In modern NASA culture, extended spaceflight might as well be science fiction. The no-risk requirement coupled with volumes of employment criteria, rules and regulations were why the Constellation program was going to take far longer to go back to the moon than it took to go there in the first place and there is no serious manned exploration in the works.

Nonetheless, the Institute of Medicine, the health arm of the National Academy of Sciences, would like to get more funding to create a health framework and they even make a recommendation that is positively un-government-like: allow exceptions to existing health standards on a mission-by-mission basis, but they dutifully qualify that any exceptions should be rare and occur only in extenuating circumstances. 

Worries about risk are not in the cultural DNA of most astronauts; they want to get a mission accomplished. NASA is not bogged down by concerns of astronauts, it does not want deaths on television, it does not want political grandstanding by opposing politicians about the hiring practices of some sub-contractor, and it wants funding, so it spends a lot of time preventing any risk at all. 

Their ethics framework is designed to allow at least some risk is based on six principles and related ethics responsibilities. 

For any potential mission, NASA has to consider numerous factors related to mission necessity, health and safety risks for the crew, technological feasibility, financial costs and the possible health risks - vision impairments, bone demineralization, radiation exposure, and impact on behavior. As part of its risk management process to protect the health and safety of astronauts, NASA has adopted standards to provide a healthy and safe environment before, during, and after all flights. The committee stressed that NASA's policies to initiate and revise health standards should reflect the most relevant and up-to-date evidence, but recommended that NASA explicitly indicate how these policies are consistent with the ethics principles described in the report.

"From its inception, space exploration has pushed the boundaries and risked the lives and health of astronauts," said chair of the committee Jeffrey Kahn, Levi Professor of Bioethics and Public Policy, Johns Hopkins Berman Institute of Bioethics, Baltimore. "Determining where those boundaries lie and when to push the limits is complex. NASA will continue to face decisions as technologies improve and longer and farther spaceflights become feasible. Our report builds upon NASA's work and compiles the ethics principles and decision-making framework that should be an integral part of discussions and decisions regarding health standards for long duration and exploration spaceflight."

The committee provided a three-level framework that NASA should follow to make decisions about long duration and exploration spaceflights that are unlikely to meet current health standards. The first decision level requires NASA to decide whether it is acceptable to risk astronaut health and safety for missions that could exceed the health standards. If NASA decides such missions are ethically acceptable, it must then determine the process and criteria for granting exceptions. The second decision level has NASA determine whether a specific mission that is unlikely to meet health standards is ethically acceptable. If a mission is deemed ethically acceptable, the third decision level focuses on the selection of the crew for the mission and an astronaut's decision to participate on that mission.

Within each of the framework's levels are ethics principles that should help guide decisions.

• Avoid harm by preventing harm, exercising caution, and removing or mitigating harms that occur.
• Provide benefits to society.
• Seek a favorable and acceptable balance of risk of harm and potential for benefit.
• Respect autonomy by allowing individual astronauts to make voluntary decisions regarding participation in proposed missions.
• Ensure fair processes and provide equality of opportunity for mission participation and crew selection.
• Recognize fidelity and the individual sacrifices made for the benefit of society, as well as honor societal obligations in return by offering health care and protection for astronauts during a mission and over the course of their lifetimes.

The committee also recommended that NASA recognize a set of ethical responsibilities derived from the above ethics principles when considering the health standards for long duration and exploration spaceflights. Some of the responsibilities include to:

• ensure fully informed decision making by astronauts regarding the risks of long duration and exploration spaceflights;
• solicit independent advice regarding health standards for these missions;
• adhere to a continuous learning strategy so health standards evolve and improve over time;
• communicate with all relevant stakeholders in a procedurally transparent, fair, and timely manner the rationale for, and possible impacts related to, any decision about health standards;
• provide equality of opportunity for participation in long duration and exploration missions;
• require preventive long-term health screening and surveillance of astronauts and lifetime health care; and
• develop and apply policies that protect the privacy and confidentiality of astronaut health data.