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Pages 103-132

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From page 103...
... 5 Recommendations for Ethics Principles To begin developing an ethics framework for human activities involving risk and uncertainty, a series of questions needs to be asked to help define the objectives and parameters: What are the risks involved? ; What is their likelihood and magnitude?
From page 104...
... 104 LONG DURATION AND EXPLORATION SPACEFLIGHT health, as elaborated in previous chapters. Other individuals and groups are also potentially affected by the health consequences of these missions, including astronauts' families, astronauts hoping to participate in future missions, and the National Aeronautics and Space Administration (NASA)
From page 105...
... RECOMMENDATIONS FOR ETHICS PRINCIPLES 105 beyond NASA as the primary institution involved in spaceflight to a more general trust in government. NASA's health standards are based on current knowledge of the health risks and are updated as new knowledge becomes available.
From page 106...
... 106 LONG DURATION AND EXPLORATION SPACEFLIGHT This chapter provides a set of ethics principles that can guide the negotiation of each of the three levels of decision making. Each of the principles is relevant to decisions regarding the health standards -- for example, whether a given risk level is acceptable in light of impact on astronaut health, available mitigation strategies, and anticipated benefits from the mission.
From page 107...
... RECOMMENDATIONS FOR ETHICS PRINCIPLES 107 common ground on how best to approach challenging ethical issues in the context of public policy. This was the approach and reasoning used by such landmark commissions as the National Commission for the Protection of Human Subjects in Biomedical and Behavioral research and the principle-based foundation it articulated in The Belmont Report (HEW, 1979)
From page 108...
... 108 LONG DURATION AND EXPLORATION SPACEFLIGHT agreement to participate. Similarly, astronauts bear the risks, some of which are unknown or uncertain, for benefits that may be realized by the government and the general public; their participation is voluntary and based on shared decision making informed by disclosures and best available analyses.
From page 109...
... RECOMMENDATIONS FOR ETHICS PRINCIPLES 109 of avoiding harm to others has a clear place in Western moral philosophy, whether from moral theories based on duties (Kant, 1998) , utility (Mill, 1879)
From page 110...
... 110 LONG DURATION AND EXPLORATION SPACEFLIGHT harm was more likely than not, and that it was reasonable to "use conservative assumptions … risking error on the side of overprotection, rather than underprotection."1 In some cases, such as long duration and exploration spaceflights, there are many unknowns and a great degree of uncertainty regarding the nature and extent of the risks. For those types of missions, there will probably be both "known unknowns" (known risks of unknown extent, i.e., galactic cosmic radiation)
From page 111...
... RECOMMENDATIONS FOR ETHICS PRINCIPLES 111 first time in drug development, drug developers often introduce margins of safety into calculations of the starting dose to account for the possibility that toxicities may have gone undetected in prior animal studies. Second, they often stagger dosing between patients and across cohorts of patients to learn from the experiences and fully inform subsequent research.
From page 112...
... 112 LONG DURATION AND EXPLORATION SPACEFLIGHT and protective gear for firefighters, or limiting the type and duration of risky work for oil rig workers. Focusing on the Principle in the Context of Spaceflight Human spaceflight is undertaken with the knowledge that it exposes others (astronauts)
From page 113...
... RECOMMENDATIONS FOR ETHICS PRINCIPLES 113 (HEW, 1979; Beauchamp and Childress, 2013)
From page 114...
... 114 LONG DURATION AND EXPLORATION SPACEFLIGHT Focusing on the Principle in the Context of Spaceflight Although individual astronauts have personal motivations and may receive benefits to participate in spaceflight, the benefits of human spaceflight, for the most part, accrue to society through technological and scientific advances, as well as to national and international pride and collaboration. NASA is founded on a mission to realize the benefits of space exploration, as noted in its vision statement, "To reach for new heights and reveal the unknown so that what we do and learn will benefit all humankind" (NASA, 2013a)
From page 115...
... RECOMMENDATIONS FOR ETHICS PRINCIPLES 115 that could result in harm to self. For some individual-centered decisions, there are few society-imposed restrictions for avoiding harm.
From page 116...
... 116 LONG DURATION AND EXPLORATION SPACEFLIGHT Activities are unacceptably risky when other safer means are available to accomplish the same objective. For example, a mis sion might be redesigned, more shielding countermeasures ap plied, crew members selected who are less susceptible to risks, and labor/work flows divided to minimize risk exposures.
From page 117...
... RECOMMENDATIONS FOR ETHICS PRINCIPLES 117 For many occupations, such as rescue work, risks are harder to anticipate and quantify. Here, a crucial risk-mitigation strategy involves developing protocols and decision frameworks so that risk-benefit decidecisions can be informed by systematic moral and scientific thinking.
From page 118...
... 118 LONG DURATION AND EXPLORATION SPACEFLIGHT rounding such evidence. In the case of long duration and explo ration space missions, decision makers need to render as explicit as possible not only the risk estimates, but also the nature and value of missions, the viability of alternative and safer strategies for achieving these ends, and why pursuit of those values is suf ficient to redeem the health hazards associated with missions.
From page 119...
... RECOMMENDATIONS FOR ETHICS PRINCIPLES 119 consider, accommodate, and earn the confidence of credible skeptics who might question a particular decision, given their in dividual perspective. RESPECT FOR AUTONOMY The principle of respect for autonomy has been among the most fundamental principles of bioethics since the latter half of the 20th century (HEW, 1979; Faden and Beauchamp, 1986; Tauber, 2005; Beauchamp and Childress, 2013)
From page 120...
... 120 LONG DURATION AND EXPLORATION SPACEFLIGHT risk. Professionally, individuals join the military service or work in emergency situations or in jobs, such as mining, that involve higher than average risks.
From page 121...
... RECOMMENDATIONS FOR ETHICS PRINCIPLES 121 Informational Risks Autonomy is also expressed in the right of individuals to regulate the flow of information about themselves to others. The rights to privacy and confidentiality of health information derive from this principle (HEW, 1979; Faden and Beauchamp, 1986; Moskop et al., 2005; Beauchamp and Childress; 2013)
From page 122...
... 122 LONG DURATION AND EXPLORATION SPACEFLIGHT provided in-depth briefings and opportunities to participate in NASA's risk management processes at many levels. Preparing for future exploration missions will necessitate changes in the current modes and procedures for communications and interactions between crew members and ground control (NASA, 2010)
From page 123...
... RECOMMENDATIONS FOR ETHICS PRINCIPLES 123 and confidentiality of sensitive individual health information are an essential precondition for such activities. Astronauts have the ability to report inflight medical problems via a private medical conference.
From page 124...
... 124 LONG DURATION AND EXPLORATION SPACEFLIGHT In addition, men were unfairly being burdened with the risks of such research (IOM, 1994)
From page 125...
... RECOMMENDATIONS FOR ETHICS PRINCIPLES 125 have arisen specifically about risks of radiation-induced cancers being higher for women (see Chapter 3)
From page 126...
... 126 LONG DURATION AND EXPLORATION SPACEFLIGHT FIDELITY In situations where risks are to some degree unquantifiable, uncertain, and unknowable, and so cannot be well managed in advance, the principle of fidelity has been proposed as a "promise to stand by after" (Zoloth, 2013)
From page 127...
... RECOMMENDATIONS FOR ETHICS PRINCIPLES 127 The nonbinding nature of research participation has been seen as blunting the need to develop a concept of fidelity that imposes binding, affirmative obligations owed by research sponsors and investigators to a consenting research volunteer. Focusing on the Principle in the Context of Spaceflight An astronaut's consent becomes binding and irrevocable at the moment the mission launches.
From page 128...
... 128 LONG DURATION AND EXPLORATION SPACEFLIGHT through approaches to risk prevention and mitigation that in corporate safety margins and include mechanisms for con tinuous learning that allow for incremental approaches to risk acceptance. • Beneficence -- the principle to provide benefit to others.
From page 129...
... RECOMMENDATIONS FOR ETHICS PRINCIPLES 129 for astronauts not only during the mission but after return, in cluding provision of lifetime health care for astronauts. REFERENCES ALI (American Law Institute)
From page 131...
... RECOMMENDATIONS FOR ETHICS PRINCIPLES 131 Shapiro, D

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