February 28, 2024

Are performance-reducing drugs for South African Olympian Caster Semenya ethical?

Questions raised about IAAF directive

Caster Semenya / Citizen 59 / flickr 

South African Olympian Caster Semenya has been ordered by the International Association of Athletics Federations (IAAF) to take medication to lower her natural levels of testosterone.

Other athletes have questioned whether Semenya really is a woman, because of her outstanding performance on the track. The IAAF contends that athletics requires a level playing field and that the “female classification” needs to be “protected”. It suggests that she take hormonal contraceptives to reduce testosterone.

The decision has been criticised for being inconsistent. While other athletes are banned from taking performance enhancing drugs, Semenya is being told to take performance-reducing drugs.

The World Medical Association also slammed the IAAF’s directive. It points out that there is nothing medically amiss with Semenya and that forcing her to take drugs is “contrary to medical ethics”. In a letter to the IAAF the WMA says:

“A medical treatment (with a few legal exceptions, which do not apply here) is only justified when there is a medical need. The mere existence of an intersex condition, without the person indicating suffering and expressing the desire for an adequate treatment, does not constitute a medical indication.

“The days when doctors or society would determine which gender a person should have are definitely over. It is the ethical duty of physicians to respect the dignity and integrity of people, regardless of whether they are female, male, intersex or transgender. Medical treatment for the sole purpose of altering the performance in sport is not permissible”.

Writing in Nature, Roger Pielke Jr, of the University of Colorado Boulder, also criticises the IAAF on ethical grounds. His angle is that the use of performance reducing drugs is a form of experimental medicine. According to the Helsinki Declaration of medical ethics for human subject research, he says,

“unproven interventions are acceptable only to save life, re-establish health or alleviate suffering. The interventions required by the IAAF fall under none of these categories, and turn otherwise healthy individuals into patients.”

“The Helsinki declaration states that unproven interventions must be accompanied by informed consent from the patient, and must be studied to evaluate their safety and efficacy. And medical research involving human participants must be clearly described and justified in a research protocol …  Such studies must also be approved by an independent research-ethics committee.

“The IAAF has followed none of these provisions.”

There is sure to be more discussion and debate about this ruling. Stay tuned.

Michael Cook is editor of BioEdge  

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