Good sport and good doctoring: when patients want enhancements, not therapy (The Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics)

We know that athletes, from aspiring teens to professional and aging masters, use drugs to enhance their performance. We know that in almost all sports using performance-enhancing drugs (PEDs) is forbidden. Why do athletes use them despite the prohibitions and sanctions if they are caught? Anyway, what's wrong with using PEDs in the first place? If everyone was allowed to use them, wouldn't the competitions be just as fair? How can physicians respond ethically to patients requesting help in obtaining or monitoring their health as they use PEDs? How can our experience with biomedical enhancement in sport help us understand other ways patients ask your help in using medicine to pursue goals well outside the accepted legitimate goals of medicine?