Critical Care

[Captrek]

In Critical Care, The Doctor is working in a hospital on an alien ship.

Scratch that. It’s their ship. He’s the alien. A reluctant alien, to be sure.

The medical ethics practiced here are different that the ones with which The Doctor is programmed. To him, a patient is a patient is a patient. To them, a small minority of patients who make disproportionate contributions to society are higher priority.

An interesting conflict of ethical systems, to be sure.

How does The Doctor resolve this conflict? He infects the hospital administrator with a fatal disease, lies about his Treatment Coefficient, and tells him, “If you want to live, we do things my way.” Is this a reasonable way to resolve an ethical dispute? Yes, if you’re on the right side of the argument!

In the end, The Doctor and Seven agree that he did the right thing because the needs of the many outweigh the needs of the few.

I might point out that the hospital works that way for the benefit of society at large, but that doesn’t concern The Doctor. The needs of the medium number outweigh the needs of the few or the whole world.

This can’t be justified. Not on deontological grounds. Not on utilitarian grounds. Not on “needs of the many grounds.” Certainly not by medical ethics. Trying to uphold the rights of patients is not justification for infecting someone with a fatal disease.

Anyone here think The Doctor is right to poison the administrator?

 

[DonIago]

Yes. Access to basic healthcare shouldn't be merit-based.

 

[Captrek]

Yes. Access to basic healthcare shouldn't be merit-based.

The question is about whether he’s right to poison the administrator rather than whether he’s on the right side of the argument.

I think the standards evolved on Earth the way they did largely because there’s nobody we trust to determine merit. Doesn’t mean it’s the best standard for all possible worlds and all possible species. The Doctor knows nothing of this world, its people, or its culture.

But this is a common thing in Trek. Go to alien worlds, forcibly impose (Western) Earth values, pat themselves on the back for being enlightened, and leave.

 

[DonIago]

The question is about whether he’s right to poison the administrator rather than whether he’s on the right side of the argument.

I think the standards evolved on Earth the way they did largely because there’s nobody we trust to determine merit. Doesn’t mean it’s the best standard for all possible worlds and all possible species. The Doctor knows nothing of this world, its people, or its culture.

But this is a common thing in Trek. Go to alien worlds, forcibly impose (Western) Earth values, pat themselves on the back for being enlightened, and leave.

As I consider access to basic healthcare a universal right, while I entirely respect the PD, let's remember that the EMH was abducted and forced into this situation; he didn't just show up and start telling them how things should be.

And I think there's also the question of whether we really think the EMH would have let the administrator die.

 

[Captrek]

As I consider access to basic healthcare a universal right, while I entirely respect the PD, let's remember that the EMH was abducted and forced into this situation; he didn't just show up and start telling them how things should be.

And I think there's also the question of whether we really think the EMH would have let the administrator die.

Equality in healthcare is a right. On a world that does not recognize that right, it is appropriate to enforce that right with violence and without regard to the impact on that world at large. Is that what you’re saying?

 

[Farscape One]

Considering The Doctor was abducted and forced to work on an alien world, he did the right thing.

If he was visiting or otherwise volunteered to work on that world? No, and for a very simple reason.

While I agree everyone should have proper healthcare, we also don't know about the resources of that planet or their situation. That world brought in Chellik's people because they needed an administrator for their resources.

If resources are finite, you need ways to make sure they last.

 

[DonIago]

Equality in healthcare is a right. On a world that does not recognize that right, it is appropriate to enforce that right with violence and without regard to the impact on that world at large. Is that what you’re saying?

Again, the EMH didn't choose to be in that situation.

 

[Tosk]

Equality in healthcare is a right. On a world that does not recognize that right, it is appropriate to enforce that right with violence and without regard to the impact on that world at large. Is that what you’re saying?

If you were kidnapped and forced to work in a foreign country, would you hold true to your values or immediately abandon them in favor of the values of your captors? Just curious.

In my opinion, the Doctor stretches one of his values (do no harm) to reinforce another (medical care for all who need it). The needs of the many forced him to do something he might not otherwise do.

 

[Captrek]

As I consider access to basic healthcare a universal right, while I entirely respect the PD, let's remember that the EMH was abducted and forced into this situation; he didn't just show up and start telling them how things should be.

And I think there's also the question of whether we really think the EMH would have let the administrator die.

I don’t see his status as an abductee as relevant. This had nothing to do with an escape attempt nor with proportionally punishing the kidnapping. His status as an abductee certainly doesn’t constitute an exception to the PD. (Thanks for mentioning that, BTW.)

As for the latter point… extorting a hospital administrator by threatening their life is defensible as long as they cave and you don’t end up killing?

 

[Captrek]

If you were kidnapped and forced to work in a foreign country, would you hold true to your values or immediately abandon them in favor of the values of your captors? Just curious.

In my opinion, the Doctor stretches one of his values (do no harm) to reinforce another (medical care for all who need it). The needs of the many forced him to do something he might not otherwise do.

“Needs of the many” reasoning weighs in the other side. The hospital worked the way it did for the benefit of society at large.

It’s also not consistent with medical ethics. You don’t save multiple lives with organ transplants by killing the person with all the healthy organs. The needs of the many do not justify doing harm. He didn’t stretch that rule, he demolished it.

On a completely related note, would you justify violence against the administrator of a 21st century Earth hospital that doesn’t respect the rights of patients as you see them, but is complying with an unjust law? How is that situation different?

 

[DonIago]

I don’t see his status as an abductee as relevant. This had nothing to do with an escape attempt nor with proportionally punishing the kidnapping. His status as an abductee certainly doesn’t constitute an exception to the PD. (Thanks for mentioning that, BTW.)

As for the latter point… extorting a hospital administrator by threatening their life is defensible as long as they cave and you don’t end up killing?

If you don't think the fact that he was abducted is relevant then I don't think I have anything further to contribute to this conversation. It rather seems you've already made up your mind.

 

[Captrek]

If you don't think the fact that he was abducted is relevant then I don't think I have anything further to contribute to this conversation. It rather seems you've already made up your mind.

I could say the same about you.

If you don't think the fact that he was abducted is relevant then I don't think I have anything further to contribute to this conversation. It rather seems you've already made up your mind.

I’ve already made up my mind? I’m not the one drawing absolutes and refusing to engage with reasoning. I didn’t say I don’t care that he was abducted, I’m saying that doesn’t necessarily justify everything when it’s not related to escaping.

 

[Captrek]

If you don't think the fact that he was abducted is relevant then I don't think I have anything further to contribute to this conversation. It rather seems you've already made up your mind.

I’ve already made up my mind? I’m not the one drawing absolutes and refusing to engage with reasoning. I didn’t say I don’t care he was kidnapped, I said that being kidnapped doesn’t entitle one to crimes that have nothing to do with escape and that it doesn’t constitute an exception to the PD.

It’s also not the justification given on screen and there’s no indication it’s what motivated the Doctor.

 

[NCC-73515]

Relevant parts:

EMH: I just saw a boy on Level Red who's dying. This medicine could save his life.

EMH: Voje, when you look at your patient lying there, you have to ask yourself what can I do? What must I do?

EMH: You have as much right to treatment as anyone.

EMH: You're not just rationing health care here. You're getting rid of the sick and the weak.

EMH: I don't know any other way to help these people.

SEVEN: There's no indication of diminished capacity.
EMH: No problems with my ethical subroutines?
SEVEN: None.
EMH: I see.
SEVEN: You seem disappointed.
EMH: While I was aboard that ship, I poisoned a man.
SEVEN: Deliberately?
EMH: Yes. I was trying to force him to let me treat patients who were dying.
SEVEN: You were prepared to sacrifice an individual to benefit a collective.
EMH: No offence, Seven, but I don't exactly aspire to Borg ideals.
SEVEN: You were hoping your behaviour was the result of a malfunction. I'm sorry Doctor, but I must give you a clean bill of health.

So he is aware of the ethical dilemma. This episode did what Trek became famous for. In the end, no one died, many were saved, society was shown a better way, while acknowledging the problematic way it was achieved.

 

[Captrek]

Relevant parts:

EMH: I just saw a boy on Level Red who's dying. This medicine could save his life.

EMH: Voje, when you look at your patient lying there, you have to ask yourself what can I do? What must I do?

EMH: You have as much right to treatment as anyone.

EMH: You're not just rationing health care here. You're getting rid of the sick and the weak.

EMH: I don't know any other way to help these people.

SEVEN: There's no indication of diminished capacity.
EMH: No problems with my ethical subroutines?
SEVEN: None.
EMH: I see.
SEVEN: You seem disappointed.
EMH: While I was aboard that ship, I poisoned a man.
SEVEN: Deliberately?
EMH: Yes. I was trying to force him to let me treat patients who were dying.
SEVEN: You were prepared to sacrifice an individual to benefit a collective.
EMH: No offence, Seven, but I don't exactly aspire to Borg ideals.
SEVEN: You were hoping your behaviour was the result of a malfunction. I'm sorry Doctor, but I must give you a clean bill of health.

So he is aware of the ethical dilemma. This episode did what Trek became famous for. In the end, no one died, many were saved, society was shown a better way, while acknowledging the problematic way it was achieved.

I’m not denying that the ethical dilemma was acknowledged, I’m saying that the “benefit a collective” (I.e., “needs of the many”) argument doesn’t weigh on their side like they say it does, unless the “many” of society at large doesn’t count. It was made clear that this system works for their society and that changing it would damage them. The Doctor’s “the needs of many patients outweigh the needs of the few patients” position is incompatible with “the needs of those patients outweigh the needs of the whole world.” It’s also incompatible with medical ethics, and he’s supposed to be a doctor.

 

[NCC-73515]

Not sure what you're looking for here

 

[Captrek]

Not sure what you're looking for here

I’m looking to understand other people’s values, and I’m getting it. I keep asking whether his ends justify his means. I keep getting answers that his ends were correct. I guess that’s a yes, with which I disagree.

Admittedly, I think his ends are debatable, but my concern is his means—and the laws, ethical standards, and Prime Directive those means apparently violated.

 

[Tosk]

The hospital worked the way it did for the benefit of society at large.

Who says? The guy who was willfully withholding medicine from people who would die without it?
The Allocator is a program, so throw away people's lives on its say-so? No thanks.

On a completely related note, would you justify violence against the administrator of a 21st century Earth hospital that doesn’t respect the rights of patients as you see them, but is complying with an unjust law?

It depends. In this situation am I a person who has been taken against my will to a culture not my own? Am I enslaved, as the Doctor was?

It was made clear that this system works for their society and that changing it would damage them.

Made clear only by people looking to justify the arrangement.

It was also made clear that some patients received medicine for purely preventative reasons when other people were literally dying from lack of said medicine. It was also made clear that when medicines weren't used to a certain level, less was allocated to them in subsequent periods. A hideous, idiotic arrangement.

and Prime Directive those means apparently violated.

How would the Doctor specifically go about observing the PD in this situation? The Prime Directive isn't meant to be used as a reason to blindly do as you're told by anyone who kidnaps you.

I keep getting answers that his ends were correct. I guess that’s a yes, with which I disagree.

I'm not personally saying that what the EMH did is the only way to go about it. But I do understand why he did what he did.

But fair enough, you disagree. What do you think the Doctor should have done?

 

[Captrek]

Who says? The guy who was willfully withholding medicine from people who would die without it?
The Allocator is a program, so throw away people's lives on its say-so? No thanks.

Who says? The laws of the world in which you are, for one thing. But the general argument here is that being abducted immunizes you from the laws of the place to which you are abducted.

The Allocator is a program developed by this society for its general benefit. It’s not an intelligence imposing its own will.

It depends. In this situation am I a person who has been taken against my will to a culture not my own? Am I enslaved, as the Doctor was?

Yes.

Made clear only by people looking to justify the arrangement.

You don’t know a thing about this world. The people who actually live there find that this system benefits them as a whole.

It was also made clear that some patients received medicine for purely preventative reasons when other people were literally dying from lack of said medicine. It was also made clear that when medicines weren't used to a certain level, less was allocated to them in subsequent periods. A hideous, idiotic arrangement.

The patients who received medicine for purely preventative pressings received it for the greater good of society, according to that society.

I’m not saying their position isn’t questionable, again, I’m mainly concerned with the means the Doctor used to change that position.

How would the Doctor specifically go about observing the PD in this situation? The Prime Directive isn't meant to be used as a reason to blindly do as you're told by anyone who kidnaps you.

No, it’s meant to be used as a reason to blindly avoid imposing your own values on another world, even at the cost of your freedom, even at the cost of your life.

I'm not personally saying that what the EMH did is the only way to go about it. But I do understand why he did what he did.

But fair enough, you disagree. What do you think the Doctor should have done?

I think the Doctor should have accepted the fact that he disapproves strongly of this world, but there’s nothing he can legally, ethically, or morally do to change them.

 

[Tosk]

I think the Doctor should have accepted the fact that he disapproves strongly of this situation, but there’s nothing he can legally, ethically, or morally do about it.

So just...be a slave ostensibly forever.