Drugs could thus be introduced from the armed forces into wider society through several channels, including prescribing to veterans and reservists for whom the military has a duty of care.
The final ethical and legal consideration of pharmacological performance enhancement by the military is how its use might affect society, and how society might affect its use. The armed forces do not exist in isolation from civil society; soldiers are recruited from society and they transition back into society on the completion of their service. Therefore, attitudes towards drug use in the military and in society are mutually constitutive. Narratives relating to amphetamine use during the Second World War show that it is ultimately societal opinion that will determine whether soldiers start taking performance-enhancing drugs. Military policy is shaped by the response of social and cultural attitudes that are themselves driven by the media to a very significant degree.
There is a growing acceptance in modern UK society of the use of both prescription and illegal drugs, particularly among the younger population from which the military recruits. This has the potential to influence soldiers’ willingness to consent to performance-enhancing pharmaceutical programmes in the military, and underlines the need to have an informed debate now about the ethical and legal considerations of their use. Changing social attitudes also reflect the increasing availability of information, as people take more interest in their health and physical fitness, both through greater access to information online and through technology such as wearable fitness trackers and smartwatches. However, this improvement in the availability of information gives rise to a proviso that soldiers wish to be better informed about medical procedures, and therefore expect to have access to the relevant information. The former paternalistic practice of ‘doctor-knows-best’ medicine is much less widely accepted. However, this shift could present challenges where the details of performance-enhancing drugs are classified and such information is not releasable.
Another area where drugs might impact society is in the migration of military technology into society. This is a common evolution, as advances in military technology often have valuable civilian applications – as was the case for GPS (Global Positioning System) satellites, canned food, zip fasteners, or stainless steel, which were all originally developed for military use. In this way, it can be expected that new technological advances in military pharmacology will eventually make their way into broader society. This could be significant where performance-enhancing drugs are created exclusively for use by the military, rather than consisting of off-label applications of previously approved prescription drugs which are already available to society. Drugs could thus be introduced from the military into wider society through several channels – including prescribing to veterans and reservists, for whom the armed forces have a duty of care.
Such soldiers who have used performance-enhancing drugs during their military careers could present a predicament when they leave the armed forces and transition back into society. Depending on their exposure and use, soldiers may wish to continue to have access to these drugs as veterans, either because of addiction or because they appreciate their benefits. Addiction would raise serious ethical concerns, and any planned exposure to drugs that resulted in addiction would be unlikely to receive ethical approval. However, misuse of drugs by soldiers could inadvertently lead to addiction, as highlighted by the following, which describes a first-hand experience from the Gulf War, as told by a former US Marine:
This experience illustrates the importance of strictly controlling the use of drugs in the military. Any performance-enhancing drugs issued to soldiers should be subject to the same sort of control restrictions that govern explosives and weapon safety, with specially qualified personnel responsible for their handling and issue. Government and armed forces’ responsibility for the long-term health of veterans in society would mean that, in the UK, civilian doctors and the National Health Service would require access to comprehensive information about what drugs soldiers had been exposed to during their service, in order that they can monitor any addiction or other long-term health concerns. Again, this could present problems where military drug programmes are classified.
One ethical difficulty concerns whether veteran soldiers should be permitted access to performance-enhancing drugs after leaving the service. Such benefit may be an attractive recruitment incentive for service, much like learning a new skill or trade. However, where this would give retired soldiers an advantage over those who have not served, it would present disparities in society, and a level of special treatment that goes beyond the moral obligations of society towards the armed forces. It is therefore recognized that any use of performance-enhancing drugs by the military must be reversible on discharge from the service.
