The purpose of this thread was to discuss the poisoning of Chellick. I wanted us not just to pass verdict on the Doctor, but to think about the standards by which that act might be judged and the consequences of applying those standards to others. Are we really judging according to coherent, consistent standards, or just reflexively defending someone we like?
I was not interested in picking nits with behavior and rhetoric throughout the episode because it was not relevant to that purpose. However, since discussion on the thread topic is dead, here are some observations:
CHELLICK: These patients will be your chief responsibility from now on. Do whatever you can to make them well.
EMH: Why are these patients getting preferential treatment?
CHELLICK: They have a higher TC than the others.
EMH: Indulge me. What's TC?
CHELLICK: Treatment Coefficient. The Allocator assigns one to every patient. It determines the level of care they receive.
EMH: How is this coefficient derived?
CHELLICK: Through a complex formula that involves profession, skills, accomplishments.
EMH: How is any of that relevant to medical treatment?
CHELLICK: An agricultural engineer is obviously more important than a waste processor.
EMH: Important to whom?
CHELLICK: Society. When your resources are limited, you have to prioritise.
Yeah, but prioritize how? The Denaali way, the Terran way, or whatever the Doctor is doing in this episode?
EMH: So you base treatment on whether patients have particular abilities?
CHELLICK: It's much more complicated than that. The Allocator assesses the entire individual.
EMH: And reduces his life to a number.
CHELLICK: It may seem impersonal, but it's what the Dinaali have contracted us to do.
On the page, this almost reads like McCoy and Spock. On the screen, the Doctor’s delivery is unlike anything McCoy ever does without Cordrazine.
EMH: In some societies, it's considered rude to refer to someone in the third person while he's standing in front of you.
”In some societies (i.e., mine)” is what the Doctor says throughout the episode:
You’re not following the values of my world. Shame on you.
DYSEK: Keeping her healthy contributes to our survival. Can you say the same for the boy on Level Red?
EMH: Who knows what he'll accomplish if he has the chance.
I’m not sure what he’s saying here.
Is he saying that the uncertainty of the future makes it a pointless exercise to try to estimate the impact of a public policy on social welfare?
Is he saying that the calculation should treat those who might possibly become major contributors as equivalent in impact to proven major contributors?
What is his point here?
DYSEK: I'm sorry he's sick, but our society is much better off since we began following the Allocator's protocols.
EMH: Some of you are.
Dysek said society as a whole, not literally everyone. It is the Doctor, not Dysek, who is limiting his considerations to “some.”
TEBBIS: You're wasting time you could be spending with other patients.
EMH: You have as much right to treatment as anyone.
Tebbis is talking about a concept with which an EMH ought to be familiar: triage. You spend your time where it will do the most good. You don’t just pick out someone you like and say, “You have as much right to treatment as anyone.” Everyone else has as much right to treatment as he does, and some of them need it a lot more right now.
You have to allocate what you have. That’s not a rule of behavior, it’s a mathematical fact, and if you don’t think of it as allocation, it’s still allocation. “In some societies,” doctors practice triage. It’s just allocating your time and supplies with awareness of their limits.
The Denaali system is, essentially, a different approach to triage.
Here in Western medicine, doctors allocate limited resources where they are projected to do the most good. When they project that good, they consider only the good of the patients. They do not project the impact of the care of particular patients on the lives and welfare of people outside the hospital walls. That’s a good thing too, because doctors are not qualified to make that evaluation.
On the Denaali world, there is an understood and accepted set of objective standards to project the expected impact of a patient’s care on the outside world, and they take those projections into account when allocating.
You can approve or disapprove of the Denaali system, and I’m certainly not advocating that we attempt to implement a similar system here, but for the Denaali it seems to work.
EMH: Nurse?
NURSE: Yes, Doctor?
EMH: Why hasn't this patient received her additional cytoglobin injection?
NURSE: Additional?
EMH: If you'd examined her chart, you'd see that I've increased her dosage.
NURSE: Doctor Dysek didn't say anything.
EMH: Doctor Dysek is at home with his family. Would you like me to contact him so you can explain why you're not doing your job?
NURSE: No, Doctor. Requesting one cytoglobin injection for Patient B three, priority blue seven gamma.
ALLOCATOR: One cytoglobin injection authorised.
EMH: I'll do it myself.
NURSE: Can I assist you?
EMH: You may go.
(When she has gone he pockets the hypo and goes down to Level Red, where he uses it on Tebbis instead.)
Prescribes medicine for a patient, records that the patient has been dosed with it, and pockets it. This is supposed to be modeling how medical ethics work? Is needing the medicine supposed to justify this?
EMH: How are you feeling?
TEBBIS: Better.
EMH: That's what happens when you get the proper treatment.
TEBBIS: But I'm not authorised to receive cytoglobin.
EMH: You are now.
In some societies, that’s called insurance fraud. Most doctors consider it unethical.
TEBBIS: Whatever you did, they'll find out. They'll punish you.
EMH: You're assuming I've done something illicit.
TEBBIS: Didn't you?
EMH: Of course not. I simply had a talk with Chellick, explained to him what a bright young man you are, and he had the Allocator recalculate your TC.
If he’s proud of his conduct, why lie to Tebbis?
TEBBIS: I've never met a doctor like you.
I would hope not.
VOJE: Where did you get the cytoglobin?
EMH: Level Blue, where else.
VOJE: You stole it?
EMH: I prefer to think of it as reallocation.
How about “Yes”? Stealing is always reallocation.
VOJE: Three of the patients we injected are practically virus free.
EMH: What did you expect?
VOJE: Maybe we could reallocate other medications. Treat more patients.
EMH: Now you're thinking like a doctor.
Stealing medicine is not thinking like a doctor, even if your patient needs it.
EMH: I demand an explanation for the death of that boy.
CHELLICK: I'm responsible for thousands of patients. You'll have to be more specific.
EMH: His name was Tebbis, Patient R twelve.
CHELLICK: Acute chromo-viral disease.
EMH: He was recovering.
CHELLICK: Apparently, he developed complications.
EMH: What kind of complications?
CHELLICK: A secondary infection. It spread rapidly.
EMH: How was it treated?
CHELLICK: It wasn't. The patient had exceeded his medication allotment. It seems someone had given him unauthorised injections. Did you think I wouldn't find out?
EMH: Don't you have any ethical standards?
Of course he does. What the Doctor really means here is, “Don’t you have
my ethical standards?” Meanwhile, he is hardly modeling those standards himself.
CHELLICK: You are hardly in a position to speak to me of ethics. Lying, stealing. Any other crimes you wish to confess?
EMH: I was trying to save lives.
CHELLICK: And I am trying to save a society. Do you really think Patient R twelve is going to help me do that?
EMH: His name was Tebbis.
CHELLICK: He wasn't contributing. He was a drain on resources.
EMH: You're not just rationing health care here. You're getting rid of the sick and the weak.
CHELLICK: If the boy had been fit, he would have survived.
EMH: Why don't you just put a phaser to their heads?
Not having enough resources to save everyone is in no way comparable to phasering patients.
EMH: I'm going to expose you.
CHELLICK: To whom, the people who employ me? They brought me here to make the hard choices they don't want to make.
By all indications, the system is widely understood and accepted on this world. We don’t hear Red patients and other doctors railing against the unfairness, only the Doctor. He thinks “I’m going to expose you” is a threat because things aren’t done here the way they are “in some societies.” There is nothing to expose. The Doctor just can’t believe that this world actually accepts a different set of healthcare standards.
EMH: You mean those patients that I treated? Yes, that was inconsiderate of me.
CHELLICK: It was. You managed to exceed their annual medication allotment in a matter of days. They're being sent home.
EMH: They'll die.
CHELLICK: You should have considered the consequences of your actions.
EMH: Please, don't make them suffer for my mistakes. It won't happen again.
It’s not punishment. It’s exhaustion of resources. It’s the arithmetic of limited budgets and finite supplies. It’s the Doctor who’s making people suffer for his mistakes, not Chellick.
EMH: I demand an explanation for the death of that boy.
CHELLICK: I'm responsible for thousands of patients. You'll have to be more specific.
EMH: His name was Tebbis, Patient R twelve.
CHELLICK: Acute chromo-viral disease.
EMH: He was recovering.
CHELLICK: Apparently, he developed complications.
EMH: What kind of complications?
CHELLICK: A secondary infection. It spread rapidly.
EMH: How was it treated?
CHELLICK: It wasn't. The patient had exceeded his medication allotment. It seems someone had given him unauthorised injections. Did you think I wouldn't find out?
EMH: Don't you have any ethical standards?
CHELLICK: You are hardly in a position to speak to me of ethics. Lying, stealing. Any other crimes you wish to confess?
EMH: I was trying to save lives.
CHELLICK: And I am trying to save a society.
Chellick is implementing policies calculated to maximize total social welfare for the world. The Doctor doesn’t see beyond the impact of that policy on Tebbis.
CHELLICK: I suspect young Doctor Voje helped you escape.
EMH: He had nothing to do with it.
CHELLICK: No matter. You're becoming far too troublesome. I'm going to have to deactivate your programme.
(Chellick reaches for the mobile emitter. The EMH grabs his arm, pulls him down across the console and injects him.)
Poison? To quote a great philosopher, “Why don’t you just put a phaser to his head?” Oh yeah, this is more poetic. And painful.
VOJE: What's wrong with him? What are you doing?
EMH: A little experiment in empathy.
The Denaali hired him to be Spock because a world full of McCoys couldn’t get the job (however they defined it) done without him. He doesn’t need a lesson in empathy for certain people.
Correction: Doc didn’t say “lesson” in empathy, he said “experiment” in empathy. He’s testing a hypothesis:
Does a hologram feel empathy for a hospital administrator it just poisoned for allocating medicine according to the wishes of his employer?
VOJE: You told me you were just developing new treatment protocols.
…
VOJE: I trusted you.
EMH: And Tebbis trusted me.
I violated your trust because I couldn’t save Tebbis. Don’t take it personally, Voje, I’m lying to
everyone in this episode. I even lied to Tebbis. I find it an effective form of persuasion.
The Doctor is horrified at the way medicine is practiced here.
He tells people like Chellick and Dysek that medicine should be practiced the “right” way.
When talking doesn’t work — he tries yelling.
When yelling doesn’t work — he resorts to fraud.
When fraud hits its limits — he turns to a particularly sadistic form of armed robbery (in the name of empathy

).
Is the result of these actions supposed to be a world stopping to think, “We should listen to what the medical hologram had to say about the way we practice medicine”? He didn’t even write a manifesto.