Good ethics begins with good facts” is a mantra I learned in my early years at The Hastings Center. The relevant facts include, of course, scientific and medical ones. But just as important are the forces that shape perceptions, motivations, and outcomes. The importance of understanding those factors—call them grounded realities—soon became clear in my first major research assignment: the ethics of performance enhancing drug use in sport.
The bioethics literature circa 1980 led me to expect to find athletes struggling against the unjustified paternalistic restraints of anti-doping zealots. Listening to elite athletes, their coaches and others in that world, I heard a very different story. Where drugs made a palpable difference—and they had no doubt that anabolic steroids and amphetamines did—athletes faced three unhappy choices: compete without doping and face nearly certain disappointment; give up competing at the level their talent and dedication warrant; or dope like their competitors hoping thereby to “level the playing field.” The relentless competitive dynamic of sport coupled with the reality that performance enhancing drugs can overwhelm differences in talents and dedication has profound consequences for health, values, and meanings.