Ethical Aspects of Radiological Protection Jacques LOCHARD ViceChair

Ethical Aspects of Radiological Protection Jacques LOCHARD Vice-Chair of ICRP Phoenix Leader Education Program International Symposium Hiroshima, Japan 15 -16 February 2014 This presentation has neither been approved nor endorsed by ICRP

Science and ethics in radiological protection - A tradition - "Radiation protection is not only a matter for science. It is a problem of philosophy, and morality, and the utmost wisdom. ” Lauriston S. Taylor (1902 – 2004) The Philosophy Underlying Radiation Protection Am. J. Roent. Vol. 77, N° 5, 914 -919, 1957 From address on 7 Nov. 1956 2

Wisdom • A basic definition of wisdom is the judicious application of knowledge • As a virtue wisdom is the disposition to perform actions with the highest degree of adequacy under any given circumstances • In its popular sense, wisdom is attributed to a person who takes reasonable decisions 3

The three pillars of the system of radiological protection Science Values System of radiological protection Experience General Recommendations Publication 103, 2007 4

The aims of the system of radiological protection “… to contribute to an appropriate level of protection against the detrimental effects of ionising radiation exposure without unduly limiting the benefits associated with the use of radiation. ” ICRP 103, § 26 “… to manage and control exposures to ionizing radiation so that deterministic effects are prevented, and the risks of stochastic effects are reduced to the extent reasonably achievable. ” ICRP 103, § 29 5

The scientific basis of the system of radiological protection Epidemiology Radiobiology Risk coefficients Detriment Value judgements Anatomy Physiology Metrology Dose equivalent System of radiological protection Effective dose 6

A key value judgement: prudence � « It is prudent to take uncertainties in the current estimates of thresholds for deterministic effects into account… Consequently, annual doses rising towards 100 m. Sv will almost always justify the introduction of protective actions » . ICRP 103, § 35 � « At radiation doses below around 100 m. Sv in a year, the increase in the incidence of stochastic effects is assumed by the Commission to occur with a small probability and in proportion to the increase in radiation dose… The Commission considers that the LNT model remains a prudent basis for radiological protection at low doses and low dose rates. » ICRP 103, § 36 � «There continues to be no direct evidence that exposure of parents to radiation leads to excess heritable disease in offspring. However, the Commission judges that there is compelling evidence that radiation causes heritable effects in experimental animals. Therefore, the Commission prudently continues to include the risk of heritable effects in its system of radiological protection. » ICRP 103, § 74 7

Prudence • Long tradition in ethics: Aristotle, Buddhist tradition, Confucianism, the ancient people of Oceania and America • Prudence is a virtue: how to behave without the full knowledge of the consequences of our actions? = virtue ethics • The object of prudence is the contingent i. e. what can happen or not happen, what is occasional, accidental, uncertain • Prudence is the virtue of deliberation, judgement and making choices: the disposition to choose and act on what is in our power to do and not to do = relationship to action 8

The prevention of deterministic effects Probability of occurrence of an effect 1 Limit Application of prudence Threshold Dose level Safety margin 9

The management of stochastic effects � The main implications of adopting a prudent attitude with regard stochastic effects i. e. the LNT model, are that: � Being exposed is justified only if there is a benefit in return � The exposures must be kept as low as reasonably achievable � Remark : maintaining exposures below a limit is not a guarantee of absence of risk 10

The management of stochastic effects Probability of occurrence of an effect Application of prudence Statistical evidence Extrapolation Dose level 11

The principles of radiological protection � The principle of justification. Any decision that alters the radiation exposure situation should do more good than harm � The principle of optimisation of protection. All exposures should be kept as low as reasonably achievable, taking into account economic and societal factors with restrictions on individual exposure to limit inequities in the dose distribution � The principle of application of dose limits. The total dose to any individual from regulated sources other than medical exposure of patients should not exceed the appropriate limits recommended by the Commission 12

Justification: « do more good than harm » � « This means that, by introducing a new radiation source, or by reducing existing exposure…, one should achieve sufficient individual or societal benefit to offset the detriment it causes. » ICRP 103, § 203 � « … the responsibility for judging the justification usually falls on governments or national authorities to ensure an overall benefit in the broadest sense to society and thus not necessarily to each individual. » ICRP 103, § 208 � The duty to do more good than harm through public actions because, in practice, no action will have exclusively beneficial effects, is called in ethics beneficence or principle of utility 13

Beneficence � Beneficence means «the doing of good » i. e. to act for the benefit of others � Beneficence as an ethical requirement means: do no harm, maximize benefits and minimize harms � Beneficence is strongly tied to the utilitarian theory of ethics. � Beneficence concerns human welfare with the objective to reduce the harms and optimise the benefit of social practices Remark: beneficence is one of the 4 basic ethical principles used in health care decision-making 14

Optimisation: « keep exposures as low as reasonably achievable » � «The optimisation of protection is a forward-looking iterative process aimed at preventing exposures before they occur. It is continuous, taking into account both technical and socioeconomic developments, and requires both qualitative and quantitative judgments… Optimisation is a frame of mind, always questioning whether the best has been done in the prevailing circumstances. » ICRP 101 b, § 27 � Reasonable: 1. having sound judgement; fair and sensible: 2. as much as is appropriate or fair; moderate. Oxford dictionary � Reasonableness is closely related to prudence 15

Restriction and limitation : «to limit inequities between individual exposures and unacceptable risks» � “The benefits and detriments are unlikely to be distributed through society in the same way. Optimisation of protection may thus introduce a substantial inequity between one individual and another. This inequity can be limited by incorporating source-related restrictions on individual dose into the process of optimization. ” ICRP 103, § 232 � “Dose limits are aimed at ensuring that no individual is exposed to radiation risks that are judged to be unacceptable in any normal circumstances. ” ICRP 60, § 112 � Dose limits are boundaries to prevent excessive individual risk 16

Equity and justice � The word 'equity' means to do something fairly � Inequity = injustice, unfairness, lack of equity � Equity is about social fairness and justice � Equity refers to the fair distribution of advantages and disadvantages within a society i. e. how burdens and benefits, goods, services, jobs and salaries, but also risks are distributed � Equity is related to the ethical concept of distributive justice 17

Stakeholder engagement � In its most recent Recommendations (2007) ICRP mentions, for the first time, “the need to account for the views and concerns of stakeholders when optimising protection” (Pub 103, Editorial) � Why to engage stakeholders? • To take into account more effectively their concerns and expectations and the specificity of the context at stake • To promote their empowerment and autonomy • To maintain their vigilance • To adopt more effective and fairer protection actions 18

Dignity � Dignity is an attribute of the human condition : idea that something is due to the human being because she/he is human. This means that every individual deserves unconditional respect, whatever her/his age, sex, health, social condition, ethnic origin and religion � Dignity of individuals is the corollary of autonomy: idea that individuals have the capacity to act freely and morally. Autonomy implies: � Freedom: the absence of constraint � The capacity to deliberate, decide and act � Dignity means to treat individuals as subjects and not as objects 19

How the system is promoting dignity ? � Right to know � Self-help protection � Practical radiation protection culture 20

The right to know principle � Right to know is related to the hazards an individual is exposed to, the harm they might cause, and the precautions that could prevent these harmful effects in order to allow her/him to act based upon a clear appreciation and understanding of the facts, implications, and future consequences of her/his action � In other words, right to know refers to the type of information that affected persons should receive to make informed and effective decisions � Right to know corresponds to practical knowledge allowing the person to make an accurate representation of reality and to act wisely � The right to know principle in the field of radiation protection is closely related to the access to radiation protection culture 21

Self-help protection • Self-help protection is the capacity of individuals facing a risk to protect themselves • This include activities that improve awareness, develop competence and interpersonal relationships, and enhance quality of life • Self-help protection considers the extent to which the affected persons can implement protection actions and their degree of control or choice over the situation : it promotes the accountability of individuals • Voluntary actions carried out by affected individuals themselves are deemed positive as they respect the fundamental values of autonomy and dignity 22

Radiation protection culture • Definition: The knowledge and skills enabling citizens to make choices and behave wisely in situations involving potential or actual exposure to ionizing radiation • Practical radiation protection culture allow people: • • To interpret results of measurements • • To bring elements to make decisions and take actions To orient themselves in relation to radioactivity in everyday life To assess the effectiveness of the protective actions they implement themselves 23

Summary � The system of radiological protection is based on the following ethical values: � Benevolence : to do more good than harm � Prudence : to keep exposure as low as reasonably achievable � Justice: to reduce inequities in the dose distribution � Dignity: to involve stakeholders 24

Confucius Aristotle 25

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