The Goals of Sports Medicine What are They and What Should They Be? Christian Munthe Department of Philosophy, Göteborg University

Sports Medicine vs. Health Care n HC-goals u Secure a certain level of health F Prevention (public health, health information, preventive medicine) F Restoration (therapies, cures, rehabilitation) F Ailment (palliative medicine) u In a just way n SM-goals u Secure a level of health conducive to athletic performance F Involves the goals of HC, but goes beyond and differ from them F The level of health aimed for in SM typically goes beyond the one aimed for in HC F Involves also “enhancement” of the bodily functions of individuals F No apparent requirement of justice

The Dual Influences of SM n The “Ethos” of Traditional Medicine u Life & Quality of Life (primary but limited) u Autonomy (contested scope and strength) u Justice (contested policies) n The “Ethos” of Sports u Supreme performance and excellence (primary & unlimited) u Fairness (determined by policies/rules) u Autonomy (presupposed)

Rationing Health Care Resources n HC views u Need is paramount (combined with prognosis) u Provide for the worse off up to a certain level u Contested ideas about the relevance of numbers, but numbers relevant in some way. u Contested ideas about the relevance of merit and/or desert n SM-views u Unclear what is paramount: potential for supreme performance? (Fairness á la sports) u Providing of resources not limited by the same level as in HC u Numbers problematic (athletes a minority + conflict: elite vs. leisure sports) u Merit/Desert can work both ways F Sports injuries etc. self-inflicted F Sports heroes of great benefit to society

Contested Procedures: four lines of reasoning n “Doping”, nutrition, training methods, gene-technology etc. n Line 1 u SM should adapt to the “ethos” of HC (safety, justice) u Either: problematic since SM’s goals are different u Or: a reason for revising the goals of SM (and the practice of SM) n Line 2 u SM should adapt to the “ethos” of sports (excellence, fairness) u Either: problematic due to the rules and goals of sports being arbitrary from a medical point of view u Or: reason for breaking SM out of the HC context alltogether n Line 3 u Sports should adapt to the “ethos” of HC/SM ( determining fairness) u (If SM, this presupposes an “ethos” of SM independent of sports) u Medical safety an argument against doping etc. (but what safety level?) u Medical justice arguments against doping etc. n Line 4 u HC should adapt to the “ethos” of SM/Sports (safety, justice) u Either: extremely problematic due to the large differences u Or: reason for radical revision of the “ethos” of HC

Remarks and Reflections n What “ethos” - if any - is relevant for an ethics of SM? n What is the “place” of SM in society? n A Basic Problem for “ethos”-based ethics u Virtue oriented sports philosophy u Communitarian theories of justice n A Challenge for SM and Sports, but also for Medical Ethics n There is no given “archimedian point” n Inquiries into concrete, particular issues the way forward (?)