HEALTH STANDARDS FOR
LONG DURATION AND
Ethics Principles, Responsibilities,
and Decision Framework
Committee on Ethics Principles and Guidelines for Health
Standards for Long Duration and Exploration Spaceflights
Board on Health Sciences Policy
Jeffrey Kahn, Catharyn T. Liverman,
and Margaret A. McCoy, Editors
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This project was supported by Contract NNH13CK14D between the National Academy of Sciences and the National Aeronautics and Space Administration. The views presented in this publication are those of the editors and attributing authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
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Suggested citation: IOM (Institute of Medicine). 2014. Health standards for long duration and exploration spaceflight: Ethics principles, responsibilities, and decision framework. Washington, DC: The National Academies Press.
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OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
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COMMITTEE ON ETHICS PRINCIPLES AND GUIDELINES FOR HEALTH STANDARDS FOR LONG DURATION AND EXPLORATION SPACEFLIGHTS
JEFFREY KAHN (Chair), Johns Hopkins University, Berman Institute of Bioethics, Baltimore, MD
NANCY CONRAD, The Conrad Foundation, Washington, DC
PETER F. DEMITRY, 4-D Enterprises, LLC, Haymarket, VA
BONNIE J. DUNBAR, University of Houston, TX
BARBARA J. EVANS, University of Houston Law Center, TX
BERNARD A. HARRIS, JR., Vesalius Ventures, Houston, TX
DAVID G. HOEL, Medical University of South Carolina
JONATHAN KIMMELMAN, McGill University, Montreal, Canada
ANNA C. MASTROIANNI, University of Washington School of Law, Seattle
LAWRENCE PALINKAS, University of Southern California
CAROL E. H. SCOTT-CONNER, University of Iowa Hospitals & Clinics
MICHAEL A. SILVERSTEIN, University of Washington School of Public Health
RONALD E. TURNER, ANSER (Analytic Services, Inc.), Falls Church, VA
R. LEONARD VANCE, Virginia Commonwealth University, Richmond
GREGORY R. WAGNER, National Institute for Occupational Safety and Health, Washington, DC
CATHARYN T. LIVERMAN, Co-Study Director
MARGARET A. MCCOY, Co-Study Director
SARAH DOMNITZ, Associate Program Officer (since December 2013)
CLAIRE F. GIAMMARIA, Research Associate
JUDITH L. ESTEP, Program Associate
ASHNA KIBRIA, Research Associate (since December 2013)
R. BRIAN WOODBURY, Senior Program Assistant (since December 2013)
ANDREW M. POPE, Director, Board on Health Sciences Policy
TRISH LEADER, Technical Writer
VICTORIA WEISFELD, Technical Writer
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
John R. Ball, American College of Physicians
Thomas F. Budinger, University of California, Berkeley
Naomi L. Gerber, George Mason University
Sven Ove Hansson, Royal Institute of Technology
Mae C. Jemison, BioSentient Corporation
Gloria Leon, University of Minnesota
Melissa A. McDiarmid, University of Maryland School of Medicine
Walter Schimmerling, East Carolina University
David H. Wegman, University of Massachusetts at Lowell
Laurie Zoloth, Northwestern University
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the report before its release. The review of this report was overseen by James F. Childress, University of Virginia, and Steve Fienberg, Harvard University. Appointed by the Institute of Medicine, they were responsible for
making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
The prospect of long duration and exploration human spaceflight poses many significant challenges, not the least of which are the ethical issues raised by exposing astronauts to environments with uncertain and even unknown risks to their health, and excessive levels of known health risks. As a federally funded institution, National Aeronautics and Space Administration (NASA) recognizes that undertaking missions with such great risk and high levels of uncertainty raises challenges for decision making related to the health and safety of astronauts. In response to these concerns, the Institute of Medicine (IOM) convened a group with interdisciplinary expertise and a range of backgrounds to analyze the ethical issues faced when existing health standards will be exceeded or when health risks are uncertain or unknown.
This report represents the collective conclusions and recommendations of a diverse group of experts, each of whom brought their expertise and perspectives. The charge to the committee was clear. However it did not lend itself to the typical approach of collection of data, but instead largely relied on conceptual considerations and analysis. The resulting recommendations take the form of a collection of ethics principles and a framework for their application when faced with decisions about exceeding existing health standards or when standards do not exist. In recommending this collection of principles, the committee sought to identify and articulate the relevant moral rules that must be followed in the context of health standards for long duration and exploration spaceflight. The committee’s considerations were informed by information from NASA, input from a range of stakeholders, and presentations from invited experts at public workshops. These principles and decision-making framework are not a checklist or recipe, but rather are intended to pro-
vide the parameters that must be satisfied for ethically acceptable health standards in these contexts. We hope they perform that function as NASA plans for future space exploration.
This report benefitted immensely from the dedicated, diligent, and skilled work of the IOM staff, including Meg McCoy, Cathy Liverman, Claire Giammaria, and Judy Estep; the committee gratefully acknowledges their tireless efforts.
Lastly, I want to thank my colleagues on the committee for their hard work and unflagging patience as we considered, and often reconsidered the ethical issues and challenges relevant to health standards for long duration and exploration spaceflight. It was a privilege to work with such a dedicated and insightful group.
Jeffrey Kahn, Chair
Committee on Ethics Principles and Guidelines
for Health Standards for Long Duration and
The Institute of Medicine (IOM) Committee on Ethics Principles and Guidelines for Health Standards for Long Duration and Exploration Spaceflights would like to express its sincere gratitude to everyone who made this report possible. This report was informed by the contributions of many individuals who provided expertise, personal insights and perspectives, and data.
First, the committee would like to thank National Aeronautics and Space Administration (NASA) for its support of the study. The committee especially appreciates the leadership of Richard Williams, Chief Health and Medical Officer, NASA, who was instrumental in the development of this study and in leading the responses to a number of committee requests for information throughout the study. The committee appreciates input and assistance from many other current and former NASA staff members, including John Allen, Francis Cucinotta, Jeff Davis, Homayoon Dezfuli, Donna Good, Michael Griffin, David Liskowsky, Vincent Michaud, Victor Schneider, Marc Shepanek, Ed Simones, and Paul Wolpe. The insights gained from the NASA Astronaut Office, particularly from Michael Barratt, Robert Behnken, Shannon Walker, and Peggy Whitson, provided important context for the committee’s work. The thorough and considered input provided to all of the committee’s queries was much appreciated.
The committee held two public workshops in May and July 2013 and gained valuable insights from the substantive presentations provided by the speakers (see Appendix A) and participants.
The committee greatly benefited from the work of the IOM study staff team: Cathy Liverman and Meg McCoy co-directed the study; Claire Giammaria provided research support; and Judy Estep skillfully
managed all logistical and administrative aspects of the study. Our thanks to Andrew Pope for his leadership. Additionally, Sarah Domnitz, Ashna Kibria, and Brian Woodbury were instrumental in finalizing the report.
The committee is also grateful to Trish Leader and Vicki Weisfeld of NEW Associates, LLC, for their assistance in editing the report and to Laura Penny for copyediting the report.
Finally, the committee would like to express its thanks to the IOM and the National Research Council staff members who worked behind the scenes to ensure a seamless study process and successful production and dissemination of this report: Anton Bandy, Clyde Behney, Daniel Bethea, Laura DeStefano, Chelsea Frakes, Molly Galvin, Janice Mehler, Donna Randall, Lora Taylor, Erika Vijh, and Jennifer Walsh.
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