Destiny: Gods of Night by David Mack Review Thread (Spoilers!)

Discussion in 'Trek Literature' started by haubrija, Sep 19, 2008.

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Grade "Star Trek: Destiny: Gods of Night"

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  1. Christopher

    Christopher Writer Admiral

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    But look at it from his perspective. His priority is the health of the patient. The stasis/monitor solution was considerably less safe for Deanna than a controlled termination of the pregnancy would have been, and there was no medical benefit to it either for the mother or the child. At best, it was just a way of delaying the inescapable reality that the fetus would die. I don't see why it's surprising that a doctor would strongly urge the safer option and be reluctant to suggest a more dangerous and completely pointless alternative. His job is to look out for the best medical interests of his patient, and if her preferences go directly against her own medical interests, then it's his medical duty to do everything he can to talk her out of it. Indeed, it would've been unethical for Ree to recommend a procedure that he knew was unsafe and medically unnecessary.

    Have you seen the House episode "Three Stories"? I don't want to spoil it, but the medical dilemma there is very similar to this, in that it involves a patient who's irrationally determined to take the most dangerous possible option against all advice from his doctor.
     
  2. Baerbel Haddrell

    Baerbel Haddrell Commodore Commodore

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    What is an abortion? I am a medical layman but to me it is the removal of an unborn child. This is what Dr. Ree did not only recommend, he wanted to force Deanna and he even has the law on his side. Trying to force a woman to have an abortion here and now is NOT in any woman`s best interest. Strongly recommending a hysterectomy at the same time is definitely worse because there is nothing wrong with her womb.

    That Dr. Ree insisted that the fetus is not viable and that it is endangering the mother`s life doesn`t change that. Removing a dying, mutating fetus that endangers its mother`s life is still performing an abortion. If the mother loses the baby naturally because it is not viable, that is a very different scenario. Trying to force Deanna to get the fetus removed because it will die anyway according to Dr. Ree is not making it right.

    What Dr. Ree should have done is giving Deanna time to think and options – like, as I said, getting a second opinion from an expert. As long as the patient is mentally able, the patient also has the right to be stubborn, emotional and even irrational. The right to refuse treatment should also exist in Starfleet. Obviously, it doesn`t but again, what is right and what is the law is not always identical.
     
  3. LightningStorm

    LightningStorm The Borg King Commodore

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread


    (not wanting to get into the whole moral can of worms here around the whole issue), but this particular part, I thought was specifically stated as there was actually something wrong with her womb, which was why he recommended the hysterectomy.
     
  4. Baerbel Haddrell

    Baerbel Haddrell Commodore Commodore

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    From what I remember there was a lot wrong with Deanna`s eggs and Dr. Ree wanted to prevent Deanna from ever becoming pregnant again for her own safety. His logical conclusion was to remove the womb.

    It would have done the trick, of course, but it is a very unfeeling, very cruel short sighted solution. It would take away Deanna`s ability to get pregnant and to explore other options like egg donations (maybe from her mother). Maybe there is the possibility to repair an egg that is less damaged than the others with legal gene therapy that doesn`t involve any enhancing. Any of these options would still enable Riker to father a child with Deanna.

    There were a few postings from people with more medical and scientific knowledge and it seemed to me that there are indeed possibilities Deanna and Riker could explore.
     
  5. MMCL

    MMCL Lieutenant Red Shirt

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    It does. She (and Riker) refused the treatment he offered, but at the same time they should have accepted that she was then unfit for duty.
     
  6. Claudia

    Claudia Fleet Captain Fleet Captain

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    Hm, I think we'll just have to agree to disagree. IMO a doctor's first duty is to present the truth, make his/her recommendation - and then support the patient in whatever he/she decides, even if the doctor doesn't agree. And that last point is where Ree ultimately failed horribly.

    :lol: Of course, I know that episode, one of the best of that series. :) But honestly, it was that patient's right to disregard his doctor's advice (not to spoil that episode for anyone else here *g*), and the move to save him happened when he was already unconscious.

    I think the best doctor-patient relationship of course, lies in the middle - neither is the doctor dominant, as he/she was for so many years, nor should the patient simply leave his decision making abilities just at the doctor's office's door and let him/her take over. Ree, for instance, reminded me of the former - could he get any more condescending?

    No, it was stated that allowing this pregnancy to continue could end up rupturing her uterus.

    The hysterectomy came up in the discussion of her not getting pregnant again - and even we in the 21st century have other methods of not getting pregnant than by removing the womb....

    On what grounds? Her making a perhaps irrational decision? Or her being at risk from miscarriage? The lines blurred quite a bit in the book.

    And still, I do remember that heavily pregnant pilot(?) in Titan #1/2 (still can't remember) who was on duty up to giving birth. Was she really still fit for duty? (even if the baby was born prematurely IIRC - *I* wouldn't want to be shipped around by someone who could go into labour at some point in the very near future....) Aren't there any maternity programmes in ST, meaning getting a period of rest before and after giving birth, not least in order to minimize the risk of premature labour?
     
    Last edited: Nov 10, 2008
  7. JD

    JD Admiral Admiral

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    I don't mean to come across as an ass, but IMO the third part isn't really an absolute. Hell, I know that if I wouldn't want my doctor to automatically support me in whatever I decide. If the doctor thinks I'm being an idiot, I'd want them to tell me.

    As for the Deanna debate, I think part of the problem is that this is a lot more complicated than should she or shouldn't she get an abortion. The most important part of this is the fact that Deanna WILL DIE if she doesn't get the abortion, so it's not really a matter of the baby. As for the baby, as far as they know there is nothing that can be done for it, so to Vale and Ree who have no connection to it, it is pretty much a non-issue, and this is where the problems start, because to Deanna it is.
     
  8. Baerbel Haddrell

    Baerbel Haddrell Commodore Commodore

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    It only worked because Riker challenged Dr. Ree and he didn`t want to fight the captain. I am not sure what would have happened if Dr. Ree would have insisted. He as the CMO is in a very powerful position, too and if he also would have Vale, the first officer, on his side - it would probably have meant that Riker and Deanna would resign.

    I don`t think Deanna was unfit for duty but of course she wasn`t fully fit either. I think what would have made sense is putting Deanna on a kind of limited duty. That means maybe allowing light desk work but nothing physical demanding.

    Dr. Ree assured Riker that he can handle her condition. In hindsight Riker should not allowed Deanna to go but I can see why he did. Deanna is highly qualified and this task did indeed help her emotionally until things went wrong.
     
  9. MMCL

    MMCL Lieutenant Red Shirt

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    The lines are blurred however it was clear the danger was imminent and as such it would have been a precaution to keep her in for observation as was suggested.
    Pregnancy isn't an illness and doesn't need to be treated as such - however she should've been relieved of duty, not for the irrational decision she made (which I agree she is allowed to make) but for her own health and so as to prevent her condition becoming a danger to those around her.
     
  10. Christopher

    Christopher Writer Admiral

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    The word "abort" simply means "to stop before completion." Any time a pregnancy ends before delivery, any time a fetus dies, it is technically an abortion, whether it happens naturally or by medical intervention. Laypeople are used to using the word "miscarriage" for a spontaneous termination and "abortion" for a surgical termination, and we've attached a lot of emotional and political baggage to the latter term. But medically speaking, a miscarriage is simply a spontaneous abortion.

    Hmm, I suppose I can see your point. You're looking at it from the perspective of a woman's right to decide what's done with her own body, and I can sympathize with that, being pro-choice myself. On the other hand, I think that if someone is determined to make a choice that places herself in danger, especially when there's no possible gain, then that person's ability to make responsible judgments is open to question.

    And let's remember that she's an officer in a pseudomilitary organization. That means she doesn't have quite the same degree of freedom that a civilian would have. When she joined Starfleet, she chose to accept that she would be subject to the orders of superior officers. And we know that in Starfleet, a chief medical officer has the authority to give medically related orders to anyone, even the captain. Since we're talking about a military(ish) chain of command, the standards for individual freedom are necessarily different. If Ree and Deanna were civilians, the situation might be very different than it is. But they aren't civilians, and I think that needs to be taken into account.


    Well, Ree is from a predatory culture, and as we've seen, although his commitment to preserving life and health is clear, his approach can be a lot more forceful than we'd expect from a human doctor (for instance, biting off an aggressor's arm but making sure to reattach it promptly thereafter). It's in his nature to push hard for the well-being of his charges. It's an aspect of his species' psychology and culture. Titan is about being who think differently learning to coexist. Ree's definitions of medical ethics aren't necessarily human ones.
     
  11. David Mack

    David Mack Writer Commodore

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    ^ A few quick notes to add to that.

    First, Ree recommends the hysterectomy at least in part to prevent the risk of "future oncological complications" -- in other words, he believes that Troi's prolonged Eichner radiation exposure has put her at a significantly elevated risk for ovarian cancer.

    Second, in his first two meetings with Troi, he recommends procedures to Troi but does not explicitly order them. He is reluctant to exercise that authority.

    Third, because Troi's failed second pregnancy puts her life at risk, Ree does have the authority as a Starfleet chief medical officer to take such action as is necessary to save her life, even if she does not wish him to do so. As a commissioned officer, she doesn't have the privilege of refusing necessary medical treatment.

    And yes, his cultural and species biases do influence his approach to medicine and his perception of Troi's situation.
     
  12. Baerbel Haddrell

    Baerbel Haddrell Commodore Commodore

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    I understand that a CMO can give medically related orders to anyone. Nevertheless, I am sure (or at least, that should be the case!) an officer also has the right to refuse a medical order that is illegal. There should be limits. In the past a captain could order a Vulcan to force a mind meld with someone else. This is finally illegal now. Deanna didn`t have cancer and refused to get the tumour removed. We are talking about an unborn baby. From Dr. Ree`s point of view it is doomed, badly mutated and first of all a danger to its mother. Nevertheless, it is still a baby that isn`t dead yet. I most definitely would classify Dr. Ree`s order as an illegal order. If he would have pushed her any further I am sure she would have resigned and Riker would have done the same. I just wish this would have been spelled out in the books – at least I haven`t seen it yet.

    After having posted this I saw David Mack`s posting. Some more comments:

    Even a higher risk of ovarian cancer does not give Dr. Ree any right to demand a hysterectomy here and now. Maybe a hysterectomy is a good idea in a few years after Riker and Deanna had children. Until then strict observation should be sufficient.

    That Dr. Ree first asked and then ordered doesn`t make the orders any more acceptable in my opinion.

    Well, what is necessary medical treatment? An immediate hysterectomy certainy wouldn`t be. Otherwise, I think I already made my point.
     
    Last edited: Nov 10, 2008
  13. LightningStorm

    LightningStorm The Borg King Commodore

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    (emphasis mine)

    His order (had he made it one) would not have been illegal. "Illegal" strictly means against stated laws i.e. Not legal. Your personal classification can't be that it is against the law, it might be that it should be, but it isn't. You classify it as immoral not illegal. Immoral is a personal thing, Illegal isn't.

    Your use of Vulcan mind melds is actually a good example. Before they were illegal they could be made an order without being illegal. Then morals kicked in and later it became against the law so it is now illegal to force vulcans to mind meld, where it wasn't before. This situation is the same. There (as far as we know) isn't a law saying that Ree can't force this upon her. In fact as mentioned she's a commissioned officer and can be forced to undergo treatment or procedures that a doctor has deemed necessary for her to continue to function. Now, of course she has every right to resign, but that doesn't change the legal nature of the order.
     
  14. Christopher

    Christopher Writer Admiral

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    Technically, it's a 12-week-old fetus. In humans, an embryo doesn't even enter the fetal stage until 11 weeks into the pregnancy, and a Betazoid pregnancy is 10-11 percent longer than a human pregnancy, so it's perhaps borderline even to call it a fetus rather than an embryo at this stage.
     
  15. David Mack

    David Mack Writer Commodore

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    And you would be wrong. Just because an order is distasteful or offensive, that does not necessarily mean that it is "illegal." Furthermore, because Ree has not yet made it an order, you are accusing the character of something he didn't do.

    And now you are grossly misrepresenting what Ree said in the books. At absolutely no time did he demand, order, or insist that Troi have a hysterectomy; he merely recommended it, because he believed it to be the safest course of preventive medicine. (Of course, that doesn't mean he's right; this is why in the real world people get second opinions before having major procedures.)

    He never crossed the line into making it an order, so you're getting worked up over nothing.

    Which is why he didn't rush her into surgery; he merely recommended it as an option.

    I don't agree.
     
  16. Baerbel Haddrell

    Baerbel Haddrell Commodore Commodore

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    Now that I am back, a few more comments:

    Lightning Storm
    I understand what you are saying. I don`t deny that looking at the letter of the law, Dr. Ree did nothing wrong. As soon as an order becomes controversial but is within this letter of the law, of course it becomes a matter of debate and as with the Vulcan mind meld issue, a clarification is necessary.

    Christopher
    All right, a 12 week old fetus then. Well, I was about 12 weeks pregnant when I had my first ultrasound. At that time I was still wondering if I was pregnant at all and expected to see maybe a lump of cells. I don`t care if the medical term is embryo or fetus. What I saw was a baby with a head, arms and legs. It was moving around. It was playing with its toes. I was amazed.

    I am not digging through the book again in order to find the exact wording. Maybe strictly speaking Riker stopped Dr. Ree from making it an order, maybe he made it an order and retracted it, maybe he just threatened to make it an order. I am not getting worked up over nothing. The fact remains that Starfleet doctors have the legal right to force a woman to have an abortion.

    This discussion is becoming too difficult for me emotionally and it seems continuing it is pointless anyway. This is probably the last posting about this matter for now.
     
  17. Claudia

    Claudia Fleet Captain Fleet Captain

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    Of course, that's included in the third part... even going as far as refering the patient to another doctor if you *can't* support his/her decisions. Support's definitely not the same as 100% agreement.

    Yes, exactly. And how much harder would the choice (and discussion) have been if there had been even the remotest chance that the baby could be born alive (even if maybe with defects)...

    Er... I think you're wrong on that one. Once an embryo developed the beginnings of all the major organ systems it's called fetus - and that happens at around 8-9 weeks into the pregnancy...

    But of course, it could be that in the US the definition of embryonal and fetal stages differ...

    Sorry, my mistake, I forgot the risk for ovarian cancer... but while that might warrant a removal of the ovaries, it still doesn't mean the womb has to go as well. Therefore, he should have "merely" suggested an ovarectomy but not a hysterectomy since Troi doesn't have cancer yet. ;)

    BTW, David, thanks for even toeing that fine line of abortion, pro-life/pro-choice etc. While I'd have loved to see this situation go even further (see above in this post), I appreciate that such a serious topic is brought up at all - that not every miracle of life is demystified, so to speak, in the 24th century, but that people still have to face the same, sometimes awful, decisions like we do.
     
  18. MMCL

    MMCL Lieutenant Red Shirt

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    An interesting debate :)

    Without looking at the nature of the medical problem we should remember that the issue here is that she is a senior officer in a pseudo-military organisation. She has a responsibility to her duties and the crew first and foremost. Anything medical that effects her ability to carry out those duties is a risk to 'the team' or 'the mission' and as such the CMO has the power to stop and minimise that risk.

    Her CMO has advised her (not ordered) the best precautions in his opinion - and remember he is an expert in this specific field - and she is unwilling (in the book, when asked she chose WON'T over CAN'T) to take those precautions.

    After her decision has been made (which she should be allowed to make from a moral perspective) the CMO has the choice to then make it an order or not, or to suggest a compromise - eg light duties.
    If it's then an order she has two choices - accept the order, or resign. That's the nature of the establishment she is in.

    If she was a civilian, the issues would be the same but her doctor could not take the same stance - eg her can't order her, and she can chose to do whatever she wants.

    The fact it is a pregnancy/baby that's involved is not the issue IMO.
     
    Last edited: Nov 11, 2008
  19. Christopher

    Christopher Writer Admiral

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    Wikipedia said it begins 9 weeks after fertilization but at the beginning of the 11th week in gestational age. Evidently I misinterpreted that, since gestational age is counted from the start of the previous menstrual period, which apparently is traditionally assumed to be two weeks before fertilization. So you're right. So the fetus would've been 12 weeks old and thus in its "14th week" of gestational age.
     
  20. Ronald Held

    Ronald Held Rear Admiral Rear Admiral

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    Re: Star Trek: Destiny: Gods of Night - SPOILER Thread

    Interesting discussion. The civilizations of the Alpha and Beta Quadrants have a high probablilty to become extinct, and Dianna's medical condition fills pages of this thread.
     

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