Western University researchers call for new licensing system to allow physicians to practise in space

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Government space flights are limited to only the healthiest of humans. But as commercial space travel takes off, anyone with the financial means will now have the opportunity to journey beyond Earth’s atmosphere.

For researchers at Western University, this presents a problem that has been largely overlooked: Who will take care of the health of space travellers?

“When we look at the people with millions of dollars of disposable money to do whatever they want in space, they’re not always the healthiest people in the world,” said Adam Sirek, an adjunct research professor at the university’s Schulich School of Medicine and Dentistry.

Yet space is arguably the most dangerous environment possible because of its extreme radiation, lack of gravity and the fact one’s blood would instantly boil without the protection of spacecrafts and suits, he said. “It’s trying to kill you every second.”

Dr. Sirek and his team are calling for changes to the Canadian medical licensing system that would allow doctors in this country to practise medicine beyond Earth’s limits. In a recent paper, published in the Institute of Electrical and Electronics Engineers’ IEEE Open Journal of Engineering in Medicine and Biology, they propose possible solutions such as developing a pan-jurisdictional licence for doctors to practise in all provinces, as well as space.

Currently, doctors are required to be licensed in each province or territory where they practise. But space doesn’t fall under any licensing jurisdiction.

The need to ensure doctors are licensed to practise in space is no longer merely theoretical, the researchers say. The era of civilian space travel has already arrived, with private enterprises such as SpaceX, Blue Origin and Virgin Galactic driving space tourism. In their paper, the authors note the space economy is expected to generate $1-trillion in sales by 2040.

“That, to me, was the big ‘whoa’ moment with this research: How are you sending people to space and we haven’t talked about who’s going to take care of them, and what the standard is,” said co-author Valerie Nwaokoro, a law student at Western University.

In multinational missions, the problem becomes even more complicated, as travellers may be from various countries that have different standards of medical care, Ms. Nwaokoro said. “What care do you provide?”

Additionally, there’s the unanswered question of who would be responsible if someone from one country was injured on a space flight that was owned by a private company from another country, she said.

To address some of these problems, the researchers proposed the idea of a pan-jurisdictional licence, or else fast-track or rapid temporary licences that would allow doctors to provide care for Canadians outside of their regular licensing jurisdiction, as well as in space.

Since the pandemic, health care advocates have increasingly called for a licensing system that would allow doctors to easily travel or provide virtual care across provinces to places where they’re needed.

Implementing these licensing changes could help satisfy the needs for medical care in space, as well as here on Earth, too, they said.

“If we can tackle both at the same time and say, ‘Yes, you can be in Quebec and you can treat someone in British Columbia and help here on Earth,’ wouldn’t it be nice if you could be in the Northwest Territories and take care of a Canadian on the moon?” Dr. Sirek said.

He added that if Canada wants to take part in the growing space economy, it will need to find a way to license its doctors to safely and effectively practise medicine in space.

The kinds of medicine doctors could expect to practise in that environment are still being debated in the field of aerospace medicine, Dr. Sirek said. But he predicted that as commercial space flight becomes more accessible to people who may not be in the best health, there could be a greater need for doctors with emergency medicine and critical-care skills.

In their paper, the researchers suggest specialists may also be required to manage conditions such as hypertension, cardiovascular disease and diabetes, which are common among the general public, during space flights.

Much of that care would likely be provided remotely from Earth, Dr. Sirek anticipated, similar to how an airplane captain will call for ground-based medical support for an emergency if there are no doctors or nurses on board a flight.

The types of health issues people experience in space and on Earth may not be much different. Rather, doctors practising space medicine need to understand the environment, including the pressure, lighting, atmosphere and the resources on board, he said.

That means, aside from licensing, doctors will need to show they are competent in space medicine. The Royal College of Physicians and Surgeons of Canada said it recently made changes to its pathway for doctors to obtain credentials for aerospace medicine, and its committee responsible for discipline-specific standards is now piloting the new route. Currently, there are only two people who have been certified in aerospace medicine through the Royal College, but it said with the new route, it anticipates demand for the credential will grow.