Jake Holdridge

Mark Jaudalso
Junqing Ji
Satshabad Khalsa
Group # 6
A preventable disaster

Some disasters are remembered for the way they catch the publics eye; the sinking of
the Titanic, the crash of the Hindenburg. Others are remembered for the sheer amount of
lives lost; the sinking of SS Sultana, the Bhopal disaster. Unfortunately the crash of the
Columbia will be remember for how preventable it was. The Columbia case reads like
something written for an ethics class, something written so obviously and with it's point so
blunt that you can't help but say, How was this not prevented?. The events that led up the
the tragedy underline how important it is for engineers to aggressively pursue all possible
options when it comes to protecting the lives of their team and public. The case imparts to us
the necessity of examining our own motives and self interests and comparing them to what
ought to be done. If the decision makers in this case had done that then Rick D. Husband,
William C. McCool, Michael P. Anderson, Kalpana Chawla, David M. Brown, Laurel Clark and,
Ilan Ramon might still be alive today.
On January 16, 2003 the Columbia took off from Kennedy space center in Cape
Canaveral Florida for its final mission. The Columbia was one of the oldest shuttles in the
fleet and was the only shuttle not capable of docking with the international space station. As
Columbia was reaching speeds of Mach 2.5, at an elevation of 66,000 feet, a piece of foam
which was attached to the main fuel tank broke off and punctured the ceramic tiles on the

leading edge of the left wing. NASA had been having problems with foam shedding on
previous flights, but deemed it not a threat to safety even though the original specification of
the thermal protection on the wing was said that it could not withstand significant impact.
Engineers noticed the impact of the foam on day two of the mission when they were reviewing
the high resolution launch tapes. They felt that more inspection was needed to asses whether
the damage was a flight risk or not. They ask NASA management if the astronauts could
inspect the wing, but this request was denied outright. They then made three separate
requests for high resolution imaging of the space shuttle from the ground. NASA management
went to other engineers and asked them to use software to predict how much damage had
been done to the shuttle's wing. Those engineer's, along with management, downplayed the
risk of shuttle damage even though the software said that there was a 1 in 15 chance that the
wing had been damaged when doing analysis for a much smaller piece of debris. NASA
management denied the requests for high resolution imaging using the risk analysis
information and the rationale that even if there was damage, there was nothing anybody could
do about it. Manager John Harpold said Don't you think it would be better for them to ... die
unexpectedly during entry than to stay on orbit, knowing that there was nothing to be done,
until the air ran out? Many NASA managers felt more inclined to conduct what-if scenarios
rather than find out how much damage had been done. The crew was not informed of any
possible risk to their mission, and was given the go-ahead to come back to earth. Upon
reentry the shuttle and it's crew were destroyed after the hole in the wing created by the foam
strike allowed the shuttle to disintegrate.
A few factual issues that is important to clarify: it was later found that a rescue mission
was possible, although risky, with the space shuttle Atlantis. It is also important to note that
the imaging would have been done by the DOD and was costly and a big deal to have done.
The engineers had always been tasked with proving that the shuttle was safe to fly, but in this

case they were asked to prove that it was unsafe to fly. Lastly, this shuttle mission had been
delayed already 18 times, for over 2 years.
Management was responsible for the safe flight of the shuttle, from launch to landing.
They were also responsible for making sure that NASA's public image was pristine so that
they could continue to get funding. In addition they were responsible for keeping the mission
under budget. These are often conflicting obligations since every delay and extra safety
precaution costs the mission a significant amount, as well as tarnishes their public image as
an efficient American institution. Getting the imaging of the space shuttle would have caused
NASA further delays. A rescues mission could have cost millions of dollars and put even more
lives at risk.
There are many moral issues in this case: should the engineer's have downplayed the
impact with their manager's support? Should NASA have kept launching missions with the
repeated foam strikes? Should the crew have been kept in the dark about the possible risks to
their lives? We feel that, while all of these issue are important, the central moral issue in this
case is: Should NASA management allow the shuttle to be imaged for closer inspection of the
foam strike? This was the decision that could have singly saved the lives of the crew and
prevented disaster.

Application of moral theory

(Satshabad)
Rule Utilitarianism say that we should live by universalizable rules that provide net
happiness for all parties involved for each decision. These rules should provide net happiness
when it is considered that most rationale people would obey in the same situation. The moral
issue we will consider with Rule Utilitarianism is: should NASA management request high
resolution images of the space shuttle to asses the damage by the foam strike? The options

available to them were to let the engineers request the images, block the request for the
images. A universal rule we could apply for the first option would be: we should always seek
the most information possible in each situation that involves us being responsible for other's
lives. For the second option a rule could be: We should not bother exploring potential
situations that we think we can do nothing about.
Those affected by our decision will be the astronauts, the NASA managers, and the
public. If we say that we should always seek the most information possible in each situation
that involves us being responsible for other's lives, then the result for the astronauts will be
that we will always continue to try to see if there is a way we can keep them alive, even if it
means bringing ugly information to the surface, such as their impending doom. For the NASA
managers, it means that we may discover things we don't want to hear, but it also means we
may get better at our jobs and help the astronauts by saving them. For the public it means
that regardless of the hopelessness of the situation new information will always surface which
may help protect them.
If we say that we should not bother exploring potential situations that we think we can
do nothing about, then the astronauts will probably die happier, but since they would probably
be happier if we helped them live, it may be a net negative. For the managers it means that
we can make decisions without revealing our mistakes, which may be a happy thing in the
short run, but if this results people dieing on our watch, then that will make us unhappy. For
the public it means living in ignorance and loss of life in the long run. Overall the first rule will
generate more happiness so I conclude that the NASA managers should let the engineers get
the images by rule utilitarianism.

(Junqing)
Engineering Codes of Ethics are the guidelines that say how engineers should apply

ethics into practice. Therefore, by learning the code of ethics, one can determine whether a
decision is made right or wrong. The moral issue that relates to the Engineering Codes of
Ethics upon this case is: Should NASA management give the high resolution pictures to the
engineers? The two available options are either: the managers refuse to provide the high
resolution pictures to the engineers or the managers give them to the engineers.
Based on the National Society of Professional Engineers (NSPE) code of ethics: "Engineers
shall avoid deceptive acts ", Engineers shall acknowledge their errors and shall not distort or
alter the facts and, Engineers shall advise their clients or employers when they believe a
project will not be successful.
Since managers at NASA must have engineering degree or background, the
Professional Engineering Codes of Ethics can be applied. If the managers take the first
option, in which they refuse to provide the pictures to the engineers, they would highly violate
the engineering top concern of safety and peoples' lives and doing everything in their power
to help protect those lives. Also, they would violate the standard honesty and integrity
because they are essentially lying to themselves about how much damage was done to the
wing by ignoring the facts. They are also being deceptive to themselves and their team since
they are avoiding finding out what the the true facts of the situation are. On the contrary,
option 2 would be the right action the managers should take since it doesnt violate any of the
canons of the ethical code. Adding to that, admitting the mistake they made and consulting
with other engineers with all possible efforts they could make to save those astronauts is the
ethical action the managers should take. The facts shows us a rescue mission is feasible.
Therefore, if the engineers follow the ethical codes and make good judgments and right
decisions, even though they would still lose the Columbia space shuttle, those astronauts
may survive.

(Jake)
I feel NASA management did not act Utilitarian in its decision to not inform the crew or public
in the incident that occurred with the piece of foam hitting the wing of the Space Shuttle
Columbia because they did not consider the moral outcomes or consequences of their
decisions. If I would have been the decision maker in that situation I would have informed the
crew so they could brainstorm amongst themselves and decide whether or not they want to
do a spacewalk to assess the damages. Also I would have held a press conference and
discussed the situation with the public to determine whether or not I had public support to
send Space Shuttle Atlantis to conduct a rescue mission or try and replace the damaged tile.
The moral reasoning behind my decision is now everybody is in the know about the situation
and I believe it would result in the best outcome for the greatest amount of people. Instead of
being concerned with my own self-interests and whether or not Im going to keep my job as
head manager at NASA I would be concerned with the welfare of the astronauts that have no
idea their wing is damaged. Although it is often difficult to predict the outcomes of certain
decisions which are sometimes viewed as the difficulty with being utilitarian, I feel it is in
everyone's best interest to be forthcoming and direct when dealing with these types of
decisions because it would result in the overall good of everyone involved.

(Mark)
Virtue of Ethics is a moral theory based on Aristotles principle. He makes an argument that
an individuals ethical values are to not be based solely of his actions but rather examine his
reasoning, desires and motives for the actions he made. Also his functions as an individual
shall be observed to be able to make a better judgment of his moral ethics.
The moral issue considering Virtue of Ethics was to whether or not NASA should obtain high
quality images to further make an assessment on the safety of the shuttle regarding re-entry

to the atmosphere.
From this moral dilemma faced by NASA and the different teams responsible for assessing
the foam strike situation, two options are available. The first one is to allow the design
engineers request for those high quality images in order for the team to make better analyses
of the situation. Second would be for the NASAs management to deny this request due to
assumptions that the foam strike situation is more of a matter of maintenance rather than
safety.
A moral exemplar chosen for this case is the engineer, Mr. Roger Boisjoly. Mr. Boisjoly was a
key engineer in the Challenger shuttle case and was a strong advocate of letting the
astronauts know of all possible safety issues. Given the sequence of actions that Mr. Boisjoly
took throughout the Challenger Shuttle disaster, he acted virtuously and if he had been in a
position to make the key decisions the deaths of the Challenger crew could have been
prevented. If Mr. Boisjoly was given the options of the Columbia case and was in a
management position I have no doubt that he would instantly inform the astronauts, approve
the pictures and start looking at rescue options. I conclude this based on his actions in the
Challenger case, where he placed the safety of the crew above all other concerns. So by the
the ethics of our moral exemplar, Mr Roger Boisjoly the morally right thing to do would be to
inform the crew, approve the pictures, and organize a rescue crew.

individual analysis

(Junqing)
Based on Professional Engineering Codes of Ethics, besides safety, health and public
welfare, which should always be the top concerns, engineers should maintain honesty and

integrity. The other moral theories do agree with this and I feel the right thing to do would be
to approve the images so that the truth about the damage can be revealed. Also, when
engineers acknowledge any flaw in their designs or products that may cause negative effects,
they should alert the employer and come up with effective solution immediately. If the
employers were caught up with any violation of the code, engineers should try to strengthen
their power to force the employers back into the right track.
(Mark)
Analyzing more the Columbia case, the causes of the failure are from ignorance, greed and
self interest. The management is more driven by ignorance and self-interest. They have
ignored the results from previous incidents where the foam became an issue during the
re-entering process. Although the previous shuttle missions were not a complete failure, the
fact that structural problems manifested it should have been more of a priority that time
around. Part of the cause of the failure is the engineers who were not persistent in showing
the severity of the problem. If they presented a better argument, the decision of the
management could have been different. If each of the individual that is part of this project
applied their own virtue of ethics, the ones that they have gained through their experience and
the one deemed acceptable everyone would have acted differently and took more into
consideration the safety of all crew member of Columbia shuttle.

(Jake)
I am sure there are many things the managers involved wish they would have done differently
looking back on these series of events, but had they taken this class they may have
understood utilitarianism a little better causing them to think more ethically. Had the
managers at NASA taken more a Utilitarian approach to solving this problem seven
astronauts would still be alive today as well as the funding and future of NASAs space

program. In order for NASA to act Utilitarian they should have looked at how their decision
would affect the overall happiness of all parties involved, unfortunately they had the snowball
effect where when they make one bad decision and then another to cover up the previous
and so on and so on. If NASA had made it more important to act in a moral and ethical way
many more people would still be employed by NASA therefore effecting the overall happiness
of those involved which is directly related to Utilitarianism, not to mention the families close to
the astronauts. Instead the management decided to act out of self interest in order to try and
save their own skins from poor the decisions they had made leading up to the Columbia
Disaster. All of the ethical theories that we have tested in the case have lead me to believe
that the management at NASA failed in the decision making process and lacked the ethical
training to make sound moral decisions.

(Satshabad)
All three applications of moral theories came the the same result, that the NASA
managers should get the high resolution images to the engineers so that the potential
damage could be inspected, although the results of the virtue ethics seemed to say we
needed to do even more and inform the astronauts. They came to nearly the same result, but
for different reasons. The utilitarian theories indicated that this was a morally right choice
because it brought the most happiness. Virtue ethics said that this was what our moral
exemplar would have done. The ethical code of engineering stated that engineers, and
management, have a responsibility to the safety of peoples lives. These theories dont always
agree with each other, and if the facts of the case were to change even a little bit, utilitarian
might disagree.
As a group we agree that the NASA management ought to have given the pictures to
the engineers so they could inspect the possible damage. In addition the application of virtue

ethics told us that we must do even more. We must also inform the astronauts , and explore
the possibility of a rescue mission because thats what our moral exemplar would have done.
All the theories agreed with this at least minimally and it seems to be the morally right thing to
do in each of our own opinions as well.
In conclusion we feel that every engineer should have to study this case in order to
meet the requirements to graduate because it involves so many ethical issues that they will
experience in their careers. The mistakes that NASA management made in ignoring the
requests for further information about a possible danger, cost the crew of the Columbia their
lives. Many engineers will face the dilemma of whether or not to aggressively seek out
information about a situation or a problem even when they don't want to hear the truth of the
matter, but finding that information is critical to doing all we can to protect the lives of our team
and the public. Even when all seems lost, and we want to ignore the facts of the matter and
just hope for the best, we must continue to look at every possible option, no matter the
personal consequences. There were several impediments to the responsible action by
management. Their fear of failure, the egocentric tenancies displayed by John Harpold in
saying that they would rather die peacefully than know the truth, conflicts of interest in
delaying the shuttle launch, and the list goes on.
Columbia was a tale of willful ignorance by NASA management in order to preserve the
short term happiness of themselves and the crew. If only they had taken a minute to think
about their actions in an ethical perspective, whether in regards to their code of ethics, or a
personal moral code like utilitarianism, or virtue ethics, they could have avoided this
catastrophe. Really any kind of reasonable moral compass would have told them to at least
seek out additional information about the damage instead of ignoring it. Instead, all we have
now are the memories of the ones who were lost.

Works cited

Columbia Accident Investigation Board (2003). "Decision Making at NASA" (PDF).

CAIB Report, Volume I, chapter 6.4 "Possibility of Rescue or Repair". p. 173ff. Retrieved June
12, 2013

Email told fatal shuttle it was safe". AP/Guardian.co.uk. July 1, 2003. Retrieved June
12, 2013