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Submitted by Bernd Lorenz, ENISS
   Commenting on behalf of the organisation
Document Ethical Foundations of the System of Radiological Protection
 



General Remarks

1.The focus of the document


Regarding ethics in general, there are a large number of ethical principles and it would be good to explain why ICRP had chosen the ones described in the document. Ethical principles are often contradictory. So one can find a number of ethical principles that do not support the ICRP RP System as it is now. The methodology and the structure of the document show that the ethical values have been selected to adjust to the RP principles and not the other way around. To us, in order to be rigorous, first the ethical values should be established and then the current RP principles should be discussed to check as to whether they match those values.


The document fails to explain adequately how and why the final list of ethical values has been selected. The question remains open as to why other ethical values such Autonomy (included in Bioethics), Responsibility or Solidarity have not been included.


In the case of the beneficence and non-maleficence value, some reference should be made (for medical application) to, for instance,  “rigorous and constantly updated theoretical and practical training to engage in professional practice, research on new treatments, procedures or therapies, to improve existing ones in order to make them less painful and harmful to patients”.


In chapter 2 there is an historical review of how the RP system has evolved. Although interesting and educational, there seems to be a contradiction between the title and the scope, as it is stated in chapter 1.2, line 442. The focus ought to be on the ethical values/theories followed by a deeper analysis of how the RP system agrees with these values/theories, otherwise discrepancies will arise. It is suggested to remove chapter 2 and include it as an appendix. The introduction should be changed accordingly. It should be noted that the history of the ICRP is well documented in ICRP 109 “The History of ICRP and the Evolution of its Policies”, even with regard to the underlying ethics. The document on Ethics is not as precise and comprehensive in this respect.


 2. Target audience, purpose and how to use it


One of the first questions that arise is the question about the target audience. In chapter 1.2 of the document it is written:


“(9) Although primarily addressed to the radiological protection community, this publication is also intended to address authorities, operators, workers, medical professionals, patients, the public and its representatives acting in the interest of the protection of people and the environment.”


This document is certainly of interest for people with an interest in philosophy. What it does not provide is an incentive for people who are engaged in doing radiation protection every day to read it. It is hard to imagine that workers will read this document. In addition, the document does not guide workers to a better understanding of their daily work. The document is simply too sophisticated for practitioners, but perhaps not sophisticated enough from a philosophical standpoint. The document should clearly state to whom the report is addressed, a practitioner or a person with a high education in philosophical matters.


“This publication aims to emphasise how the Commission has used ethical values in developing the system of radiological protection.”


 It is generally understood that radiation protection is not pure science or engineering and is influenced by judgement taking into account societal values and aspects. In ICRP 109 the reader will already find the explanation of the ethical shift from virtue ethics before WWII to a utilitarian ethics, maximizing the benefit for society in the 1970s and finally to a deontological ethics aiming at the best for an individual nowadays.


What ICRP 109 has done to a certain extent but what the new document on ethics only sparsely does is to explain the rationale behind these shifts. By putting the emphasis on the rights and fair treatment of an individual egoism may be fostered which may hinder the wellbeing of society and other individuals too. So in reality the RP system should be based on a mixture of both ethical principles: the utilitarian and the deontological one.


“(8) A particular objective of this publication is to outline to society, what it can reasonably expect from radiological protection. In so doing it helps to clarify the inherent value judgements made in achieving the aim of the system of radiological protection as underlined by the Commission in its Publication 103 (ICRP, 2007a), and broadly facilitates the decision-making process and communication on radiation risk.”


This objective is according to our opinion not achieved. There are several parts that do not apply to the full radiation protection spectrum but may well be valid for certain fields. This should be presented in a clearer way. There is no unique radiation protection for all situations and applications of radiation.


 3. Environmental protection


The document includes environmental protection but it is difficult, not to say impossible, to impose the same ethics on the environment as those for human beings.


The inclusion of “protection of the environment” is important in a report on ethical foundations of the RP system, but it seems as if it is not entirely thought through. The ethics for the environment (non-human biota) would probably not be the same as for mankind.


There could be two alternatives for improvement, either rewrite relevant sections/text or delete the sections/text on the protection of the environment and publish a new report solely addressing this complex issue.


 Some notes:


a.         Biota, environment and non-human biota are not defined or consistently used. Sometimes it seems that people are included in the concept of environmental protection and sometimes not.


b.         The ICRP approach for the protection of the environment is an assessment of radiological impact on biota (RAPs) but by using this approach, can biodiversity or sustainability (mostly important in the protection of the environment in general) be preserved and improved? How relevant are the selected (imaginary entities) RAPs for “protecting the environment in a distant future” for e.g. high level waste repositories?


c.         Does prudence have the same meaning in the protection of the environment as in the protection of human, considering the differences in the knowledge base of the two?


d.         In case of emergency there may be conflicts during decision making by RP authorities between the protection of humans and protection of the environment including the RAPs, and in this case priority will be given to the protection of humans. Is that ethically correct in view of environmental justice?


 4. Stakeholder involvement


Stakeholder involvement should be applied in a graded approach depending on the circumstances, in particular for large projects. This does not appear in the document. The principle of stakeholder involvement cannot be applied to all the different fields of using ionizing radiation. Many of the statements are only reasonable for special fields such as disposal facilities or Nuclear Power Plants but do not fit into the more simple applications of radiation such as X-ray units or sealed sources used in e.g. gauges. Radiation protection is always special and dependent on the concrete use of radiation. General statements on e.g. stakeholder involvement are generally misleading. Moreover competence in the field is needed, which is gradually fading away.


Most of the controlled use of radiation happens in X-Ray diagnosis and the majority of occupationally exposed people are working there. We have not heard any example about stakeholder involvement in this field. When talking about stakeholder involvement it needs to be made clear in which context advice is given.


Stakeholder involvement in the decision making process of certain major projects is crucial to be able to take concern and expectations into account as it is pointed out in the publication. But it is not unproblematic. To inform and educate all relevant stakeholders (risk communication remains an unsolved problem) and to include stakeholders in the decision making process are two separate things. The ultimate responsibility of protection actions lies within the operating organization or relevant authority. It seems that by reading the text about stakeholder involvement, it is only for the benefit of the stakeholder. But this would be a wrong understanding.


 Reasonable stakeholder involvement in the localisation process of high level waste disposal could be an example that would help elucidate this matter.


In addition, decision making also includes responsibility and this complexity should be better clarified in the publication.


 5. Empowerment of individuals


The empowerment of individuals to make their own informed decisions also needs to have a context. Workers are informed about their work in a radiation field but the basic message is that they are safe when they follow the working rules. They are not allowed to make their own decisions about radiation protection. On the other hand workers are taught to practise radiation or safety culture in their work and they are asked to live the optimization in their daily work. This allows for a certain margin of own decisions. But it has to be in the overall framework of the integrated management system of the company. If somebody wants to make changes, he cannot undertake the changes himself, he must follow the establish process. This situation is not correctly presented in the document and gives the false impression that individuals can do what they want.


The deontological principle is not appropriate for an enterprise where the utilitarian ethics is dominating. Otherwise success of an enterprise in its activities would not be possible. “Preserving the autonomy and dignity of the individuals potentially or actually exposed to radiation”, as stated in the Main Points, may be completely misunderstood by the individuals. In a context of an enterprise discipline and strict observation of rules and procedures are the ruling principles.


 6. Inequity


To avoid inequity in dose distribution is an unnecessary additional requirement as the equity is guaranteed by the dose limits which are valid for all, irrespective of age or sex. This was acknowledged in a former version of the ethics document (lines 376-377) about limitation: “The purpose is to ensure an acceptable degree of equity of protection.” However it was deleted and is no longer in the document. It should be reintroduced.


 


Regarding Definitions


Autonomy: nobody in real life can act freely. There are always restrictions given by society as long as an individual is part of the society.


Beneficence: to increase the benefits for individuals, communities and the environment. This may be impossible at the same time, and perhaps rather seldom to achieve. A benefit for individuals may be negative for the communities or the environment. There need to be a clear emphasis to what has priority, individual vs. society, environment vs human beings etc.


Equity: fair distribution of risks and benefits of radiation exposure: this is guaranteed by limitation.


Inclusiveness: ensuring that all those concerned… participating in decision-making: this may give the impression to stakeholders that they decide. But this would be a completely wrong understanding of stakeholder involvement. The decision lies in the hands of those responsible.


Non-maleficence: delete “and the environment”.


Reasonableness: delete “that respect other views, goals, and conflicting interests”. It is by far not reasonable to respect conflicting interests as long as they have their origin in e.g. society hostile attitudes (see demonstrations against Castor-Transports).


Transparency: delete “and honesty” as unnecessary attribute.


Value judgement: delete “subjective”. It is the set of values and priorities that is subjective, not the assessment.


 


Some further remarks


Line 418: The interest is not recent. It has always been a part of radiation protection. A famous quotation of L.S. Taylor may prove this: “Radiation protection is not only a matter of science. It is a problem of philosophy, and morality, and the utmost wisdom.” This was 1956. There may be some doubts about the content of (4).


Line 437 (6): In this paragraph it is stated that “the ethical values associated with the ICRP system of radiological protection for occupational, public and medical exposures, and for protection of non-human species” are reviewed. Environment is not used, intentionally?


Line 592 (25): ICRP 26 is not appropriately acknowledged and the change to ICRP 60 is poorly explained. A much better explanation can be found in ICRP 109.


Line 613 (27): This is a self- fulfilling prophecy. Until today there is no situation where the statement that if man is protected also the environment is protected does not hold. There are in addition treaties that forbid exposing the environment in areas where there are no man. So the problem of environmental radiation protection in reality does not exist.


Line 672: “negligible impact” is too ambitious. Nearly all human activities will have an impact on environment. The aim is to find a compromise between serving mankind and not imposing an inappropriate burden to the environment.


Line 683: What is the benefit for biota from an exposure situation that needs to be considered according to the justification principle?


Line 728 (39): What is the benefit of the environment that has to be weighed against harmful consequences?


Line 746 (41): In emergency exposure situations, in the practical application of protection, the primary objective is the protection of people. This could be discussed somewhere in the report in connection to the ethical basis.


Line 748 (41): In this paragraph, both “non-humans and “the environment” is used. A bit confusing. And the priorities should be clear: first humans and second environment and not vice-versa.


Line 760 (42): Same comment as in the definition of prudence. And: the guidance should not be what we can do but what is necessary to do.


Line 778: “The LNT model is not universally accepted as biological truth.” This should be emphasized and discussed in the light of the consequences. See also Line 788.


Line 796: Why is that a prudent decision?


Line 804 – 808: Important could be emphasized.


Line 804 (48): “Neither prudence nor the precautionary principle should be interpreted as demanding zero risk, choosing the least risky option, or requiring action just for the sake of action. “ This is very important in the application of protective actions and could be further stressed in the publication.


Line 821 – 827: Important could be emphasized.


Line 846: Inequity is solved by setting limits. No further measures are necessary.


Line 948: The problem was that a seemingly objective cost-benefit analysis could not justify radiation protection measures that have been done or were accepted for other reasons. CBA was used only seldom since then but this was one reason that the minimization gained priority in radiation protection and not optimization due to a lack of competence.


Line 978: Also ICRP needs to have a line of accountability. This is not clear regarding some recent recommendations, especially regarding the new dose limit for the lens of the eye.


Line 997 (69): Consider using this definition of transparency in the glossary.


Line 1081: The opinion of L.S. Taylor is outdated. There are numerous examples of not-well-meaning stakeholders.


Line 1210 (92):”The primary goal…public benefit”. The wording is not really in line with ICRP Publication 103: “The primary aim of the Commission’s Recommendations is to contribute to an appropriate level of protection for people and the environment against the detrimental effects of radiation exposure without unduly limiting the desirable human actions that may be associated with such exposure.”


 


Final remark


The former version had a chapter 4 about tolerability and reasonableness. Why this chapter was deleted?