Safe Passage Astronaut Care for Exploration Missions (2001) / Chapter Skim
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Pages 173-188
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From page 173... ...
Longduration missions beyond Earth orbit, space colony habitation, or interplanetary travel will create special circumstances for which ethical standards developed for terrestrial medical care and research may be inadequate for astronauts. These ethical standards may require reevaluation.
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From page 174... ...
They fear that abnormal preflight medical test results, disclosure of an illness during a space mission, or even evidence of common responses to space travel such as prolonged space motion sickness may be used to disqualify the astronaut from subsequent missions. During its conversations with physician-astronauts in Woods Hole, Massachusetts (see Appendix A)
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From page 175... ...
. ton space missions.
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From page 176... ...
At NASA, medical information that is not part of a defined research protocol has been regarded as confidential, to be known only to the astronaut's flight surgeon and the astronaut. This strict stance on privacy also applies to data collected for the Longitudinal Study of Astronaut Health and to all medical information about current astronauts and astronauts in training (Pool, 20001.
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From page 177... ...
vration space missions, the ethical concerns almost astronaut privacy must Ise appropriately modified. 177 An unfortunate side effect of the overemphasis on individual astronaut privacy may be that future astronauts will be required to undergo observation and experimental investigations that would have been unnecessary if data from past space missions were available and had been analyzed.
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From page 178... ...
The degree of monitoring and the breadth of data gathering should be proportional to the newness of the work environment; more monitoring, and thus less privacy, would be more appropriate in the first 5 plants than in the 20th plant. Individual astronauts traveling beyond Earth orbit for the first time are quite similar to those workers in early nuclear power plants; there are known and unknown risks to long-duration space missions, and there is a need to create a safe workplace for astronauts on current and future missions.
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From page 179... ...
Third, the opportunity to travel in space is highly desired by those in the astronaut corps. Although long-duration space missions will involve substantial hazards, there are likely to be many who will gladly accept the risk in exchange for the unique opportunity to leave the bounds of Earth's orbit.
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From page 180... ...
These complicated and multiple roles require rethinking the usual boundaries of medical confidentiality. ETHICAL ISSUES IN THE ASTRONAUT-FLIGHT SURGEON RELATIONSHIP Astronauts and flight surgeons often have divergent opinions regarding the boundaries and norms of the doctor-patient relationship in the context of space missions.
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From page 181... ...
This sort of routine collection of medical data would be part of good preventive health care on any long-duration mission on the ISS or in future missions beyond Earth orbit. Planned analysis of various physical and psychological factors, as well as routine testing to measure the ongoing medical and psychological stresses of space travel, would be required.
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From page 182... ...
Their situation is quite unlike that of either the healthy or the sick participants in clinical research in typical settings on Earth (Levine, 19861. In particular, the research review process must recognize the unique pressure on astronauts to overcome any obstacle to participating in space travel.
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From page 183... ...
Astronauts are reluctant to reveal medical incidents or complaints and to report symptoms during space missions for fear that any physiological variation, however small, may jeopardize their chances of future space travel. If this is the case, astronauts could be expected to sign clinical research consent forms out of the same reluctance, regardless of the official policy.
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From page 184... ...
In such cases, participation in the protocols should be required of all astronauts. The second category would include protocols that examine procedures, methods, devices, and so forth that are not likely to be needed during longduration space travel but that are of value for the testing of early phases of experimental countermeasures or hypotheses about clinical care for the general population on Earth (Box 6-41.
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From page 185... ...
It is only particular types of protocols low-risk protocols designed specifically to create a safer space travel environmentto which the pressures related to crew selection can legitimately be applied. If such a two-category system of astronaut clinical research and data collection protocols is adopted, a new clinical research review process for space medicine will have to be developed with greatly increased and active participation from the astronaut corps.
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From page 186... ...
will support a category system of astronaut clinical research with the presence of full and honest informed consent. ETHICAL ISSUES AND THE SPECIAL CIRCUMSTANCES OF INTERNATIONAL CREWS The international nature of the ISS presents additional concerns regarding the ethical boundaries of privacy and research.
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From page 187... ...
· NASA should develop new rules for human research participant protection that address mission selection, the limited opportunities for research on human health in microgravity, and the unique risks and benefits of travel beyond Earth orbit. · A new interpretation or middle ground in the application of the Common Rule (45 C.F.R., Part 46, Subpart A)
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From page 188... ...
Artist's rendition of the fully assembled International Space Station Alpha. The pressurized volume of the station following a 5-year, 45-mission sequence of assembly will be roughly equivalent to the space inside two Boeing 747 jet airplanes.
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