Health Standards for Long Duration and Exploration Spaceflight Ethics Principles, Responsibilities, and Decision Framework (2014) / Chapter Skim
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asked the Institute of Medicine (IOM) to develop an ethics framework and to identify principles to guide decision making about health standards for long duration and exploration class missions "when existing health standards cannot be fully met" or adequate standards cannot be developed based on existing evidence (see Box S-1)
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These standards would address potential hazardous exposures and work ing conditions that are uncertain, unknown, or that go beyond current NASA risk limits. NASA is looking, in particular, for a framework of ethical and policy principles that can help guide decision making associated with implementing health standards for exploration class space missions when existing standards cannot be fully met, or the level of knowledge of a given condition is sufficiently limited that an adequate standard cannot be devel oped, for the mission.
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This report provides the committee's recommendations on ethics principles, responsibilities, and a decision framework to guide decisions about the application of health standards to long duration and exploration spaceflights. The recommendations include many components that NASA has considered or is already implementing in its work on health standards for spaceflight.
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The committee found this approach wanting, lacking a clear and compelling justification for why acceptable risks and levels of uncertainty should be greater for long duration and exploration missions than other human spaceflight missions. Having excluded the options of modifying existing standards or creating a separate set of standards, the committee concludes that the only ethically acceptable option that could allow for increased risk exposures in the context of long duration and exploration spaceflights is granting an exception to existing health standards.
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The committee adopted a principle-based approach in recognition of its accessibility and applicability for its task. Recommendation 2: Apply Ethics Principles to Health Standards Development and Implementation NASA should apply the following ethics principles in the devel opment and implementation of its health standards for decisions regarding long duration and exploration spaceflights:
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• Beneficence -- the principle to provide benefit to others. NASA should consider in its decision making the potential benefits of a specific mission, including its scientific and technological importance, as well as its potential beneficiar ies including current and future astronauts and members of society at large.
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Specifically, the ethics principles need to be incorporated into decisions about whether risks in excess of those allowed under current health standards are acceptable and, if so, what conditions must be satisfied to engage in ethically acceptable long duration and exploration class missions. These decisions are further influenced by the limitations imposed by costs, time lines, and technological feasibility.
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AN ETHICS-BASED DECISION FRAMEWORK In assessments of long duration and exploration spaceflights that are unlikely to meet current health standards, NASA can facilitate its planning by structuring decision making in a three-step process (see Box S-2)
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The second decision level (Level 2) is whether a specific, contemplated mission that is unlikely to meet current health standards is ethically acceptable.
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Ethics principles and applications: Avoid harm, beneficence, acceptable risk-benefit balance, fidelity, transparency of decision making, commitment to continuous learning, procedural fairness of decision making Examples of ethics responsibilities: • Ensure that all feasible means will be taken to reduce astronaut risks to the lowest achievable levels • Examine all approaches to minimizing risk including alternate ap proaches to meeting the mission's objectives • Assess and communicate the benefits • Determine and communicate the time urgency to conduct the mission • Thoroughly monitor and conduct research on health impacts dur ing and after spaceflight to inform current and future missions • Commit to the future health of current and future astronauts by ensuring access to health care, longitudinal follow-up, and pre ventive screenings
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Ethics principles and applications: Informed decision making by astro nauts, fairness, avoid harm, risk minimization (including risk to other crew members) , commitment to continuous learning while protecting privacy and confidentiality Examples of ethics responsibilities: • Thorough sharing of risk data with astronauts • Transparent and fair processes and policies on decision making • Astronaut responsibilities to participate in data collection and health monitoring during and after spaceflights to inform current and future crews • Selecting crew members in a manner that ensures fairness among groups and considers risk susceptibilities in general and for individuals in a way that allows inclusion, individual decision making within a range of risk that is prudent for the welfare of all astronauts during the mission
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The ethics framework outlined in this report builds on the work of NASA and others and identifies a set of recommendations for ethically assessing and responding to the challenges associated with health standards for long duration and exploration spaceflight. Establishing and maintaining a firmly grounded ethics framework for this inherently risky activity is essential to guide NASA's decisions today and to create a strong foundation for decisions about future challenges and opportunities.
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