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.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON ETHICS PRINCIPLES AND GUIDELINES FOR HEALTH STANDARDS FOR LONG DURATION AND EXPLORATION SPACEFLIGHTS
• Reviewers
• Preface
• Acknowledgments
• Summary
  • HEALTH STANDARDS FOR HUMAN SPACEFLIGHT
  • ETHICS PRINCIPLES
  • ETHICS-BASED RESPONSIBILITIES
  • AN ETHICS-BASED DECISION FRAMEWORK
  • CONCLUDING REMARKS
• 1. Introduction
  • SCOPE OF WORK
  • REPORT STRUCTURE
  • REFERENCES
• 2. NASA Risk Management and Health Standards
  • NASA RISK MANAGEMENT PROCESSES
  • HEALTH STANDARDS
  • SUMMARY AND RECOMMENDATION
  • REFERENCES
• 3. Health Risks
  • MISSION OPERATIONS RISKS
  • VISION IMPAIRMENT
  • BEHAVIORAL HEALTH AND PERFORMANCE RISKS
  • BONE DEMINERALIZATION
  • RADIATION EXPOSURE
  • SUMMARY
  • REFERENCES
• 4. Risk Acceptance and Responsibilities in Human Spaceflight and Terrestrial Activities
  • RISK MANAGEMENT IN THE WORKPLACE
  • RISK MANAGEMENT IN RESEARCH WITH HUMAN PARTICIPANTS
  • RISK MANAGEMENT IN UNFAMILIAR ENVIRONMENTS
  • RISK MANAGEMENT IN HIGH-RISK ACTIVITIES
  • FACTORS AFFECTING DECISION MAKING ABOUT ACCEPTABLE LEVELS OF RISK
  • SUMMARY
  • REFERENCES
• 5. Recommendations for Ethics Principles
  • OVERVIEW
  • AVOIDING HARM
  • PROVIDING BENEFIT
  • FAVORABLE BALANCE OF RISK AND BENEFIT
  • RESPECT FOR AUTONOMY
  • FAIRNESS
  • FIDELITY
  • RECOMMENDATION
  • REFERENCES
• 6. Recommendations for Ethics Responsibilities and Decision Framework
  • ETHICS RESPONSIBILITIES FOR LONG DURATION AND EXPLORATION SPACEFLIGHTS
  • AN ETHICS-BASED DECISION FRAMEWORK
  • CONCLUDING REMARKS
  • REFERENCES
• APPENDIXES
  • A Meeting Agendas
  • B Committee Biographical Sketches

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.

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.

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.