Radioactivity in the environment chapter 3 moral thinking and radiation protection

Radioactivity in the environment chapter 3 moral thinking and radiation protection Radioactivity in the environment chapter 3 moral thinking and radiation protection Radioactivity in the environment chapter 3 moral thinking and radiation protection Radioactivity in the environment chapter 3 moral thinking and radiation protection Radioactivity in the environment chapter 3 moral thinking and radiation protection

Radioactivity in the Environment, Volume 19

ISSN 1569-4860, http://dx.doi.org/10.1016/B978-0-08-045015-5.00003-4

Moral Thinking and Radiation Protection

Sven Ove Hansson

Royal Institute of Technology (KTH), Division of Philosophy, Stockholm, Sweden

E-mail: soh@kth.se

3.1 INTRODUCTION

Moral thinking is part of our everyday lives, but it has also been condensed into specialized discourses There are two major types of such discourses One of them can be called fundamental ethics It is usually conducted by philosophers and has a strong emphasis on the search for comprehensive basic principles for morality Several moral theories have been put forward that purport to contain all the moral information needed to answer any and all ethical questions Two of the most important groups of such theories are the utilitarian and the deontological ones In utilitarian theories, it is assumed that the goodness or badness of alter-native courses of action can be measured with some number, and acting rightly consists in choosing an alternative with a maximal degree of goodness Accord-ing to deontological theories, morality is based on a set of duties or obligations, and acting rightly consists in satisfying the duties that one has Both deontologi-cal and (in particular) utilitarian theories come in many variants, and there are also several additional classes of moral theories, such as those that are based

on rights and on contractual relationships To put it somewhat bluntly, moral philosophers tend to agree that one of the many available moral theories is the one and only correct theory However, they do not agree on which that theory is

Chapter Outline

3.1 Introduction 33

3.2 Individual vs Collective

3.3 Weighing vs Limit-Setting 39

3.4 The de minimis Issue 43

3.5 Valuing Future Effects 46 3.6 Protecting the Most

Sensitive People 47 3.7 Conclusion 49

The other type of ethical discourse is usually called applied ethics It is devoted to the practical ethical issues that arise in various specialized types

of human activities Most of the areas of applied ethics refer to the activities

of the members of a particular profession, such as physicians, nurses, research scientists, engineers, business managers, etc The ethical discourses in these areas have their origin in initiatives in professional organizations Applied eth-ics is usually conducted both by members of the concerned profession and by moral philosophers In addition to the profession-related areas, there are also a few areas of applied ethics that do not have their origin in discussions within a profession Environmental ethics and food ethics are examples of this However, most social activities that lack a strong and unified profession also lack a well-developed ethical discourse, even if they have urgent ethical issues that need to

be investigated Traffic safety, welfare provision, and foreign aid are examples

of such areas (Hansson, 2009b) Radiation protection is (hopefully) currently in

a transition phase, developing a specialized ethical tradition of its own

One might expect that applied ethics should proceed largely by applying fundamental moral theories to practical problems, in much the same way that applied mathematicians and physicians apply mathematical and physical theory

to practical problems But in practice, applied ethics is seldom performed in that way Instead of applying all-encompassing theories like utilitarianism or deon-tology to solve their problems, applied ethicists tend to appeal either directly to our moral intuitions or to principles developed specifically for the subject-area

in question (Hansson, 2003b) The reason for this is that in spite of their pre-tensions of complete coverage, fundamental moral theories have surprisingly little to say on the practical problems to be dealt with in applied ethics This has become particularly evident in biomedical ethics Experience shows that the fundamental theory that a moral philosopher adheres to has little or no predic-tive power for her standpoints in concrete issues in biomedical ethics (Heyd,

1996; Kymlicka, 1993) You can for instance find a utilitarian and a deontologist who agree on most of the ethical issues in healthcare, although they have dif-ferent underpinnings for their standpoint Similarly, two adherents of the same moral theory can disagree vehemently in practical moral issues since they apply

it in different ways The reason for this is that moral theories operate on an abstract level, and most practical moral problems cannot be connected in an unequivocal way to principles or standpoints on that level (Hansson, 2013) But there is one major exception to this: the ethics of radiation protection Many of the most important issues in radiation protection turn out to correspond

to well-known problems in fundamental moral philosophy Indeed, some of these problems have been discussed in parallel in both radiology and moral phi-losophy for many years, with few if any contacts between the two discussions (Hansson, 2007) The major reason for this connection between the two disci-plines is that radiation protection refers to doses that are measured in numeri-cal terms and added just like utilities are added in utilitarianism (Provided, of course, that the linear nonthreshold assumption is used.) From a mathematical

viewpoint, the difference between minimizing doses and maximizing the good

is trivial; it is just a matter of a minus sign Therefore, radiation protection can

be used as a test lab for moral theories We can for instance try out different principles for the distribution of goods by applying them to the distribution of radiation doses

The rest of this chapter is devoted to five particularly important parallel issues in moral philosophy and radiation protection

3.2 INDIVIDUAL VS COLLECTIVE APPROACHES

The first of the five contact points between moral philosophy and radiation protection is the way in which we weigh risks and benefits against each other

A useful method to prepare ourselves for a decision is to identify and weigh the advantages and disadvantages of each of the options that are open to us

A practicable way to do this was proposed by Benjamin Franklin in 1772 in a letter to the chemist Joseph Priestley:

“When these difficult Cases occur … my Way is, to divide half a Sheet of Paper by a

Line into two Columns, writing over the one Pro, and over the other Con Then during

three or four Days Consideration I put down under the different Heads short Hints of the different Motives that at different Times occur to me for or against the Measure When I have thus got them all together in one View, I endeavour to estimate their respective Weights; and where I find two, one on each side, that seem equal, I strike them both out: If I find a Reason pro equal to some two Reasons con, I strike out

the three … and if after a Day or two of farther Consideration nothing new that is of

Importance occurs on either side, I come to a Determination accordingly.”

(Franklin, 1970; pp 437–438)

Franklin struck out items or group of items with equal weight From this the step is not big to assigning a number to each item, representing its weight, and adding up these numbers in each column This is the moral decision procedure proposed by Jeremy Bentham (1748–1832):

“Sum up all the values of all the pleasures on the one side, and those of all the pains

on the other The balance, if it be on the side of pleasure, will give the good tendency of

the act upon the whole, with respect to the interests of that individual person; if on the

side of pain, the bad tendency of it upon the whole.

Take an account of the number of persons whose interests appear to be concerned;

and repeat the above process with respect to each Sum up the numbers … Take the balance which if on the side of pleasure, will give the general good tendency of the act,

with respect to the total number or community of individuals concerned; if on the side

of pain, the general evil tendency, with respect to the same community.”

(Bentham, 1780, pp 27–28)

Bentham used the word “utility” for “that property in any object, whereby

it tends to produce benefit, advantage, pleasure, good, or happiness”

(Bentham, 1780, p 2) Therefore, moral theories based on this type of calculus are called “utilitarian” But neither Bentham nor any of his successors have been able to come up with a method to actually measure the moral values of options Therefore, the literature on utilitarianism does not contain actual calculations

of utility in real life, only hypothetical calculations in the style of “Suppose person A receives 3 units of utility and person B loses 2 units…” In this respect, radiation protection is more concrete Radiation doses are summed up for each individual person, and then these values are in their turn summed up for the total number of “persons whose interests appear to be concerned”, just as Bentham prescribed But there are at least two major differences between dosimetry and Benthamite utility calculus First, the latter is devoted to both positive and nega-tive values (both of Franklin’s columns) whereas the radiation protector only has negative values to record Secondly, whereas the moral calculus is only a hypothetical exercise, dosimetry is a well-established empirical practice based

on reasonably reliable dosimeters

In the passage quoted above, Bentham proposed that we perform two procedures in order to compile information for utilitarian calculations First,

we sum up the values that pertain to each concerned individual, collecting

so to say the values in one basket for each individual (See Figure 3.1) In the second procedure, we pour together the contents of all the individual baskets into one big, collective basket This second step is an essential part of the utilitarian idea It has the effect that an advantage or a disadvantage (such as

a radiation dose) will be counted the same irrespectively of whom it affects This was probably a major reason why Bentham proposed that we blend the contents of all the baskets He was a strong advocate of equality In his view, every person—nobleman or commoner, rich or poor, man or woman— should count for one and no one should count for more than anyone else (Guidi, 2008; Williford, 1975)

Identifiable

individual

information

Collective

information

FIGURE 3.1 Bentham’s method for compiling utility information.

But the pouring together of all the baskets also has another effect that is quite problematic from an egalitarian or otherwise justice-seeking point of view

In the one-basket approach, advantages and disadvantages will count the same irrespective of who receives them Therefore, a disadvantage to one person will always be outweighed by a somewhat larger advantage to another person This runs contrary to the idea of equality From an egalitarian point of view, it is better to provide a disadvantaged person with a certain advantage than to grant

an already advantaged person a somewhat larger advantage The one-basket approach also effaces the distinctions that are necessary to make sense of moral categories such as compensation and desert Inflicting an injury on you in order

to gain an advantage for myself will count the same as inflicting that same injury on myself in order to gain the same advantage

But we can avoid these drawbacks while still treating everyone equally Instead of pouring all the individual baskets together we can keep them sepa-rated, but “anonymize” them More precisely, the baskets should carry no infor-mation of the type that justice requires us to disregard such as whether they pertain to a man or a woman, a person from the upper or the lower classes, etc To illustrate this, we can see Bentham’s second step as actually consisting

of two steps (Figure 3.2) First we remove the labels from the baskets At that stage, we know how the contents are distributed but we do not know which

Anonymized

individual

information

Identifiable

individual

information

Collective

information

FIGURE 3.2 A more detailed account of Bentham’s method, showing the possibility of an

intermediate step (that may also be taken as the final step).

basket each person receives In the second step, we pour all the baskets together, arriving at the same end result as with Bentham’s method The obvious advan-tage of this more detailed description is of course that it opens up the interest-ing option of only performinterest-ing the first step, i.e remove the labels but not pour together the baskets

Having observed this, we can distinguish between two major ways to weigh pros and cons, or risks and benefits, against each other: individual and collective weighing Individual weighing is concerned with the balance between advan-tages and disadvanadvan-tages for each individual person, whereas collective weighing compares the total sum of all advantages to the total sum of all disadvantages (Hansson, 2004b) Individual weighing can be performed on either the upper or the middle level in Figure 3.2 (labeled or unlabeled individual baskets) whereas collective weighing takes place on the lower level (one collective basket) Both of these approaches are commonly used in various social practices Clinical medicine is perhaps the application area in which individual weighing

of risks and benefits is most consistently used In order to choose treatment rec-ommendations for their patients, physicians weigh the expected positive treat-ment effects against the negative side effects With few exceptions (infectious disease prevention being one of them) advantages pertaining to persons other than the patient do not enter the calculation As one example of this, it is con-sidered unethical to sedate a patient in order make him/her easier for the staff to handle; like other medical interventions sedation has to be justified with appeal

to the patient’s interest Another example is that in medical research ethics as codified in the Helsinki declaration, a patient should not be offered to take part

in a clinical trial if there is some treatment available that is known to be better than one of the treatments to which the patient can be randomized in the trial

This is often expressed as a requirement that there should be clinical equipoise

between the different treatments, by which is meant the absence of any compel-ling reason from the viewpoint of the individual patient’s interests to choose one treatment over the other A patient should not participate in a clinical trial

if that would be to her disadvantage, even if the total effect of the trial would be positive due to the expected benefits to future patients (Hansson, 2006) However, outside of clinical medicine risk analysis is dominated by methods that employ collective risk-weighing Disadvantages are measured in terms of the expectation value (probability-weighted value) of the number of fatalities Values derived from different sources of risk are added to obtain a measure of the total “risk”, i.e sum of such expectation values Suppose that a certain operation

is associated with a 1% probability of an accident that will kill five persons, and also with a 2% probability of another type of accident that will kill one person Then the total expectation value is 1% × 5 + 2% × 1 = 0.07 deaths In similar fash-ion, the expected number of deaths from a nuclear power plant is equal to the sum of the expectation values of each of the various types of accidents that can occur in the plant One author has described this as “[t]he only meaningful way

to evaluate the riskiness of a technology” (Cohen, 2003, p 909)

One interesting example of the dominance of collective risk-weighing is the common criticism against the so-called NIMBY (not in my backyard) phenom-enon By this is meant that a person or group of persons protest against the siting

in their neighborhood of a facility that will be disadvantageous to themselves but advantageous to society as a whole Risk analysts who condemn NIMBY reactions seem to take it for granted that collective risk-weighing is justified in these cases But the common assumption that NIMBY represents some type of irrational thinking only seems plausible if the discussion on siting of facilities refers to the big basket, not if it refers to the full information that is available

if we retain information about the distribution of advantages and disadvantages (Hermansson, 2007; Luloff, Albrecht, & Bourke, 1998)

Radiation protection differs from most other areas in combining the individ-ual and the collective methods of weighing There is a long tradition of attending both to individual and collective doses For individual doses, maximum allow-able exposures have been specified For collective doses, the major approach

is expressed by the so-called ALARA principle for dose reduction (“as low as reasonably achievable”, see Chapter 9) There is consensus in the radiation pro-tection community that both these levels of analysis are needed, although their relative importance has been subject to debate (Wikman, 2004) This combina-tion of two levels of analysis gives rise to a more nuanced—and consequently more complex—structure than if only one of the two levels of analysis is cho-sen This may be one of the thought patterns in radiation protection that moral philosophers have something to learn from

3.3 WEIGHING VS LIMIT-SETTING

In the case with only collective information (a single large basket), there is an obvious decision rule to apply:

The collective weighing principle ( Hansson, 2003a ):

An option is acceptable to the sum of all extent that the sum of all individual disadvantages that it gives rise to is outweighed by the sum of all individual advantages that it gives rise to.

If we have chosen to retain individual information, then the choice of a decision rule is less obvious There is a simple case, namely that in which decisions can

be made separately for each individual, one at a time In such cases the follow-ing decision rule can be used:

The individualist weighing principle for a single concerned individual:

An option is acceptable to the extent that the sum of all disadvantages that it gives rise to for the concerned individual is outweighed by the sum of all advantages that it gives rise to for that same individual.

This is the rule commonly applied in clinical medicine in the choice between treatments that differ in their therapeutic and adverse effects

These two decision rules apply to simple cases in which there is only one basket to consider, either because we only take one individual into account or because we have decided to pour together the contents of all baskets into one The tricky problems arise when we have decided to take the separate interests

of more than one individual into account, i.e when we are on the top or middle level in Figure 3.2 We have to stay on one of these levels if we wish to account for moral considerations such as equality, justice, and individual rights These levels also represent the types of situation that the radiation protector has to manage Having received the dosimeter readings from all the employees of a plant, you should of course add up all these doses in order to see what the total (collective) dose was Discussions on how to reduce that sum are self-evident parts of the established practice in radiation protection But so is also a focused discussion on the highest individual doses and what can be done in particular

to reduce them, even if such measures do not coincide with the most straight-forward and most economical ways to reduce the collective dose The radiation protector is therefore in the same situation as the egalitarian who worries not only about the total welfare of a society (conventionally but very defectively measured as the gross national product), but also about the welfare of individual residents, in particular those who are worst-off

The problem how best to take several individuals’ interests into account has both a substantial and a procedural component The substantial issue concerns how good or bad different outcomes are, if by an outcome we mean a state

of affairs defined by what is in each individual’s basket The procedural issue concerns how the decision on such distributions should be made Although the procedural issue is of paramount importance (see Chapters 16–19), here the discussion will be restricted to the substantial one Both these aspects are so complex that it is often helpful to discuss them one at a time

A common and conceptually quite simple solution is to set an individual limit and require (only) that each individual be on the right side of that limit:

The individual limit principle:

An option is acceptable if and only if each individual’s situation is above a certain limit that is the same for all individuals.

In general social policies, this corresponds to the idea that each individual should

be above a certain level, often called the “poverty line” or “poverty threshold” It

is usually identified with the amount of resources necessary to obtain sufficient food, clothing, health care, and shelter According to this view, once everyone is above the poverty line, the situation is acceptable, and there is no further need

to worry about inequalities in income and resources In radiation protection, this would correspond to a policy that only requires that all individual doses be below the dose limits and has no further requirements on the reduction of doses Both in social policies and radiation protection, such a policy can be criti-cized both for demanding too little and for being too uncompromising It demands too little since it provides no stimulus to further improvements once

the limit has been reached In social policies, it makes no distinction between

a society in which everyone is just above the poverty line and one in which everyone is far above that level It would seem strange, to say the least, to be unbothered by such a difference In radiation protection, we have a correspond-ing problem: The individual limit principle does not distcorrespond-inguish between a workplace in which every employee’s exposure is just below the exposure limit and one in which everyone’s exposure is a small fraction of the exposure limit

A radiation protector who does not worry about that difference could hardly be said to take her professional duties seriously

It is the sharpness or absoluteness of the limit that makes this principle open

to the criticism of being too uncompromising (and by its very nature, a limit has to be sharp in order to be unambiguously applicable) Consider a society

in which everyone is well above the poverty line except very few who are just below it Most of us would probably prefer such a society to one in which every-one is just above the line Similarly, in radiation protection, consider a situation

in which everyone’s exposure is very small except a few persons whose expo-sure is just above the limit We would probably prefer this to a situation in which everyone’s exposure is barely below the limit—at any rate this is how radiation protectors would assess the two situations

These examples show that the individual limit principle is too crude It has the advantage over the collective weighing principle that it takes individual allotments seriously, but it has the serious disadvantage of not making any other distinctions than that between values above and below the limit In radiation protection, we want to distinguish between different doses below the dose limit, and also between different doses above it For obvious reasons, the correspond-ing nuances are also needed in moral philosophy and its application to social policies In both cases, we need to combine concern for individual allotments with concern for gradations beyond that of being above or below a single limit Before attending to how that can be done it is worth noting that the indi-vidual limit principle is much akin to—and arguably expressible as a form of—one of the major alternatives to utilitarianism, namely deontological eth-ics, also called duty ethics Deontologists such as Immanuel Kant (1724–1804) have proposed that an adequate moral theory should be based on strict moral limits that we are never allowed to transgress A Kantian approach to radiation protection could be based on the precept that a duty-holder such as an employer

is required to ensure that each individual’s radiation exposure satisfies a precise criterion such as that of being below the dose limit The same stipulation could also be expressed in the terms of a closely related type of moral theories namely

rights-based ethics The central postulate would then be that each individual has

a right not to be exposed to doses above the limit

Hence, in terms of moral theories, a radiation protector who only worried about collective doses would apply utilitarian thought patterns whereas one whose attention was limited to individual doses would follow deontological or rights-based thought patterns (Hansson, 2007) In moral philosophy, the general

approach is to treat the different types of moral theories as mutually exclu-sive alternatives that one has to choose between Moral philosophers typically identify themselves as adherents of one of these theories On a conference in moral philosophy utilitarians will argue that deontology is a misconceived form

of moral philosophy, deontologists will say the same about utilitarianism, and adherents of various other moral theories (such as virtue ethics) will claim that both utilitarianism and deontology are fundamentally flawed In contrast, on a conference in radiation protection, we will usually not find proponents of collec-tive dose minimization who consider individual dose limits to be useless or pro-ponents of individual dose limits who see collective doses as irrelevant Instead,

we will find radiation protectors who try to combine the two lines of thought

in various ways, although they may disagree on the relative priorities and on how the two principles are best combined The common approach in radiation protection is to see to it that (1) the individual dose limits are upheld and (2) given that, the collective dose is minimized This amounts to the following more general principle:

Combined individual limit and collective weighing:

An option is acceptable to the extent that (1) each individual’s situation is above

a certain limit that is the same for all individuals, and (2) the sum of all individual disadvantages that it gives rise to is outweighed by the sum of all individual advantages that it gives rise to.

Hence, whereas moral philosophers have discussed whether to choose a utili-tarian or a deontological approach, radiation protectors have attempted to find ways to combine them Since both thought-patterns have strong support in our moral intuitions, such a combinative line of thought may very well turn out to

be the most useful and constructive one also for a wider field of applications than radiation protection Moral philosophers may have something to learn from radiation protectors in this respect

But we need not settle with the last-mentioned principle There are other ways than this to combine the limitation of individual doses with that of col-lective doses Another way is to modify colcol-lective dose minimization so that

it gives higher weight to the reduction of high doses For illustration, this can

be done in a very simple way by tripling the part of a dose that exceeds, say,

10 mSv/year We can call the resulting number the severity of the exposure Hence, if the dose is 5 mSv then the severity is 5, but if the dose is 20 mSv then the severity is 40 Now consider the following two exposure patterns:

Dose pattern A: Eleven persons receive 10 mSv/y

Dose pattern B: One person receives 50 mSv/y and ten persons receive 5 mSv/y According to collective dose minimization (and our collective weighing prin-ciple) dose pattern B is slightly better than dose pattern A since the collective dose is somewhat lower (100 respectively 110 mSv/y) However, according to the “tripling” criterion, B is by a wide margin worse than A since it scores