Medical Consent in the Federation

[chrinFinity]

Greetings,

Can anyone suggest examples of situations, from any series on screen or in lit, which depict one of the following situations:

- Medical patient refusing treatment
- Patient being treated against their will
- Characters discussing the ethics of medical treatment

The obvious examples which come to my mind are "Ethics," "Life Support," but I'm looking for more.

Thanks for any help you can provide.

 

[Defcon]

- Patient being treated against their will

Sons of Mogh could fit. It's some time since I've seen it, but I don't think Kurn was aware that his Memory would be altered.

 

[Mr. Laser Beam]

There was an ENT episode where Phlox can't treat a patient who refuses to allow it, since Denobulan medical ethics put the patient's wishes above all else.

 

[T'Girl]

Tuvix would be a case of the patients (Tuvok and Neelix) not being able to be consulted.

The third season ENT episode where Tucker was cloned, so the clone could provide "something" to save Tucker's life. But the clone would die in the process.

 

[Christopher]

There's "The Enemy" on TNG. Everyone always talks about how Worf refused to give a transfusion and let the Romulan patient die, but I've always found that a misreading of events, because the Romulan himself explicitly refused treatment, which rendered Worf's opinion irrelevant. Indeed, I got the distinct impression that Worf was on the verge of agreeing to give the transfusion when the Romulan made it clear that he would refuse it.

Phlox was pretty firm in "The Breach" (IIRC) about not forcing treatment on an unconsenting patient.

In the literature, what comes to mind is Destiny, where Deanna refused to terminate her unviable pregnancy even with the knowledge that the inevitable miscarriage would kill her. There were some lively debates about consent there, I think.

 

[Enterprise1701]

A plot point in Articles of the Federation revolves around the character Doctor Rebecca Emmanuelli. During the Federation-Tzenkethi War, she was captured by the Tzenkethi, who reported her dead to the Federation because they valued her medical skills. Several times while she was a prisoner on Ab-Tzenketh, the Tzenkethi forced her to prioritize patients of higher castes per their social protocol, disgusting Emmanuelli. Several years later, after she had been freed, she initially refused to utilize her experience to treat a Tzenkethi child because she had been a prisoner of the Tzenkethi for so long. President Bacco finally personally persuaded Emmanuelli to do so. Never mind that though because the child ended up being beyond help and thereafter died.

 

[Snaploud]

Star Trek: Deep Space Nine: The Quickening (season 4, episode 24) is a good one. A planet suffers from a seemingly incurable disease that creates a slow, painful death. The locals are able to offer a quiet, comfortable death for the afflicted, but Bashir wants to find a cure. Unfortunately, even the possibility of finding a cure means putting such individuals through agony as he runs diagnostics and tries different medicines.

Star Trek: Voyager: Nothing Human (season 5, episode 8) involves a hologram of a Cardassian doctor who experiments on individuals to gain medical knowledge. B'Elanna is treated by this holographic doctor (using knowledge acquired through those experiments) and is furious that she was denied the right to refuse treatment.

There's also a short bit in a couple pages of Star Trek: Department of Temporal Investigations: The Collectors (starting at location 279):

A DTI agent is sent to the future, injured, and then healed using future-technology without asking his permission (as he was unconscious at the time). Once conscious, he was offered additional medical treatments but refused due to concerns about affecting the timeline.

 

[Christopher]

It's pretty much standard procedure to treat unconscious accident victims, isn't it?

 

[Idran]

Yeah; if the patient is in immediate danger but not conscious, there's no immediate family around to give consent on their behalf, and it's something that the average person would likely give consent to in the opinion of the one treating them, then consent is assumed until one of those things is no longer true.

 

[Thrawn]

The DS9 novel The Siege also has a really strong plotline about this. (Oddly enough, it's almost scene for scene identical to a Babylon 5 episode written independently at the same time.)

 

[Snaploud]

It's pretty much standard procedure to treat unconscious accident victims, isn't it?

Yeah; if the patient is in immediate danger but not conscious, there's no immediate family around to give consent on their behalf, and it's something that the average person would likely give consent to in the opinion of the one treating them, then consent is assumed until one of those things is no longer true.

I would agree that the above quotes are representative of average twenty-first century human cultural norms and standards. However, it seems to me that, given the 31st-century technology shown, the doctors could or perhaps should have put the body in stasis and sought ways to communicate with the individual in order to determine his desired course of medical care. Alternatively, the body could have remained in stasis until a court or other group reasonably determined how the patient would want to be treated.

 

[Idran]

It's pretty much standard procedure to treat unconscious accident victims, isn't it?

Yeah; if the patient is in immediate danger but not conscious, there's no immediate family around to give consent on their behalf, and it's something that the average person would likely give consent to in the opinion of the one treating them, then consent is assumed until one of those things is no longer true.

I would agree that the above quotes are representative of average twenty-first century human cultural norms and standards. However, it seems to me that, given the 31st-century technology shown, the doctors could or perhaps should have put the body in stasis and sought ways to communicate with the individual in order to determine his desired course of medical care. Alternatively, the body could have remained in stasis until a court or other group reasonably determined how the patient would want to be treated.

Given the 31st-century culture shown, though, how it was handled seems to fit right in with what we saw of the rest of the society of the day.

 

[Christopher]

The DS9 novel The Siege also has a really strong plotline about this. (Oddly enough, it's almost scene for scene identical to a Babylon 5 episode written independently at the same time.)

Not so odd; as one of the two writers observed (I forget whether it was Peter David or David Gerrold), they were both responding to a recent news story along similar lines. And the two stories weren't really about a patient refusing treatment, but about a child whose parents' religion led them to refuse the child's treatment. I think that in both cases, the child consented in defiance of the parents' will -- or rather, in defiance of one of the parents, while the other parent was convinced to go along.

And I liked The Siege's outcome better than the outcome in "Believers" (I think that was the title).

 

[The Wormhole]

There's "The Enemy" on TNG. Everyone always talks about how Worf refused to give a transfusion and let the Romulan patient die, but I've always found that a misreading of events, because the Romulan himself explicitly refused treatment, which rendered Worf's opinion irrelevant. Indeed, I got the distinct impression that Worf was on the verge of agreeing to give the transfusion when the Romulan made it clear that he would refuse it.

Pretty much how I've always interpreted that episode, although I'm not sure if Worf was considering giving the transfusion. But I guess he did go and talk to the Romulan despite his personal feelings on the matter, which is a pretty significant step for Worf to take.

I think what causes everyone to misinterpret the episode is the fact that even after the Romulan says he doesn't want Klingon blood "polluting" his veins the storyline continues for a while longer with Worf being pressured by Dr. Crusher into donating his blood and eventually getting called into the ready room to have a heart-to-heart with Picard on the matter.

 

[Snaploud]

It's pretty much standard procedure to treat unconscious accident victims, isn't it?

Yeah; if the patient is in immediate danger but not conscious, there's no immediate family around to give consent on their behalf, and it's something that the average person would likely give consent to in the opinion of the one treating them, then consent is assumed until one of those things is no longer true.

I would agree that the above quotes are representative of average twenty-first century human cultural norms and standards. However, it seems to me that, given the 31st-century technology shown, the doctors could or perhaps should have put the body in stasis and sought ways to communicate with the individual in order to determine his desired course of medical care. Alternatively, the body could have remained in stasis until a court or other group reasonably determined how the patient would want to be treated.

Given the 31st-century culture shown, though, how it was handled seems to fit right in with what we saw of the rest of the society of the day.

Agreed. I don't think it was written improperly. I'm just pointing out how another society might have acted with similar technology.

 

[drc]

There is also "Up the Long Ladder," where it's shown that you're allowed to phaser your own clone under certain circumstances.

 

[Christopher]

There is also "Up the Long Ladder," where it's shown that you're allowed to phaser your own clone under certain circumstances.

Well, that was a case where Riker and Pulaski were cloned without their consent, which constituted a violation. It was no doubt intended as an abortion-choice analogy, tantamount to the issue of whether someone impregnated by rape has the right to terminate the pregnancy -- coming down on the side that they do have that right. Although the episode somewhat confused the issue by portraying the unfinished clones as full-grown adults rather than fetuses.

 

[drc]

There is also "Up the Long Ladder," where it's shown that you're allowed to phaser your own clone under certain circumstances.

Well, that was a case where Riker and Pulaski were cloned without their consent, which constituted a violation. It was no doubt intended as an abortion-choice analogy, tantamount to the issue of whether someone impregnated by rape has the right to terminate the pregnancy -- coming down on the side that they do have that right. Although the episode somewhat confused the issue by portraying the unfinished clones as full-grown adults rather than fetuses.

Yeah, a change in the size of the prop would have helped a lot in that situation. The rest of the episode treats the clones as individuals with lives of their own, but makes no effort to tell us if the clones of our heroes would be the same.

The same issue happens in "A Man Alone" we're told in a log entry that the clone Bashir grew "... gained consciousness and began a new life." Again proving that the Trek TV writers don't always think through the implications of the tech they introduce.

 

[Christopher]

Yeah, a change in the size of the prop would have helped a lot in that situation. The rest of the episode treats the clones as individuals with lives of their own, but makes no effort to tell us if the clones of our heroes would be the same.

Well, of course they would've been once they were fully grown, but the idea was that they were still incomplete, still "fetal," despite looking like adults.

 

[Etoile]

A plot point in Articles of the Federation revolves around the character Doctor Rebecca Emmanuelli. During the Federation-Tzenkethi War, she was captured by the Tzenkethi, who reported her dead to the Federation because they valued her medical skills. Several times while she was a prisoner on Ab-Tzenketh, the Tzenkethi forced her to prioritize patients of higher castes per their social protocol, disgusting Emmanuelli. Several years later, after she had been freed, she initially refused to utilize her experience to treat a Tzenkethi child because she had been a prisoner of the Tzenkethi for so long. President Bacco finally personally persuaded Emmanuelli to do so. Never mind that though because the child ended up being beyond help and thereafter died.

Oh yes, fine example. There were military-type ethics involved as well, as Emmanuelli had threatened to resign her commission if she received an order to perform the surgery. Bacco sweet-talked her into it instead of having to give an order.