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In August the papers were full of Caster Semenya, the South African athlete who won the 800 metres at the world championships in Berlin, but who, because of her outstanding performance was to be tested to establish whether she was eligible to compete as a woman. In statements this was described as ‘a medical matter’.1 Presumably the suspicion is that Semenya has androgen insensitivity, or another metabolic anomaly which leads someone with XY chromosomes to have a female body. No doubt when the results are available it will again be headline news.
The case raises questions about gender, but also about fairness in sport and the role of medicine in this. Firstly there is the wellbeing of the individual athlete. Whatever the situation, it must be very unpleasant to have a fundamental aspect of your identify dissected in public. Surely the system could better protect athletes' feelings and medical confidentiality. If sexual chromosomes are crucial to eligibility in sports then perhaps participants should be required to produce evidence privately before competitions, rather than questions being raised in public post hoc. The division of humanity into male and female is fundamental in most societies. At birth we are defined by our gender and weight; other distinguishing characteristics come later. But few things are entirely black and white, and some people have ambiguous genitalia, or chromosomes and a body form which does not fit in the usual way; conditions often grouped together as ‘intersex’. As well as difficulties inseparable from some of these conditions, like infertility, these people often feel stigmatised and marginalised.2
Men and women compete separately in many sports. We take this for granted; yet in other areas of life — work, financial affairs, academic achievement — such separation would be seen as sexual discrimination or debated as affirmative action. Why do we treat sport differently? There are of course significant differences in physiological averages which mean that in some sports women would be marginalised if they had to compete against men. But if on the whole, justice and human flourishing are better served by this arrangement, how do we draw the line between the genders? What is more basic; our body form, our psychological self-image, or our chromosomes? And how can we avoid excluding those who straddle these divisions from sport?
More fundamentally, what does fairness demand in relation to genetic inheritance in sport? Should we judge athletes on the basis of effort or performance? It's not just genes carried on the XY chromosomes that affect performance; people with particular body types as a result of their genetic inheritance perform very differently in many sports. This, like androgen sensitivity, is not under their control. Why should we accept these differences but not chromosomal anomalies?
We tend to treat conditions differently according to how complex their causes are and how well we understand them. If stronger muscles result from an anomaly we can describe and name, we might consider this unfair and exclude the athlete; if it comes from a fortuitous combination of many genes, not all well understood, we may not. Some would argue that distinctions between the treatment of dyslexia and poor literacy, between ADHD and bad behaviour, between psychopathy and evil, are similarly based on differences between what we now understand and what we do not yet understand, rather than on morally valid distinctions. If this is so then we need to be cautious, because medicine can be abused to support unjust practices and make unfair distinctions. Also we may find our moral judgements shifting as our understanding increases, because they are built on shifting sands — an ethical version of the ‘God of the Gaps’ problem.
How to resolve these issues is not clear: I certainly don't have the answers. But we do need to ask questions which go a lot deeper than what sort of chromosomes Caster Semenya has. Leaked reports, suggesting that Semenya has androgen insensitivity, or another metabolic anomaly which leads someone with XY chromosomes to have a female body form, led to further media debate.