INTERNATIONAL COMMISSION ON RADIOLOGICAL …

1 INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION Address ICRP PO Box 1046, Station B 280 Slater Street Ottawa, Ontario K1P 5S9 CANADA Telephone +1 (613) 944-1918 Facsimile +1 (613) 944-1920 E-mail Designations UK Reg. Charity 298173 ICRP Ref. : 4823-4273-0030 March 9, 2016 Participants in the Workshops on Ethics in RADIOLOGICAL Protection IRPA Associate Societies Special consultation on the draft report Ethical Foundations of the System of RADIOLOGICAL Protection Dear Colleagues, The system of RADIOLOGICAL protection is based on three pillars: scientific knowledge that helps us understand how radiation effects people and the environment, ethical values that guide decisions about protection, and experience that teaches us what is practical in implementation. Over the past three years the COMMISSION has dedicated a significant effort to drawing out the ethical values underpinning the system of RADIOLOGICAL protection.

2 This is not the first time that this fundamental pillar has been examined, but it is the first concerted effort to develop an ICRP publication dedicated to it. Engagement of the RADIOLOGICAL protection community in the development of ICRP publications is essential to ensure the best possible system of protection for people and the environment. Normally this means involving a group of experts in the drafting, discussing progress and getting feedback in various forums, seeking comments through a process of open public consultation, and several steps of peer review prior to publication. The nature of this publication demanded even more. We have engaged not only experts in RADIOLOGICAL protection, but also experts in ethics, and individuals who are facing the everyday ethical dilemmas associated with revitalization of communities after the Fukushima Daiichi accident.

3 This was accomplished through a series of six workshops organized in collaboration with ICRP. Four of the six workshops in the core series were organized by IRPA Associate Societies and the other two were hosted by prominent academic institutions: Harvard University in the USA, and Fukushima Medical University in Japan. ICRP also participated in several other similar events in which issues relating to the ethics of RADIOLOGICAL protection were discussed. In addition, we are now organizing an exceptional early consultation on this advanced draft. This targeted consultation seeks comments from the RADIOLOGICAL protection community through IRPA, and the individuals involved in the workshops that have driven the development of this publication. - 2 (2) - Please send your comments on this draft to by June 30, 2016. Your contribution will guide the preparation of a next draft that will undergo our usual public consultation.

4 Sincerely, Claire Cousins, ICRP Chair Jacques Lochard, ICRP Vice-Chair Christopher Clement, ICRP Scientific Secretary Donald Cool, ICRP Committee 4 Chair Kunwoo Cho, Chair of ICRP Task Group 94 on Ethics of RADIOLOGICAL Protection INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION 1 DRAFT FOR CONSULTATION ICRP ref 4819-9742-0590 2016-03-09 Annals of the ICRP DRAFT Ethical Foundations of the System of RADIOLOGICAL Protection INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION 2 DRAFT FOR CONSULTATION CONTENTS PREFACE .. 3 1 1. INTRODUCTION .. 4 2 2. EVOLUTION OF THE SYSTEM OF RADIOLOGICAL PROTECTION .. 7 3 The early days: do no harm .. 7 4 A more complex problem: managing risk, a matter of balance .. 8 5 A broader perspective: protecting the environment .. 9 6 Considering the diversity of exposure situations.

5 10 7 The system of RADIOLOGICAL protection today .. 10 8 3. THE CORE ETHICAL VALUES UNDERPINNING THE SYSTEM OF 9 RADIOLOGICAL PROTECTION .. 12 10 Beneficence and non-maleficence .. 12 11 Prudence .. 13 12 Justice .. 14 13 Dignity .. 16 14 4. TOLERABILITY AND REASONABLENESS .. 17 15 Tolerability .. 17 16 Reasonableness .. 21 17 Tolerability and reasonableness in practice .. 23 18 5. ETHICS IN THE IMPLEMENTATION OF THE SYSTEM OF RADIOLOGICAL 19 PROTECTION .. 25 20 Accountability and transparency .. 25 21 Stakeholder involvement .. 28 22 6. CONCLUSION .. 30 23 REFERENCES .. 32 24 ANNEX X .. 36 25 26 INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION 3 DRAFT FOR CONSULTATION PREFACE 27 Building on the results of several years of reflection on the ethics of RADIOLOGICAL protection 28 within ICRP Committee 4, during its meeting in Fukushima, Japan, in October 2012 the 29 ICRP Main COMMISSION established Task Group 94 of Committee 4 to develop an ICRP 30 publication presenting the ethical foundations of the system of RADIOLOGICAL protection.

6 31 32 As stated in the terms of reference for the Task Group, the purpose of this publication is to 33 consolidate the recommendations, to improve the understanding of the system and to provide 34 a basis for communication on radiation risk and its perception. In order to achieve these goals, 35 the COMMISSION asked the Task Group to review the publications of the COMMISSION to 36 identify the ethical and social values associated with the system of RADIOLOGICAL protection for 37 occupational, public and medical exposures, and for the protection of the environment. 38 39 Given the nature of the work the COMMISSION also encouraged the Task Group to develop 40 its work in close cooperation with specialists of ethics and RADIOLOGICAL protection 41 professionals from around the world. With this in mind, a series of workshops was organised 42 by ICRP in collaboration with the INTERNATIONAL Radiation Protection Association (IRPA) and 43 academic institutions to fully examine, discuss, and debate the ethical basis of the current 44 system of RADIOLOGICAL protection with radiation professionals and ethicists.

7 These workshops 45 were held in: Daejeon (Korea) and Milan (Italy) in 2013; Baltimore (USA) in 2014; and 46 Madrid (Spain), Cambridge (USA) and Fukushima City (Japan) in 2015. Presentations were 47 given to spur discussion in group sessions. Presenters were from a variety of backgrounds 48 and fields of expertise. A list of participants is provided in Annex X. 49 50 The Task Group also benefited from discussion at an INTERNATIONAL Symposium on ethics of 51 environmental health in Budweis, Czech Republic in 2014; the fourth Asian and Oceanic 52 congress on radiation protection in Kuala Lumpur, Malaysia in 2014; UK workshop on the 53 ethical dimensions of the RADIOLOGICAL protection system in London, UK in 2014; and the third 54 INTERNATIONAL Symposium on the system of RADIOLOGICAL protection in Seoul, Korea in 2015.

8 55 56 The membership of the Task Group is as follows: 57 58 Cho (Chair) Cantone S. O. Hansson 59 C. Kurihara-Saio N. E. Martinez D. Oughton 60 T. Schneider R. Toohey S. Wambani 61 F. Z lzer 62 63 Corresponding members are: 64 65 R. Czarwinski B. Le Guen E. Van Deventer 66 67 68 INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION 4 DRAFT FOR CONSULTATION 1. INTRODUCTION 69 Background 70 (1) In an address to the Ninth Annual Conference on Electrical Techniques in Medicine and 71 Biology in 1956, Lauriston Taylor, then incumbent President of the National Council on 72 Radiation Protection and Measurements (NCRP), and Chairman of the INTERNATIONAL 73 COMMISSION on RADIOLOGICAL Protection (ICRP), declared: Radiation protection is not only a 74 matter for science.

9 It is a problem of philosophy, and morality, and the utmost wisdom. 75 (Ta ylor, 1957). By using the term wisdom , one of the fundamental virtues of the ethical 76 tradition inherited from European classical antiquity, Confucianism, Hinduism, and 77 Amerindian oral traditions, Taylor emphasized that beyond its undeniable and compelling 78 scientific and ethical basis, RADIOLOGICAL protection was also a question of insight, common 79 sense, good judgment and experience. Through his formulation, he brought to light the three 80 pillars of the system of RADIOLOGICAL protection that had gradually built up for almost half a 81 century, namely science, ethics and experience. 82 (2) Despite a long recognition that RADIOLOGICAL protection is not only a matter of science, 83 but also values, ICRP publications have rarely explicitly addressed the ethical foundations of 84 the system of RADIOLOGICAL protection.

10 This does not mean that the COMMISSION has been 85 unaware of the importance of such considerations. Protection recommendations inevitably 86 represent an ethical position, irrespective of whether that position is explicit or implied. As 87 well, the discussion of ethical considerations is not entirely absent from ICRP publications. 88 (3) Regarding the ethical dimension, it should be pointed out at the outset that there are 89 very few writings devoted to it compared to the vast literature related to the scientific, 90 technical and practical aspects of RADIOLOGICAL protection. The first contributions directly 91 addressing the subject only appeared in the 1990s. Among them it is worthwhile mentioning 92 the pioneering contribution of Giovanni Silini who reviewed the ethical foundation of the 93 system during the Sievert Lecture he delivered in 1992 (Silini, 1992).