Instructor Notes — Chapter 43

Enhancement Outside the Clinic: Work, Sport, Military, and the Coercion Question Part VIII · intermediate · prerequisites: Chapters 14, 16, 19

What this chapter is actually teaching

On the surface it teaches an ethics debate. It is not primarily an ethics chapter, and teaching it as one produces a bad session.

The chapter's real subject is how to disassemble an argument into its factual and evaluative parts. Enhancement is the vehicle because it is the place in this book where the two are most thoroughly tangled and where students arrive with the most pre-formed positions. A student who leaves with a firmer opinion about enhancement and no new skill has not learned the chapter. A student who leaves saying "I still think what I thought, but I can now tell you which parts of that are facts and which are values, and which fact would change my mind" has learned it completely.

Three consequences for teaching.

Do not disclose your own position. The chapter deliberately does not, three separate times, and the moment an instructor does, half the room starts arguing with the instructor rather than with the structure. If asked directly, the honest and useful answer is: "I have one, and I am not going to give it to you, for the same reason the chapter doesn't."

Refuse the prevalence question. Someone will ask how many people are actually doing this. The answer for peptides is that nobody knows, and §43.2 says so explicitly. Sit in that answer rather than filling it — modeling the refusal is more valuable than any figure would be, and it is a compressed version of the whole book's method.

Enforce the naming rule from the first minute. No individuals, athletes, employers, or companies, in discussion or in written work. Students will want to reach for a famous case. The rule is not squeamishness: famous cases are systematically unrepresentative, and arguments built on them generalize badly. Say that out loud once and enforce it thereafter without further explanation.

Where students actually get stuck

They collapse the coercion argument into peer pressure. This is the single most common failure and it is diagnosable: students who describe step 4 without step 3 have done it. Peer pressure is about social influence; the coercion structure is about arithmetic. Step 3 — where non-adopters decline in standing without doing anything and without anyone acting on them — is the whole difference. Test for it explicitly.

They think ❌ means "doesn't work." It survives from earlier chapters and resurfaces here because the rating is unwelcome. Rehearse rule 2 before discussing §43.3.

They want the chapter to take a side, and read the refusal as evasion. The productive reframe: the book does take sides — on four empirical claims, with reasons and falsifiers. What it declines is the values question, and declining it is a substantive position rather than an absence of one.

Students with athletic or competitive backgrounds often arrive certain that these compounds work. Handle this with care and with evidence rather than authority. The 🔬 callout in §43.7 is the tool: the finding is not that nothing happened, it is that something visible happened and function did not change. That framing is much easier to accept than "it doesn't work," and it is also more accurate.

Students in clinical programs sometimes resist §43.1's four-element framing as idealized. They are right, and exercise Z is built for them. The reply is that a degraded version of a thing is still categorically different from its absence.

Session shapes

Single 90-minute session. §43.1 (15 min, build the four-element inventory on the board with the class rather than presenting it) → §43.5 (35 min, the five steps, then the weak/strong grid applied to settings students name) → §43.6 (25 min, structured disagreement, see below) → §43.9 (15 min, conditions, ending on condition 3).

Two sessions. Session 1: §43.1–§43.5 plus case study 2. Session 2: §43.6–§43.9 plus case study 1 and the dossier exercise. This is the better shape if you have it; the coercion structure deserves a full session and rushing it to reach the policy argument inverts the chapter's priorities.

The §43.6 exercise that works best. Assign the level-playing-field position and its opposition to halves of the room at random, and require each side to state the other side's position to that side's satisfaction before arguing its own. Then — this is the part that does the teaching — ask both sides to identify which of their own premises were empirical. Most students discover their assigned position rested on empirical claims they had not noticed and could not defend.

A five-minute exercise with unusually high yield. Have every student write, privately, one sentence answering: what would change my mind about enhancement? Collect anonymously and read a sample aloud. A substantial fraction will write something that is not an observation — "if it were safe" without a threshold, or nothing at all. That is the lesson, and it lands harder from their own words than from anything you could say.

Assessment guidance

Full guidance is in _scratch/answers/ch43.md. In brief: exercises publish no answers by design; the ethics items (AC–AG) are graded on reasoning quality, and the shared rubric is (i) opposing view stated at its strongest, (ii) facts separated from values, (iii) cost of one's own conclusion named, (iv) naming rule observed. Item AG is graded on the unanswered objection, not the proposal. Item AF is a fail if the student has the clinician supply protocol guidance.

For written work, the highest-value single instruction is the one in further-reading.md: require students to mark each sentence of their own position as a factual or a value claim.