Q. AS NASA’S CHIEF BIOETHICIST, WHAT DOES YOUR WORK INVOLVE?
A. I’m an adviser to the chief medical officer for the agency. I don’t make decisions. Instead, I analyze situations and policies and offer bioethical perspectives on specific problems.
NASA does hundreds of research studies. Every astronaut who goes into space is, essentially, a human research subject. NASA’s looking at the effects of weightlessness, of G-forces and radiation on the human body. One of the things I do is look over the research protocols and make sure they are in compliance with earth-bound regulations about informed consent and health and safety. I also try to help solve some of the thorny ethical problems of medical care for astronauts in space.
Q. WHAT WOULD BE AN EXAMPLE OF THAT?
A. According to OSHA regulations, workers — including astronauts — can only be exposed to a limited amount of radiation at their workplace over their lifetime. Humans in space are subjected to much more radiation than anyone on earth would be. So there was this one case where an astronaut was close to the limit of exposure because of space travel, and then he had medical radiation treatments for cancer.
Astronauts want to fly as much as possible. That’s what they do. This one didn’t want the medical radiation to count against the lifetime limit because it hadn’t happened in the workplace. NASA had to weigh the letter of the law against the intent of the law. I said, “Exposure is exposure.” The decision ultimately went that way.
Q. MOST BIOETHICISTS WORK IN HOSPITALS. HOW IS THE NASA JOB DIFFERENT?
A. In an earth-based medical situation, the priority is the health and well-being of the patient. On a spaceship, that has to be balanced with the health and well-being of the other crew members and the success of the mission itself. Ethics in space are more of a balancing act. You need to weigh a series of priorities and figure out which is paramount.Continue reading the main story
Imagine you had a severely injured astronaut on the surface of Mars — or a dead body. American soldiers will put themselves at great risk to retrieve a dead body. On Mars, you have a different situation. You might be endangering the entire mission by trying to retrieve the body. In that case, you might recommend that it be left behind, even if that is against our ethical traditions.
Or what do you do if someone has a psychotic episode while in space?
I’ve written that there has to be medication and restraints on the craft. If you have to restrain the person for a long period of time, you have to do it. You can’t thank the person for their service to the country and put them out into space. You can’t medicate them to insensibility for a year and a half. You have to find a reasonable way to manage the situation.
Q. YOU MENTIONED EARLIER THAT NASA DOES BIOMEDICAL RESEARCH IN SPACE. HOW DO THE ASTRONAUTS FEEL ABOUT BEING RESEARCH SUBJECTS?
A. For the most part, they want to help. There have been some who, in some situations, have refused. They are covered by something called the Common Rule, which includes the right to withdraw from an experiment at any time or to refuse to participate, without penalty — as any human research subject in the United States would be.
Astronauts have refused experiments that interfered with their getting enough sleep while in space — it’s very hard to sleep in microgravity. Others opted out because they were concerned that medical information collected on them couldn’t really be private and might interfere with their getting health insurance after retirement. But on a flight with seven people, if one opts out, you’ve cut your research population significantly. This led an advisory panel to suggest a “modification of the interpretation” of the Common Rule for astronauts.
I thought that the Common Rule was our most basic protection for human research subjects and said it was a mistake to erode it. I recommended that what NASA should do is continue to increase something they’d already started to do — involve the astronauts in every level of the research process. For a reasonable concern like health insurance, I suggested that NASA offer lifetime insurance to the astronauts, which they are trying to now do. It’s a comparatively low-cost way to solve a problem. To this date, there’s been no modification of interpretation of the Common Rule for astronauts.
Q. WHAT WAS THE MOST UNUSUAL QUESTION NASA HAS POSED TO YOU?
A. It wasn’t an ethical question, it was a religious one. My father, the late Gerald Wolpe, was a rabbi, as are two of my brothers. There had been an Israeli on the crew of the Columbia shuttle. After it broke up, NASA wanted to know about Jewish religious standards in regard to gathering and interring remains. NASA teams were recovering pieces of bodies on the ground in Texas and Louisiana, much of it unidentifiable. And NASA wanted to know if the Israeli government would want only Ilan Ramon’s flesh returned to it because, if so, NASA would have to do genotyping of every piece of tissue. That would take months.
I told them there were countervailing values. In Judaism you bury the body as soon as possible. I didn’t think the Israelis would want to have months and months pass.
I’ve since heard that a lot of the tissue buried in the various graves of these astronauts was unidentified. There’s something touching that some of what is buried in each of their resting places is tissue from all of them.
Q. DID YOUR BECOMING A BIOETHICIST HAVE ANYTHING TO DO WITH YOUR FATHER’S WORK?
A. I think so. He was very involved in bioethics, even before it was a recognized field of study. He taught a course about death and dying at a medical school. At a time when there were few dialysis machines for people with kidney disease, he was on a state commission to decide who could get priority access to them. All of that came home in 1986, when my mother had a stroke and he became her primary caregiver. It made the whole family even more aware of the stresses caregivers suffer.
I was in graduate school at the time this happened, studying medical sociology. But I could see that this new field, bioethics, was rapidly developing. It combined everything I loved: medicine, the life sciences and the ethics I’d grown up with. For me, it was the perfect fit.Continue reading the main story