You are currently viewing Ethical and Legal Considerations for Biomedical Performance Enhancement in the Military

Ethical and Legal Considerations for Biomedical Performance Enhancement in the Military

Since antiquity, exceeding the natural capacities of human beings has always been a concern for states and cities. With advancements in medicine and biotechnology, all major world powers are now exploring new ways to increase the psychological and physical capacities of their soldiers. The use of pharmacological products could, in theory, be used to improve soldier strength, mental capacity, recovery, and resistance to fatigue and trauma. However, the ethical and legal frameworks within which the use of pharmacological technology would be acceptable remains uncertain. Debates surrounding the use of performance enhancement drugs often revolve around concerns regarding safety and side effects. This paper seeks to go beyond those concerns and examine the ethical and legal considerations, assuming these products are safe and approved for military use.

Despite important technological advances in the military, war remains a distinctively human enterprise. Human beings are still the ones fighting wars, not machines, and people are bound by their natural needs, namely eating, sleeping, and drinking. Moreover, humans are restrained by the confines of their physical and mental capacities. From a military point of view, human fragility is the stress point of all military operations (Bickford, 2018).

Military performance enhancement is, first and foremost, an endeavour of imagination and anticipation. It is focused on imagining how to build a body and mind into something useful and mitigating any invasive external factors. When a civilian enters the military, he signs away the fundamental rights to his body and health to the priorities of the army, namely readiness to fight and deployability (Bickford, 2020). As soon as the civilian is recruited, he is subjected to a period of transformation designed to mould them into a compliant, useful, and strong soldier. In addition, the military asserts its right over internal health by assigning a series of vaccinations to protect the soldier and enable his deployability. There is a contract between both parties allowing the military to ‘protect’ their soldiers’ health to maintain national security. Enhancements are thus aimed at preventing the degradation of combat or labour operability of soldiers based on anticipated events, stimuli, stressors, and biological/autonomic responses (Bickford, 2020). In that respect, the lines between prevention interventions and performance enhancement can be blurred, since enhancing a soldier could also save his life in a combat situation.

Military researchers might not know what a body can do, but they know what they want it to do. They are faced with the material problem of the body contrasting with the needs of war and combat.  Therefore, the fundamental questions become: how much combat can be extracted from the soldier without causing harm (Bickford, 2020)? How do you keep soldiers mentally and physically fit after multiple deployments? Contingencies push the military towards thinking about what the body can do, and what it can be made to do, and how bodies can be reconfigured to shape a response to a given situation (Bickford, 2020).

Throughout history, there is evidence of state and non-state armed groups seeking performance enhancement through pharmacological products. A few examples include the Ancient
Greeks using opium to alleviate pain, the Viking Berserkers employing hallucinogenic mushrooms to enter a trance-like state before battle, the Inca fighters chewing on coca leaves, or the use of methamphetamines by the Wehrmacht (Kamienski, 2017).

During the Second World War, moral boundaries surrounding drug prescription in the army were relaxed and performance enhancing products became commonly used by both Axis and Allied forces. The Nazis were the first to employ them widely, particularly in the Blitzkrieg fighting troops, notably the Panzer tank crews, where methamphetamines became known as “Panzerschokolade” (Tank chocolates) (Ohler, 2016). In the United Kingdom, the Royal Air Force (RAF) provided “wakey-wakey pills” for their pilots in the form of Benzedrine Sulphates to promote concentration and wakefulness (Pugh, 2018). They also prescribed amphetamines to foot soldiers in order to lift their mood and boost their courage (Goodley, 2020). Overall, there is evidence that all major powers used performance enhancing drugs during the Second World War, with the notable exception of the Soviet Union, which preferred to distribute Vodka to its soldiers (Goodley, 2020).

Unsurprisingly, during the sixties, experimentation with the use of pharmaceuticals became more prolific, reflecting the changes in society at the time. The Vietnam War saw a record number of American soldiers consuming drugs. In 1971, a government report revealed that the U.S. had issued over 225 million tablets of stimulants between 1966 and 1969 (Kamienski, 2017). Additionally, soldiers self-prescribed illicit drugs to cope with the harshness of the battlefield. A report in 1972 found that out of a sample of 942 combatants returning from Vietnam, half had tried opium or heroin, and 1/5th had developed an opioid dependency (Robins et al, 1974).

Nowadays, drug use among fighters remains a reality, particularly in insurgent groups fighting against larger state actors. In 2018, 300,000 Captagon pills were uncovered in an operation against ISIS near the Iraqi border (Goodley, 2020). Furthermore, Al-Qaeda, the Taliban, and terrorist groups in Africa have all reportedly used psychoactive substances to recruit new fighters, promote fearlessness among their soldiers, and induce dependency, particularly with child soldiers (Goodley, 2020).

Using drugs to enhance one’s performance in a sporting event would be considered cheating, but warfare presents a different situation. In a war, performance may represent the difference between life and death for oneself and/or those around. Thus, the ‘survivability’ of a soldier goes beyond the individual, as the soldier also represents society’s values at large while entrusted to protect civilians. Furthermore, the military has different ethical considerations than the civilian core values. The well-being of an individual soldier can be overridden for the success of the mission, the welfare of the unit, or the needs of the state (Mehlman, 2019). Because their primary function is to maintain the security of the state, the subordinate therefore sacrifices personal welfare for the welfare of the nation.

Yet, another core value of the military is to protect their warfighters the best they can. When accepting the authority of military command, the soldier is bound by service law and thus sacrifices part of his agency. However, it also places liability on the commanders to accept a duty of care because they might ultimately choose when to take a life or sacrifice one of their own. Moreover, the governments that deploy such troops have a moral obligation to ensure troops’ preparation and protection. In that respect, the bioethical principles governing military life differ from those in civilian life.

Trauma is an important consequence of war that has drawn interest from the medical profession since the great wars of the twentieth century. Post-traumatic disorders can have devastating consequences on individuals and their surroundings, with symptoms ranging from sleeplessness to depression and potentially suicide. From a military point of view, it also results in a loss of deployable armed personnel and medical services resources. In 2018, the UK spent £220 million to address mental conditions resulting from combat (Ministry of Defence, 2018).

Nowadays, some drugs have the potential to block biochemical processes initiated by catecholamines, namely stress hormones such as adrenaline (Vaiva et al, 2003). Propranolol is one of these drugs, a beta blocker which, when administered during or immediately following a traumatic event, detaches the emotional connections from memories, thus making them less emotionally stressful (Goodley, 2020). In that respect, such neurological drugs could reduce the psychological impact of war and reduce the emotional suffering of soldiers. Ultimately, their impact could be a reduction of the cost of war both in terms of public spending and in terms of lives.

However, the use of these drugs would also have important ethical implications for warfare. The loss of the experience of essential components of conflict, namely violence and memories of violence, would risk turning soldiers into individual’s incapable of recognising the psychological consequences of their actions. Emotions are key components of war and play an important role in learning from events, both on an individual and institutional level. The horrors of war are something that society must not be allowed to forget if conflict is limited. At an individual level, memory loss could counteract the fight or flight instinct, thus leading to greater risk-taking.

The use of pharmacological performance enhancers also places an important question on who is responsible for certain actions. In 2002, a group of Canadian troops conducted a night-time exercise in Afghanistan when two US aircrafts returning to their home base in Kuwait mistook the gunfire for a Taliban attack, dropping a bomb and killing four soldiers. The board of inquiry later defended the pilots who had been on a 10-hour patrol mission, declaring that the amphetamines prescribed by the US Air Force to combat fatigue had impaired their judgement (Mehlman, 2019).

This raises important legal concerns for the use of such drugs. For soldiers to comply with laws during armed conflicts, they must have independent moral agency and be able to judge which actions are proscribed. Anything dissociating rational choice or freedom of choice from soldiers could render them not legally responsible under international criminal law (Goodley, 2020). Therefore, the problems associated with drugs use in the military can have two effects on a soldier’s responsibility: 1) influence mental capacity 2) influence the ability to control one’s behaviour. In both cases, the combatant would not be held responsible. As a result, if the state cannot be held accountable for the actions of its military personnel, its justification for the use of the army would be unethical ad legally undermined (Goodley, 2020).

            The issue of consent is one of the main concerns surrounding performance enhancing drugs. The European Convention on Human Rights and Biomedicine states that a medical procedure “may only be carried out after the person concerned has given free and informed consent to it” (Council of Europe, 1997). However, the scope of consent within the military framework is challenging for several reasons.

            Military personnel are generally not asked their permission when told to do something and cannot refuse a lawful order even if it puts them in danger (Mehlman, 2019). As such, there is a degree of coercion within the chain of command. A decision to not take performance enhancers could have significant effects on a soldier’s career, for instance.

            National security and secrecy also hinder informed consent on behalf of the soldiers. Security classifications can prohibit soldiers from obtaining the right information about what they are ingesting. This was seen during the Gulf War when the UK government, in fear of potential chemical weapons being used, set out to vaccinate soldiers against anthrax, bubonic plague, and other illnesses. Due to the security measurements at the time many soldiers were unaware of what vaccines they were given (Goodley, 2020). Furthermore, many of the prescribed vaccines, such as pyridostigmine bromide and botulinum toxoid vaccines, had not yet been approved for safe use (Mehlman, 2019).

            Another question that arises is if there was mixed consent over the use of these drugs, how would the performance disparities between units be perceived. Depending on the risk factors, some units would bear the burden of these drugs or would have to be compensated, thus leading to other issues around consent when material factors come in. Furthermore, superior performance is usually rewarded by promotions in the army and if enhancements were used the question of reward would have to be answered (Mehlman, 2019).

            A final ethical consideration is the implication of pharmaceutical performance enhancements for wider society. The army does not exist in complete isolation from society, as soldiers are recruited and returned to society after service. Furthermore, some members of the military nowadays, such as reservists, base personnel, and remote operators, such as drone combatants, often live with their families.  Therefore, military enhancement is bound to have an impact on civilian life. If these enhancements improve one’s skills within civil life, then the law could consider this when evaluating risk-taking behaviours. For instance, if a driver has superior vision or quicker reaction times, they could be judged by taking those factors into account if they were to crash.

            Another issue arises if veterans who have used these drugs want to keep taking them after they leave the military, either because they are addicted or enjoy the benefits. Civilians could perceive this as an unfair advantage in society. As such, the debates surrounding performance-enhancing drugs directly influence society, especially considering that military technology often permeates into the civilian world.

            Bio enhancements have the potential to improve service members performances and potentially save lives in some situations. At the same time, there are many ethical and legal concerns around their implementation, notably around voluntary consent. Ultimately, the debate surrounding the use of these drugs in the military influences society. It will be the evolution of social norms that will dictate whether they are used in the future.

Written by Matthias Meheust-Kemp



Bickford, Andrew. Chemical Heroes: Pharmacological Supersoldiers in the US Military. Duke University Press, 2020.

Bickford, Andrew. “From idiophylaxis to inner armor: imagining the self-armoring soldier in the United States military from the 1960s to today.” Comparative Studies in Society and History 60, no. 4 (2018): 810-838.

Council of Europe, ‘European Treaty Series No. 164, Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine’, 1997.

Kamienski, Lukasz. Shooting Up: A history of drugs in warfare. Oxford University Press, 2017.

Goodley, Major Héloïse. (2020), ‘Performance Enhancement and the Military’, Chatham House – International Affairs Think Tank. [online] Available at:

Mehlman, Maxwell. “Bioethics of military performance enhancement.” BMJ Military Health 165, no. 4 (2019): 226-231.

Ministry of Defence, (2018) ‘Defence Secretary shows commitment to Armed Forces mental health with over £220-million funding and new helpline’. [online] Available at:

Ohler, Norman. Blitzed: Drugs in Nazi Germany. Penguin UK, 2016.

Pugh, James. “The Royal Air Force, Bomber Command and the Use of Benzedrine Sulphate: An Examination of Policy and Practice During the Second World War” Journal of Contemporary History 53, no. 4 (2018): 740-761.

Robins, Lee N., Darlene H. Davis, and Donald W. Goodwin. “Drug use by US army enlisted men in Vietnam: A follow-up on their return home.” American Journal of Epidemiology 99, no. 4 (1974): 235-249.

Vaiva, Guillaume, François Ducrocq, Karine Jezequel, Benoit Averland, Philippe Lestavel, Alain Brunet, and Charles R. Marmar. “Immediate treatment with propranolol decreases posttraumatic stress disorder two months after trauma.” Biological psychiatry 54, no. 9 (2003): 947-949.