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Suggested Citation:"Front Matter." Institute of Medicine. 2014. Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework. Washington, DC: The National Academies Press. doi: 10.17226/18576.
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HEALTH STANDARDS FOR
LONG DURATION AND
EXPLORATION SPACEFLIGHT

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

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework. Washington, DC: The National Academies Press. doi: 10.17226/18576.
×

THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, NW • Washington, DC 20001

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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Copyright 2014 by the National Academy of Sciences. All rights reserved.

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Cover credit: All photos courtesy of the National Aeronautics and Space Administration

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.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework. Washington, DC: The National Academies Press. doi: 10.17226/18576.
×

Knowing is not enough; we must apply.
Willing is not enough; we must do.
”      

                                                —Goethe

image

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework. Washington, DC: The National Academies Press. doi: 10.17226/18576.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination o policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the Nation l Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework. Washington, DC: The National Academies Press. doi: 10.17226/18576.
×

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

IOM Staff

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

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework. Washington, DC: The National Academies Press. doi: 10.17226/18576.
×

Consultants

TRISH LEADER, Technical Writer

VICTORIA WEISFELD, Technical Writer

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework. Washington, DC: The National Academies Press. doi: 10.17226/18576.
×

Reviewers

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

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2014. Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework. Washington, DC: The National Academies Press. doi: 10.17226/18576.
×

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.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework. Washington, DC: The National Academies Press. doi: 10.17226/18576.
×

Preface

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-

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework. Washington, DC: The National Academies Press. doi: 10.17226/18576.
×

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
Exploration Spaceflights

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework. Washington, DC: The National Academies Press. doi: 10.17226/18576.
×

Acknowledgments

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

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework. Washington, DC: The National Academies Press. doi: 10.17226/18576.
×

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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Suggested Citation:"Front Matter." Institute of Medicine. 2014. Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework. Washington, DC: The National Academies Press. doi: 10.17226/18576.
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Suggested Citation:"Front Matter." Institute of Medicine. 2014. Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework. Washington, DC: The National Academies Press. doi: 10.17226/18576.
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Since its inception, the U.S. human spaceflight program has grown from launching a single man into orbit to an ongoing space presence involving numerous crewmembers. As the U.S. space program evolves, propelled in part by increasing international and commercial collaborations, long duration or exploration spaceflights - such as extended stays on the International Space Station or missions to Mars - become more realistic. These types of missions will likely expose crews to levels of known risk that are beyond those allowed by current health standards, as well as to a range of risks that are poorly characterized, uncertain, and perhaps unforeseeable. As the National Aeronautics and Space Administration (NASA) and Congress discuss the next generation of NASA's missions and the U.S. role in international space efforts, it is important to understand the ethical factors that drive decision making about health standards and mission design for NASA activities.

NASA asked the Institute of Medicine to outline the ethics principles and practices that should guide the agency's decision making for future long duration or exploration missions that fail to meet existing health standards. Health Standards for Long Duration and Exploration Spaceflight identifies an ethics framework, which builds on the work of NASA and others, and presents a set of recommendations for ethically assessing and responding to the challenges associated with health standards for long duration and exploration spaceflight.As technologies improve and longer and more distant spaceflight becomes feasible, NASA and its international and commercial partners will continue to face complex decisions about risk acceptability. This report provides a roadmap for ethically assessing and responding to the challenges associated with NASA's health standards for long duration and exploration missions. 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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