Jun Shigemura and Rethy Kieth Chhem (eds.)Mental Health and Social Issues Following a Nuclear Accident10.1007/978-4-431-55699-2_4

4. Societal and Ethical Aspects of Radiation Risk Perception

Deborah Helen Oughton¹

(1)

Centre for Environmental Radioactivity (CERAD), Norwegian University of Life Sciences, 5003, 1432 Aas, Norway

Deborah Helen Oughton

Email: deborah.oughton@nmbu.no

Abstract

This chapter provides an overview of some of the societal and ethical factors that influence risk perception. There is a tendency to assume that public aversion or fear of radiation risks is primarily due to a misunderstanding of the probabilities of harm, but risk perception is complex and shaped by a number of issues, many of which have important ethical relevance. These include autonomy and respect for personal control; justice and the distribution of risks and benefits; and community values and societal impact. The chapter gives examples of ways in which respecting these factors can improve risk management. With respect to control, in addition to a fundamental ethical respect for dignity, there is an important psychological link between coping and stress. Hence, management practices that enable personal control and empowerment could be beneficial for exposed populations. The consideration of justice with regard to the distribution of risks and benefits include awareness of the challenges of discrimination and victimisation as well as the need for the protection of the vulnerable members of society, such as children and the elderly. Community and societal impacts extend the notion of well-being to encompass not only individual physical health but also mental health and societal well-being. This raises particular challenges and issues for health surveillance and thyroid screening initiatives. A holistic approach to radiation risk management would consider both the reduction of the risks of physical harm and measures to address psychological heath and societal recovery.

Keywords

Risk perceptionEthicsAutonomyDignityPersonal controlDiscriminationCommunitySocietal values

This chapter draws from and builds on previous work published in Oughton D, Engel-Hills P. Perception of Radiation Risk: The Ethical Dimensions of Coping with Disaster. Chapter 3 in Chhem RK, Clancey G, editors. Health in Disasters: A Science and Technology Studies Practicum for Medical Students and Healthcare Professionals. Vienna: IAEA. In press 2015.

4.1 Introduction: Public and Expert Perceptions of Risk

Many people have suggested that fear of radiation and the resultant psychological stress lie behind the major health impacts seen in the populations affected by both the Fukushima and Chernobyl and other nuclear accidents [1–3] and that these effects are far greater than the direct health impacts of the radiation exposure. This aversion has been linked to public misunderstanding and put forward as evidence of an irrational perception of the risks associated with radiation exposure. The public accepts risks associated with driving cars, drinking alcohol or eating seafood containing heavy metals, but rejects the relatively low risks associated with radiation exposure. People also tend to be more tolerant towards natural radiation exposures (e.g. radon) or medical uses of radiation than man-made sources [4]. Similar accusations of irrationality have been made against the public perception of biotechnology and genetically modified organisms. Other experts have suggested that the fear is fuelled by poor communication, mismanagement of radiation risks or media hype [5, 6].

It is true that people misunderstand the probabilities; however, numerous studies of the psychological and psychometric factors that influence risk perception show that the situation is more complex than this alone. Public or lay perceptions of risk vary widely between people and can differ from the calculated, technical approach to the assessment of risks. Whereas an expert will often tend to rank risks as being synonymous with the size or probability of harm, risk tolerance or aversion is dependent on many additional characteristics [7, 8]. Many of the characteristics have strong psychological as well as societal and ethical relevance (such as control, voluntariness and distribution of risks and benefits). The conclusion is that it is a mistake to dismiss public anxiety towards radiation risks as being “irrational” or “wrong” [9].

4.2 Factors Impacting on Risk Perception

4.2.1 Autonomy, Personal Control and Consent

People tend to be less tolerant of risks that are imposed without their choice or personal control. The phenomenon applies to a range of different risks and actions, such as driving a car compared with flying. Personal control is closely related to the fundamental ethical value of autonomy (i.e. respect for the free will of individuals), dignity, integrity and individual rights. It is also linked to the requirement for free informed consent within medical ethics.

Radiation risks represent a class of environmental risks over which people feel a particular lack of control [7] and particularly those associated with exposures following accidents. The public is dependent on information from authorities or media and has little personal choice or control over the situation. They have to deal with the risks from the exposure, and in addition, they must cope with the effects of the measures imposed to reduce exposure such as relocation, bans on agriculture or access to amenities. The latter represents decisions taken at central level. They are disruptive and infringe upon liberty and free choice. Control could be part of the reason why people are less concerned over medical radiation exposures (which are largely voluntary and for an obvious personal benefit).

Uncertainties are an important aspect of radiation risk perception, particularly linked to long-term consequences of a nuclear accident. After the earthquake and tsunami, the survivors outside of contaminated areas could start the process of rebuilding their life. The situation was more ambiguous and uncertain for those affected by the nuclear accident. In general, after a nuclear accident, the time for recovery is longer, and the feeling of helplessness greater than after most chemical or natural catastrophes [4]. The levels of contamination can be initially very unclear, and the long-term risks associated with the onset of a detrimental effect, in this case cancer, can take decades. Anxiety is raised by the lack of answers to questions such as: how long before I can return home—if at all? Do I want to? The immediate devastation and loss of lives may be far worse from the earthquake and tsunami, but the uncertainties, protracted duration of the problems and lack of autonomy can be greater in the case of a radiation incident.

With respect to risk management, measures that increase personal control and understanding such as provision of dosimeters or counting equipment and participation in decision-making are considered positive and can help populations in coping with disaster. Provision of counting equipment and independent monitoring are methods that have been successfully applied in Chernobyl-affected communities. A study carried out in Belarusian villages concluded that the approach not only resulted in reducing exposures with minimal social and psychological side effects but was also more economically cost-effective than the standard “top-down” management procedures [10]. A stakeholder study following up on Norwegian farming communities most affected by Chernobyl fallout indicated that access to local food monitoring stations was particularly important [11].

The interest for access to personal dosimeters and information on personal doses has been widespread in Japan following Fukushima [12, 13]. When combined with access to experts to help interpret results, such actions can help empower populations. Ethically, procedures that involve the populations themselves can help promote the principle of informed personal control over radiation risks.

Informed consent is also important for workers that might be exposed to chemical and/or radiation risk. This is particularly significant if lower-paid workers are employed to carry out remediation or decontamination, as it has been suggested that the necessary conditions for free informed consent are often violated for these groups [14]. Both ethically and legally, most people would agree that affected persons have a right to some form of compensation for damages, either those resulting directly from the disaster or as a result of remediation. Experience from Chernobyl illustrates the problems of compensation in promoting the “victimisation” of affected populations [15–17]. Similar challenges were seen with compensation after Fukushima [18, 19], with various reports of resentment between different groups.

4.2.2 Distribution of Risks and Benefits

While the actual costs, risks and benefits may vary with the environment and even between members of the same community, it is universally accepted that these criteria have significance to the fundamental ethical values of equity, justice and fairness [20]. The doses received by individuals due to the Fukushima accident varied widely. The risks of exposure also varied with additional factors such as age, because children are deemed to be more vulnerable to the effects of ionising radiation. Furthermore, the consideration of risks and benefits goes beyond direct exposure and must include such aspects as the consequences of the radiation contamination on lifestyle for different members of the community. So, for example, some lost their livelihood, while others were able to continue more or less as before the accident. Linked to the issue of consent discussed above, it has been suggested that the less advantaged members of society often bear a disproportionate burden after accidents [14, 21]. Examples after Fukushima include the situation for the elderly evacuees and particularly those living in temporary housing who experience greater isolation from family and communities [22].

The potential for increased health risks from radiation in children mean that the risk perceptions go beyond consideration for personal risks, as is seen by anxiety over thyroid cancer in Fukushima populations [23, 24]. The fear that your child could be affected in the future can overshadow any personal concern [25]. These concerns extend to pregnant women, as exemplified by the rise in voluntary abortions after Chernobyl [26]. This may seem irrational, since many other activities have a statistically greater probability of harming children, such as traffic or even other sources of exposure to radiation. The explanation is in part due to feelings of blame, guilt and responsibility and questioning—have I really done enough to reduce the chance of my child being harmed? Even with strong epidemiological evidence to the contrary, if a child gets cancer or a baby is born with a disability, the parents will always wonder if this was due to the radiation exposure.

Concerns for children create challenges for health surveillance and particularly thyroid screening of children. While parents may, understandably, request screening of exposed children, the procedure can lead to unnecessary surgery, and without a carefully thought communication plan, it may actually raise anxiety. Many of the ethical challenges are well known from other cancer screening programmes. The basic principle is that screening should do more good than harm, but difficulties arise from overdiagnosis, ensuring informed consent of participants, whether or not the screening will reduce the disease of casualty rates and “making healthy people sick” [27]. There are also problems with control groups, since screening large numbers of unexposed populations for diseases with very low incident rates can be hard to justify. This is arguably of particular importance for effective communication of the results from screening of Fukushima children.

Finally, it is important to consider the concept of distributive justice such that some measures to reduce exposures could result in an equitable distribution of cost and dose reduction, such as investment by taxpayers to reduce activity concentrations in public areas, while others are less equitable, for example, when a reduction of dose to the majority is only possible at the expense of a higher dose, cost or welfare burden, on a minority (e.g. banning all farm production in a small community).

4.2.3 Community Values and Societal Consequences

The Chernobyl and the Fukushima accidents are both examples of disasters that resulted in a wide range of social and economic consequences. In Chernobyl, many of the evacuees lost their jobs, social network and connection to places of particular community or historical value like graveyards or places where they played as children [25]. Resettlement and long-term evacuation in Fukushima have changed the social structure of the villages and city districts. After Chernobyl, the Gomel region lost about 43 % of its population between 1986 and 2000, and demographic parameters, like mortality and birth rate, changed dramatically as elderly people in particular did not want to leave their villages, while young people did. The emigration of young people impeded the whole social and economic development of the region, including a shortage of teachers and doctors [16]. Similar demographic changes have been seen after Fukushima, with young families more likely to evacuate and less likely to return. In some cases, this led to splitting of families with, usually, mother and children leaving and fathers remaining to work [22, 28]. These lead in turn to a variety of social and health effects such as alcoholism, obesity and depression in affected populations [3, 29].

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