But it's "medical necessity" that takes the debate off into the la-la land of ethics and morality. If someone has asthma, then albuterol or whatever enhances their performance. If someone has MDS, then EPO enhances their performance. If someone has no legs, then prostheses enhance their performance.

There's no Platonic form of a human being that the regulators can point to and say, this person can be medicated until their performance reaches this level and no further - and if there were, then obviously they wouldn't be competitive in their sport, medication or no.

Some of those regulations do exist in insurance and Medicare coverage - it impacted my dad when his hematocrit rose too high for Medicare to cover his EPO. But those limits are around the level of bare survival and possibly ability to carry out ADLs. In an ideal world maybe you'd medicate the sick person to a higher level of wellness. But again ... when it stops being about sport, when we pretend the line is not arbitrary, then where is the line?