Caster Semenya: Sport, categories and the creative role of ethics

Abstract

Caster Semenya, a South African 18-year-old, won the 800-metre track running title at the Berlin World Athletics Championships in 2009. Only 3 h later, her gender was being harshly contested. The investigation of the International Association of Athletics Federations (IAAF) was neither discreet nor respectful of her privacy. Caster's case has implications for the ethics of sports and debates about gender and enhancement, and for the philosophical debate about the nature of categories and the classification of people. The IAAF has not disclosed the results of their tests on Caster, and the South African Ministry of Sport has decreed that in any case she can continue running with women in her own country. But could a scientific or medical test offer uncontroversial answers regarding Caster's gender? The concept of 'gender' is partly a social construction. The authors argue that ethics may guide science and medicine at addressing such questions.

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doi: 10.1136/jme.2010.035634
2010 36: 378-379J Med Ethics
Silvia Camporesi and Paolo Maugeri
creative role of ethics
Caster Semenya: sport, categories and the
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Caster Semenya: sport, categories and the creative
role of ethics
Silvia Camporesi, Paolo Maugeri
ABSTRACT
Caster Semenya, a South African 18-year-old, won the
800-metre track running title at the Berlin World
Athletics Championships in 2009. Only 3 h later, her
gender was being harshly contested. The investigation of
the International Association of Athletics Federations
(IAAF) was neither discreet nor respectful of her privacy.
Caster’s case has implications for the ethics of sports
and debates about gender and enhancement, and for the
philosophical debate about the nature of categories and
the classification of people. The IAAF has not disclosed
the results of their tests on Caster, and the South African
Ministry of Sport has decreed that in any case she can
continue running with women in her own country. But
could a scientific or medical test offer uncontroversial
answers regarding Caster’s gender? The concept of
‘gender’ is partly a social construction. The authors argue
that ethics may guide science and medicine at
addressing such questions.
In 2008, the debate about Oscar Pistorius’pros-
thesis stirred the sports community with an ethics-
flavoured quarrel.
1
After the Lausanne Supreme
Court of Sport had ruled on its permissibility, and
especially after Pistorius did not qualify for the
Olympics in Beijing, the waters seemed to calm
down. But in August 2009 the Berlin World
Athletics Championships were shaken by another
controversy. Caster Semenya, an 18-year-old from
South Africa, won the 800-metre title by nearly
two and a half seconds, finishing in 1:55.45. Only
3 h after winning the gold medal, Caster was at the
centre of a harsh contestation concerning her
gender. A bitterly disappointed Italian runner, Elisa
Cusma, who finished sixth, was reported as saying,
‘These kind of people should not run with us. For
me, she is not a woman. She’s a man.’
2
The International Association of Athletics
Federations (IAAF) reported that two things trig-
gered the investigation: the ‘incredible improve-
ment in the athlete’s performance and .the fact
that a South African blog was alleging that she was
a hermaphrodite athlete’.
3
The IAAF defined her
improvement ‘the sort of dramatic breakthroughs
that usually arouse suspicion of drug abuse’.
4
The
parallel drawn by the IAAF with drug abuse hinted
that Caster had won by ’cheating’. Other
commentators pointed out that Caster went from
training on the roads of Limpopo to a world-class
facility in Pretoria, and that the improvement was
actually not so incredible.
5
The results of the gender verification tests on
Caster, which were neither discreet nor respectful
of her privacy, were expected by the end of
November 2009 but were never disclosed. In
a statement released on 19 November 2009, South
Africa’s Ministry of Sport said that Caster had
reached an agreement with the IAAF to keep the
gold medal and prize money, but the IAAF refused
to confirm this. Most notably, the Ministry of
Sport has decreed that Caster can continue running
with women in her own country, regardless of
what the IAAF decides.
5
The IAAF has changed its gender verification
policies several times over the last few decades.
From the humiliating methods adopted at the 1966
European Track and Field Championships and at
the 1967 Pan American Games, where disrobed
female athletes were asked to undergo physical
examination before a panel of experts, to the
screening of the Y-linked SRY gene in 1992, gender
testing has always been controversial.
6
The current
policy, adopted in 1996 and not substantially
changed at the International Olympic Committee
meeting held in Miami in January 2010, has been
defined as an ‘I know it when I see it’policy’,
7
because it does not indicate who should be tested
and on what grounds. An athlete will be examined
if ‘there is any ‘suspicion’or if there is a ‘challenge’’:
evidently, a blog post qualifies as a challenge.
Therefore, how should Caster’s case be resolved?
And on what basis should a decision be taken?
Not every culture divides the sexs absolutely:
some North American tribal customs feature
‘two-spirit’people, who combine male and female
attributes, and in South Asia there is a word, hijras,
for persons considered neither males nor females.
8
‘Nature’is not moral, and it contains no moral
messages framed in human terms.
9
The way in
which humans group things is not merely a reading
of an alleged ‘natural order’, rather it is a more
complex social activity requiring negotiation and
reflection upon the consequences and the purposes
of such an ordering.
10
Therefore, deciding where to
draw the line in the grey area of sexual conditions
depends also on the way in which we want track
and field sports to be organised.
In an attempt to assess in which category should
Caster compete, we should first ask ourselves
whether a scientific or medical test would offer
uncontroversial answers for our purposes. What
kind of answers could such a test provide?In our
case of sex differentiation, a relatively broad spec-
trum of conditions lies between the two extremes
‘male’and ‘female’.
The number of disorders of sex differentiation
can be counted in the order of tens, with variable
degrees of severity, and can be classified as sex
chromosome abnormalities, gonadal abnormalities
and sex hormone abnormalities.
11 12
About 1.7% of
Life Sciences: Foundations &
Ethics PhD Program, European
School of Molecular Medicine
and University of Milan, Italy
Correspondence to
Silvia Camporesi, Silvia
Camporesi, c/o IFOM-IEO
campus, via Adamello 16,
20139 Milan, Italy; silvia.
camporesi@ifom-ieo-campus.it
Received 25 January 2010
Revised 25 March 2010
Accepted 31 March 2010
378 J Med Ethics 2010;36:378e379. doi:10.1136/jme.2010.035634
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people have these disorders.
13 14
Only some of these conditions
are apparent, and many people who have them do not discover
they belong to this 1.7% until they decide to have children and
find out that they are subfertile or sterile.
Can we claim that Caster could be allowed to compete with
women only if diagnosed with one certain kind of disorder and
not another?On the one hand, some may want to claim that,
were Caster affected by androgen insensitivity syndromeda
condition that affects people who are genetically XY but unable
to metabolise androgens and who therefore display external
female appearance but have no uterus or ovariesdshe should be
allowed to compete with women, since such people have none
of the physical advantages derived from an increased level of
androgens and have a female gender identity. However, such
people are genetically XYdmales.
On the other hand, Caster might be diagnosed with congenital
adrenal hyperplasia (CAH), an endocrine disorder in which the
adrenal glands of a genetical female (XX) produce abnormally
high levels of virilising hormones. In this case, the affected person
has an increased muscle bulk that might provide an advantage
over other females, and some people would want to claim that
Caster should be banned from running with women if she has
this condition. Others might claim that such a person would have
to undergo treatment to lower the level of androgens in order to
compete with females (the conclusions of the recent International
Olympic Committee meeting seem to go this way
7
).
However, we do not find it self-evident that even an allegedly
advantageous condition such as CAH can be a justification for
altogether depriving affected individuals of their right to
compete with others, nor that these people should be ’averaged’
to allegedly normal values. In other words, we do not think that
the advantagedif anydprovided by CAH would be unfair.
Humans display a great deal of biological variation. Sex is no
exception. Thus, we should look at this biological diversity as an
opportunity rather than a threat. After all, every athlete who
performs outstandingly is ‘exceptional’, in one way or another.
The National Basketball Association, for instance, has several
players with acromegaly, a condition that causes the over-
production of growth hormone and that is usually classified as
pathological, but which turns out to be a powerful advantage
when playing basketball at professional levels.
The only thing we should really care about is not the ‘nature’
of that uniqueness, but that this has not been achieved by
‘cheating’. And, by cheating, we mean breaking rules that have
been reached through a consensus to provide a fair competition.
This point has implications for the debate about enhancement
in sports. Even if a clear-cut distinction between treatment and
enhancement, normal and pathological, could be drawndwhich
is questionable in itselfdthe most important question that
remains unanswered is the following: who makes these judge-
ments and how?
15
Our ever-increasing knowledge of genetics
challenges our ordinary binary thinking about sexual boundaries.
Therefore, decisions as to whether people who fall outside this
dichotomy should be banned from sports competition, or as
these should be reformed to take into account such diversity, are
a matter of deliberation. Clearly, these decisions need to be
informed by scientific evidence. But, alas, this is not enough. It is
at this level of category-setting, we argue, that regulation should
take into account ethical thinking too. This should aim to clarify
standards of fairness of sports competition.
When taking a decision, the IAAF has also to keep in mind the
implications of banning Caster from running with women.
Indeed, what would happen if Caster were excluded from
running in the female category?Could she then switch to the
male one?Of course not, as she could not be considered, by the
very same criterion, a man either, and would not be competitive
in the male category. Indeed, were she banned from running
with women, the only option left to her would be not to
compete at all, being excluded from both categories. Would that
count as fair?The South African magazine You recently featured
a photo spread showing Caster dressed in high heels and a short
skirt, hair fluffed and heavy make up, looking unhappy. Is that
the kind of fame, and future, she should try to run up for?We
hope the answer to this question will be negative. However, this
can only be so if the creative role of ethics in making categories is
fully acknowledged by the IAAF and its regulations.
Indeed, are there any alternative ways of organising track and
field, if not on the basis of gender?Would weight be a better
criterion, as it seems to work for boxing competition?Or would
biochemical differences, such as the levels of testosterone, do the
trick?Another option might be devised by anyone wishing to
preserve strict sexual boundariesdnamely, to create a brand new
category for any disorder or syndrome related to sex! We suspect
this will not happen, because it would be both impractical and
discriminatory. Reasons for preserving the myth of ‘purity’,in
any context, have always proceeded hand in hand with making
someone an outcast, as was also the case with Oscar Pistorius.
The debate spurred by Caster ’s ordeal leads us to discuss not
only gender categories in sports. It rather demands reflection on
the meaning and aims of sportdin other words, its ethics and
philosophy.We cannot expect science to provide ready-made
answers on our behalf: decisions have to be taken, not found.
Acknowledgements We are grateful to two anonymous reviewers for their
insightful comments. Many thanks go also to Giovanni Boniolo, Matteo Mameli and
Giuseppe Testa for their support.
Competing interests None.
Contributors Both authors contributed equally to this work.
Provenance and peer review Not commissioned; externally peer reviewed.
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