The rapid expansion of commercial human spaceflight is forcing a re-examination of how we decide who is “fit to fly” in space. For more than six decades, astronaut selection has been dominated by government programmes employing stringent medical and psychological criteria designed to minimise risk for small cohorts undertaking long-duration, high-consequence missions. Contemporary standards such as NASA-STD-3001 reflect this paradigm, treating astronauts as highly trained national assets expected to perform reliably under extreme physiological and psychological stress. In contrast, commercial operators aim to fly large numbers of spaceflight participants with highly heterogeneous medical and psychological profiles, within regulatory frameworks that emphasise informed consent and currently impose very limited prescriptive health requirements on passengers. This review examines the evolution and structure of traditional astronaut selection, outlines emerging approaches to screening and certifying commercial spaceflight customers, and explores the conceptual and practical gap between “selection” and “screening”. Particular attention is given to the increasing relevance of behavioural and psychological risk in short-duration but high-stress commercial missions, where acute responses, passenger–crew interaction, and behavioural variability can influence safety, especially in mixed-capability crews. Drawing on agency standards, psychological selection research, and recent proposals for commercial medical guidelines, this paper proposes a risk-informed, mission- and role-specific framework that adapts lessons from government astronaut corps to the needs of commercial spaceflight. We argue that future practice must balance safety, inclusion, and commercial viability through proportionate, evidence-based risk management, supported by systematic data collection across government and commercial flights.
Evetts et al. (2026) studied this question.