Before asking what to do with the drug cheat, performance enhancement in sport must be explained in its broader cultural context. This context includes understanding the way in which enhanced bodies – superhumans, mutants and monsters – have been depicted within social discourses, particularly through literature and various media forms. It also requires taking into account the risks to vulnerable groups, such as children or athletes who enhance because they feel coerced, and the liberties of adults who make lifestyle decisions about body modification. Finally, it is necessary to consider the functions of organised sport, how it relates to the individual, and what responsibilities it has to society, both to promote healthy sports and ensure opportunities to compete for all.

Outside of sport, there is considerable moral ambiguity about the value of altering the natural body and the definition (and value) of cheating. Moreover, the role of technological change through medical technology has become part of the cultural landscape in a way that is, on balance, positive. Prohibition of enhancement runs counter to this change and the moral tension caused by PE drugs in sport, reflects the crisis of authenticity in contemporary society, specifically, the demise of the natural human. Fair play and health are secondary matters in this debate and, yet, they dominate the various discourses, because they lend themselves to moral intuitionism.
When considering what should be the strategy for anti-doping officials, it is necessary to return to questioning the ethical foundation of performance, while recognising the broader bioethical context within which decisions about medical technology are made. This requires that anti-doping policy are accountable to independent audit. It also requires that elite sports re-evaluate established systems of rewarding excellence, in order to promote a moral climate in sport that takes into account inherent sporting injustices, which are constitutive of the industry.

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