Therapeutic use exemptions and the doctrine of double effect

Without taking a position on the overall justification of anti-doping regulations, I analyse the possible justification of Therapeutic Use Exemptions (TUEs) from such rules. TUEs are a creative way to prevent the unfair exclusion of athletes with a chronic condition, and they have the potential to be the least bad option. But they cannot be competitively neutral. Their justification must rest, instead, on the relevance of intentions to permissibility. I illustrate this by means of a set of thought experiments in which only an athlete's intentions vary. I argue that the Doctrine of Double Effect (DDE) sheds some light on TUEs and illustrate this by applying different readings of the DDE to the thought experiment. This underpins a justification of anti-doping exemptions very different from the approach adopted by the World Anti-Doping Agency (WADA). I argue for three changes to bring TUEs in line with this understanding: rewriting of the regulations, transparency, and a greater role for athletes in determining what exemptions are allowed, and when.