TNG Rewatch: 5x16 - "Ethics"

[Trekker4747]

Worf is in a serious accident in a cargo bay that ends up damaging his spinal cord leaving him a paraplegic, an injury medical science has yet been able to fully correct. A specialist in these types of injuries is brought in on Worf's case to present to him any options he may have for his future.

The most common option is to use computerized implants in his body that will regain him some mobility, but only some 60% of it.

Worf's not happy with his future prospects and is preparing to undergo a Klingon rite that allows him to commit suicide in the event of this type of injury and he asks Riker to help perform the ritual. While Riker respects Worf's culture and rituals, he is reluctant to carry out the rite as he's personally against and, more over, the ritual requires a family member to perform it. Apparently not wanting young Alexander to help Worf kill himself he decides to go with another option presented to him by the visiting specialist.

The visiting specialist wants to test a procedure she's yet to try on humanoids and has only had minor success with in simulations. The procedure removes Worf's original, damaged, spinal column and replaces it with a replicated one. It'd allow Worf to regain all of his function before the injury following a recovery period but as the procedure is not fully tested or approved it carries with it the risk Worf will die in surgery.

Over the course of the episode Crusher and the doctor but heads over medical ethics and this procedure. Crusher feeling that even as a paraplegic Worf stands the chance of living a long, full, life. But as he's dedicated to killing himself the specialist feels her procedure is the best route to go.

Worf undergoes the surgery and while it initially seems to succeed Worf dies once off life support, but later recovers when redundancies in Klingon biology correct the problems the procedure apparently caused. Worf and Alexander work together through the rehabilitation.

It's interesting we reach this episode within the week where a woman in Oregon suffering from terminal cancer that was having a strong impact on her life opted to undergo that state's laws that allow for assisted-suicide in the event of a fatal medical condition. Without looking up the relevant dates, I suspect much of what went into writing this episode has to do with the events that allowed those laws in Oregon, namely the practices of Dr. Kevorkian.

However, it's hard to really grasp the connection between "Right-to-Die" laws when it comes to a patient suffering from a terminal illness that has a serious impact on quality of life (the woman in Oregon suffered from constant seizures and pain), a life that won't last much longer at-that; and a patient simply dealing with an injury they don't think they can live with, even though the injury has no meaningful impact on their life expectancy.

Here we have Worf being told he will live a long, healthy, life with his injury and that there are prosthetics and procedures available to him that'll allow him to have some mobility and he decides it's too much to deal with and opts for suicide. (We'll set aside that he's a Klingon with different views on what a quality of life means.) I don't think anyone would argue for someone to be allowed to commit suicide simply because they'll be confined to a wheelchair for the rest of their life.

In the episode, Picard takes on the role of the "Right to Die" argument, supporting Worf's decision (odd, since in the past he's been pretty against people's cultural rites interfering with Starfleet values. Namely when Worf killed Duras in accordance to Klingon vengeance rites conflicting with Starfleet moral ethics) to either kill himself or undergo the dangerous medical procedure. Riker, by contrast, takes the "Life" path in wanting to deny Worf the Klingon death rite. He even makes the standard "think of you friends and family" argument towards Worf when trying to talk him out of it.

Which, again, makes sense when talking to someone wanting to commit suicide over something minor as opposed to someone who's going to die anyway wanting to die under their own terms and without more, needless, suffering.

So it's hard for me to say or see what this episode is trying to go for as the message seems a bit mixed.

The visiting doctor is certainly an oddity and setting aside the notion of "perfect" humans supposedly not having her level of ambition or indifference to morals she comes across as a rather shitty doctor. Her medical "ethics" would even make Dr. House raise an eyebrow.

In one scene she's working with Crusher to treat injured survivors of another disaster and uses an experimental drug on a suffering patient not responding to conventional treatment. Rather than trying the recommended secondary treatment option she goes with a theory and tries an experimental one, ending the man's life. Justifying it that even the secondary option may not have worked and the data gained from her experiment could be valuable down the road for other patients in similar circumstances.

Seriously, how is this woman still a practicing doctor?! What she did there pretty much violates everything doctors are meant to stand-for, not to mention the present-day laws we have on patients having informed consent when undergoing a treatment. Which is why experimental drugs are done in trials where patients know the drug is experimental and that they may not even get the active drug but, rather, the placebo.

Here she just decides to do her own thing to see if it works and is rightfully relieved her ability to practice medicine on the Enterprise.

The episode also raises some questions in regards to medicine in the 24c. Here in 21c experimental drugs and procedures are usually tested on animals first and for all of the arguments one could make on the morality of testing on other creatures or whether or not tests on a rat translates to it working on a human is rendered invalid pretty much by the notion that every bit of medical knowledge, medicine and techniques we have all started somewhere on an experiment with an animal.

Maybe computer simulations in the 24c are very, very good at accurately replicating the effects an experiment would have on a living being but it feels a bit hard to believe that somewhere along the way between idea and field-use that a new drug or surgical technique isn't tried on a living being and that that living being wouldn't be a "lesser" creature whose loss would have no impact on the world. But much of what we know about the 24c tells us they respect non-humanoid animal "rights" as much as they do the rights to humanoids. So how does medical science in the 24c test a new medical procedure, device, or pharmaceutical in practical way without risking the life of a living being?

Also of note, it's a bit hard to believe that given everything we're shown about life in the 24c they cannot repair a spinal injury. If they've truly mapped out the entire human nervous system and have the ability to manipulate matter and energy on a quantum scale why would it be so hard to repair a damaged spinal cord? Hell, this is the problem with the existence of the transporter. Why not run Worf through it but use a previous pattern of him for re-materialization? We've seen the 'transporter trace' several times before to try and fix or identify problems, so shouldn't it be possible to repair a spinal injury in this manner? Sure, maybe Worf would lose the memories between that last transport and the accident but he'd be healed, right?!

Tiny little things: It's a minor thing but it's neat to see parts of the ship, in this episode it's what's likely an ICU suite.

I wonder why the dagger Worf was going to use to perform his ritual didn't have a sheath? When he lets Alexander take it back to their room we see Alexander walk off with it just holding it out in the open. (And in violation of all sharps-carrying protocol he carries it with the blade UP!)

The recreated effects on the BD look pretty good, in particular the effects of doctors looking at holograms of Worf's spine.

The episode is good, but I think the message is a little muddy. I'm also not a fan of the "Klingon redundancies" thing at the end. I mean, all organs are pretty much vital and evolution didn't see it fit to give humans a redundancy for all of organs. The most we get is two kidneys and a healthy liver that can repair itself. But Klingons are warriors so their evolution gave them "back ups" for all of their biological functions, including synaptic function? I guess it forgot to provide a back-up, or a self-healing, spinal column.

It's also interesting to note that in the realm of life imitating art the device used in this episode to "replicate" Worf a new spinal column has the hallmarks of present-day stem-cell research that could one day lead to us being able to repair spinal cord damage.

 

[tomalak301]

I didn't mind this episode, but it would have been so much better had it been Pulaski coming back.

 

[Trekker4747]

I didn't mind this episode, but it would have been so much better had it been Pulaski coming back.

Now, THAT would have been interesting. But may have damaged Pulaski's character as I'm not sure we're supposed to agree with Dr. Russell.

 

[The Old Mixer]

I always thought of the doctor as a Pulaski stand-in.

I think you're looking for the episode to take a side on the "right-to-die" issue, but it's not that simple...the episode explores both sides of the issue. If anything, it offers an interesting twist, because the closest thing we have to a religious side of the argument would be Worf's cultural paradigms, and they have him taking the opposite of the religious side of the issue in the real world.

And you can't dismiss the Klingon angle so easily. This is allegory, it explores issues through sci-fi situations. In this case, Worf's Klingon beliefs are central to the story. He'd probably rather have to endure excruciating pain than endure life as a handicapped person.

 

[BillJ]

I just hit the wall with season five during this episode. I realized I just didn't care. I didn't care about Crusher's outrage and I didn't care about Worf's honor. I haven't opened the case since trying to watch it and I didn't buy season six.

I just didn't care anymore.

 

[Memory Alpha]

I think Picard realizes that Worf will not be an officer as so long as he is paralyzed, which is probably why he more easily sees Worf's side of it. I'm simply not interested in the topic of right to die in this case because I view it as a choice best left to the person (so my mind is made up on it), we know that Worf somehow will pull through, the soul searching is boringly predictable, and I also view the organ redundancy thing as very highly contrived. They don't know this? I find that hard to believe. What does work for me is that we care about Worf, obviously, so it makes any clear cut "message" that might be here muddy. It hits closer to home, in other words, if it's a character we care about. I haven't watched this one in a long time and won't go out of my way to anytime soon.

 

[jimbotron]

My one problem with this episode is the Ready Room scene with Picard and Riker. Riker goes there to be talked out of assisting in Worf's suicide, but Picard basically nudges him in that direction. It's an out-of-character moment (up there with manic Janeway) considering the browbeating Picard gave Worf when he killed Duras "according to Klingon custom" a season earlier.

PICARD: Will, if you were dying, if you were terminally ill with an incurable disease and facing the remaining few days of your life in pain, wouldn't you come to look on death as a release?
RIKER: Worf isn't dying and he is not in pain. He could live a long life.
PICARD: You or I could learn to live with that disability, but not Worf. His life ended when those containers fell on him. We don't have to agree with it, we don't have to understand it, but we do have to respect his beliefs.
RIKER: I can respect his beliefs, but he is asking me to take an active role in his committing suicide.
PICARD: He's asking for your help because you're his friend. That means that you're going to have to make your decision based on that friendship.
RIKER: Which leaves me back where I started.
PICARD: Will. Look, I'm sorry, I cannot help you to make this decision, but I can tell you this. Klingons choose their friends with great care. If he didn't know he could count on you, he never would have asked.

So if Riker went through with it, Picard wouldn't think anything of it? Uh huh.

 

[Timo]

Now that would be consistent for Picard: with Bajorans, too, he changed his views after getting personally involved in the alien culture.

Also, it's not as if Picard actually disapproved much of Worf's murderous behavior. He would have stamped on it much harder if he did. It could be simple realpolitik - Worf murdering Duras was politically advantageous for the Federation. But more probably, it's Picard's personal views on alien behavior in action again.

Crusher's behavior is less logical here, but I find no fault in this as such. She's just as guilty of practicing "frontier medicine" and taking risky all-or-nothing approaches where conventional means have low odds of succeeding, so it's petty of her to attack Russell, but not uncharacteristic nor unwelcome from the story logic or dramatic point of view.

It seems Crusher doesn't do (or publish) much medical research, compared with Russell let alone Pulaski, so her differing views are quite understandable in that sense as well...

So how does medical science in the 24c test a new medical procedure, device, or pharmaceutical in practical way without risking the life of a living being?

Do we have a reason to believe the UFP doesn't practice animal testing?

In any case, "untested on humans" is not the same as "untested". The procedures Russell promoted might have been thoroughly tested, right up to the point of applying them on human patients, and were facing just this final hurdle, potentially not even the biggest in the path from idea to approval.

As for humans not knowing Klingon anatomy, this was still okay in ST6 (and I don't get the complaints that Uhura should have known the Klingon language, either), but not really in TNG any more. Sure, the Klingons are still considered alien and threatening and all, their status as "allies" is somewhat challenged by the fact that they still attack UFP installations on occasion, and virtually nobody interacts with them - but there's Worf, a prime specimen who has undergone several extensive medical examinations during his televised service years already.

Timo Saloniemi

 

[Marsden]

Crusher's behavior is less logical here, but I find no fault in this as such. She's just as guilty of practicing "frontier medicine" and taking risky all-or-nothing approaches where conventional means have low odds of succeeding, so it's petty of her to attack Russell, but not uncharacteristic nor unwelcome from the story logic or dramatic point of view.

Timo Saloniemi

I find this is a huge problem for me all throughout TNG, that the main characters are always right and any guest character is wrong unless they are in agreement. This is an oversimplification, I'm sure examples against it can be found, but the vast majority of interactions make all guest stars wrong and main cast right.

 

[Trekker4747]

As I said, the problem in this episode is that Russel's behavior was clearly out of line with how we practice medicine even today, let alone how it's likely practiced in the 24c.

I think saying Crusher is "just as guilty" of practicing such questionable medicine is grossly misrepresenting what happened here. I don't recall Crusher ever trying to prove her medical theories on unwitting subjects or trying to force experimental treatments on her patients.

The couple of times medical emergencies plagued the ship she went through a lot of simulated trials and tests before even attempting to use a presumed solution on a patient.

Here, Russel tests a theory on a dying patient not responding to traditional treatments. That's just beyond wrong and a violation of doctor/patient trust. Was she right that even the secondary common treatment wouldn't have worked? Maybe, but it was arrogant and reckless of her to not even try, instead, she tries a theory of hers and justifies it by saying the data gleaned from her experiment may save lives down the road.

Same goes for the issue with Worf, there was available treatment options for him. Sure, he was refusing them at the time preferring, instead, to commit ritual suicide but it wouldn't have been out-of-line for Crusher to have him monitored and his visitation restricted until the suicide threat was over. Suicide watch for despondent patients is practiced even today.

After a period of time, Worf may have came around and set-aside his desires for suicide and tried to go with the conventional treatments and prosthetics.

Overcoming a crippling injury is not something someone is going to do in days, and Crusher knew that over time Worf may have come around. Either adapting to his disability or going with conventional treatment.

Russel exploited a vulnerable patient to give him a glimpse of hope for returning to a normal life by undergoing an experimental treatment.

It's one thing to go for experimental treatment when one is in a critical situation where death is a likelihood no matter what, it's a whole other to go for it when conventional treatments can work.

Russel was way out of line and, really, it's a wonder she had any clout as a doctor taking her behavior on the Enterprise as an example of how she practiced medicine and research. In a society where so much value is placed on life, honesty and working for a greater good it's amazing Russel would be so lauded given that she tested theories on unwilling or compromised patients. Even today she'd be out on her ass.

The "worst" I can recall Crusher doing in regards to violating medical ethics are a couple autopsies she performed against the will of the patient's surviving family. Which even today is an accepted thing to do if it is suspected a crime was committed (as was the case when Crusher did her autopsies.)

 

[Timo]

Here, Russel tests a theory on a dying patient not responding to traditional treatments. That's just beyond wrong and a violation of doctor/patient trust. Was she right that even the secondary common treatment wouldn't have worked? Maybe, but it was arrogant and reckless of her to not even try, instead, she tries a theory of hers and justifies it by saying the data gleaned from her experiment may save lives down the road.

Which is different from how things are done today how? Russell's treatment supposedly has gone through all the hoops save human experimentation, and this has to start at some point. With ebola today, it starts with the set of victims readily available in western Africa, skipping the usual steps of initially small but progressively larger subject sets and going straight for a subject set of several hundred, but that's just a qualitative difference. Russell isn't even taking that risque step: she's starting with a single subject.

The ebola research is also relevant in that the researchers freely admit it has nothing to do with containing the current outbreak or helping individual victims - it's all about preparing for the next outbreak. Now, there won't be any "outbreaks" of broken spines in the near future, just further isolated cases, but the principle is much the same: withholding the cure from the future victims would be unethical.

So Russell didn't get formal approval from some higher office? We never hear Crusher waiting for such, either. Or anybody else for that matter.

it wouldn't have been out-of-line for Crusher to have him monitored and his visitation restricted until the suicide threat was over

How so? Everything in the episode points to Worf having the full legal right to commit suicide if he so wishes - ailment or no ailment. If Crusher tried to intervene, she might get arrested and brainwashed (if that's what they still do to criminals in the 24th century). Sure, our heroes always try to stop suicidees, but conveniently they never succeed, except in the case of main characters like O'Brien.

After a period of time, Worf may have came around

Or then not. How long should he remain in irons?

Russel exploited a vulnerable patient

All patients are vulnerable. Worf gave full consent. Even today, that should account for something; in the context of the episode, it's all that matters, according to Picard who's the real expert on law and morality in the show.

I'd very much have preferred Dr Russell to have been Dr Pulaski, as everything would fit: a lauded career of controversial research, a cut-to-the-chase working ethic, a bedside manner to match. Similarly, it would have been nice to see Admiral Jameison replaced by the originally intended Admiral Kirk. "Character assassination" isn't an issue in episodes of that sort, where there is real moral ambiguity involved.

Timo Saloniemi

 

[Zek]

All I gotta say is I agree with Picard's view regarding Worf's situation and Doc Crusher should have slapped the stupid quack for experimenting on her patients.

 

[jimbotron]

I'm pretty sure these were the kind of stories Gates did not want to do. She didn't take the role to be a hardass.