Losing the Peace - ethics question (spoilers)

[kkozoriz1]

His refusal to enter the healing trance could be taken as a "do not resuscitate" notice.

The scenario you're talking about is one where the patient is unconscious and clearly incapable of making an informed decision about his medical care.

So there's no resuscitation of any kind involved. A DNR is something that applies in a situation where the patient would be unable to recover or survive without medical treatment. That is simply not the case here. The patient was fully capable of recovering and leading a full life.

What Crusher did is analogous to nothing more than sedating a delirious patient to keep him from tearing his IV out. There's no way in hell that constitutes a violation of a DNR order. There is no ethical dilemma here. She was totally in the right.

This quote shows that he was capable of making a decision in regards to his care.

"“But if it’s natural, why wasn’t he healing himself?”
“Because he didn’t want to.”

He made a deliberate decision NOT to use his healing trance. And without a knowledge of how his society views suicide we cannot say his decision was not a totally valid one for his species or culture.

As to comparing it to tearing out an IV, a delerious paitent isn't making a decision to remove the IV. If the patiant was able to make the decision and removed the IV themselves would be closer to this situation.

resuscitation[/I] of any kind involved. A DNR is something that applies in a situation where the patient would be unable to recover or survive without medical treatment. That is simply not the case here. The patient was fully capable of recovering and leading a full life. .

But Crusher did administer treatment. I would say that putting someone into a coma that prevents certain parts of their brains from operating would constitute a medical procedure. If you are preventing someone's subconcious mind from operating using artifical means, could that not be taken as a medical treatment?

 

[Sci]

His refusal to enter the healing trance could be taken as a "do not resuscitate" notice.

The scenario you're talking about is one where the patient is unconscious and clearly incapable of making an informed decision about his medical care.

So there's no resuscitation of any kind involved. A DNR is something that applies in a situation where the patient would be unable to recover or survive without medical treatment. That is simply not the case here. The patient was fully capable of recovering and leading a full life.

What Crusher did is analogous to nothing more than sedating a delirious patient to keep him from tearing his IV out. There's no way in hell that constitutes a violation of a DNR order. There is no ethical dilemma here. She was totally in the right.

This quote shows that he was capable of making a decision in regards to his care.

"“But if it’s natural, why wasn’t he healing himself?”
“Because he didn’t want to.”

He made a deliberate decision NOT to use his healing trance. And without a knowledge of how his society views suicide we cannot say his decision was not a totally valid one for his species or culture.

But, again, the his culture has been a part of the Federation for decades. Crusher would by necessity know what his legal rights as a Federate and as a S'ti'ach are, and she would not have violated his culture's laws.

 

[Turtletrekker]

I have to admit kkozoriz1, that I find your views on medical ethics to be rather... "Zoidbergian"?

 

[Christopher]

This quote shows that he was capable of making a decision in regards to his care.

"“But if it’s natural, why wasn’t he healing himself?”
“Because he didn’t want to.”

He made a deliberate decision NOT to use his healing trance. And without a knowledge of how his society views suicide we cannot say his decision was not a totally valid one for his species or culture.

If it's not in a signed, witnessed legal document, it does not count. This is not something decided on a whim. You don't let someone die just because you have the impression that they might want to. It should be obvious that the burden of proof is the other way around: you assume your responsibility is to save the patient unless it's absolutely clear and legally documented that they refuse extraordinary measures.

As to comparing it to tearing out an IV, a delerious paitent isn't making a decision to remove the IV. If the patiant was able to make the decision and removed the IV themselves would be closer to this situation.

You're missing the point of the analogy. The point is that the patient was not in a terminal state. The patient would be perfectly capable of recovering without heroic intervention. Therefore, it is simply not a situation where DNR would come into play. It isn't even close to that.

Besides, you're falsely assuming that the patient was of sound mind. The fact that he was suicidal, that he wanted to die when he was perfectly capable of recovery, proves that he was not of sound mind.

Listen to me. I have recent, painful firsthand experience with this, and I'm telling you facts that I've had to learn the hard way over the past few months. This isn't a hypothetical Internet chat topic for me like it is for you. This is a very difficult part of my recent life. So please believe me, I know what I'm talking about here. You're just plain wrong about this. You're wrong on every conceivable level.

 

[kkozoriz1]

This quote shows that he was capable of making a decision in regards to his care.

"“But if it’s natural, why wasn’t he healing himself?”
“Because he didn’t want to.”

He made a deliberate decision NOT to use his healing trance. And without a knowledge of how his society views suicide we cannot say his decision was not a totally valid one for his species or culture.

If it's not in a signed, witnessed legal document, it does not count. This is not something decided on a whim. You don't let someone die just because you have the impression that they might want to. It should be obvious that the burden of proof is the other way around: you assume your responsibility is to save the patient unless it's absolutely clear and legally documented that they refuse extraordinary measures.

As to comparing it to tearing out an IV, a delerious paitent isn't making a decision to remove the IV. If the patiant was able to make the decision and removed the IV themselves would be closer to this situation.

You're missing the point of the analogy. The point is that the patient was not in a terminal state. The patient would be perfectly capable of recovering without heroic intervention. Therefore, it is simply not a situation where DNR would come into play. It isn't even close to that.

Besides, you're falsely assuming that the patient was of sound mind. The fact that he was suicidal, that he wanted to die when he was perfectly capable of recovery, proves that he was not of sound mind.

Listen to me. I have recent, painful firsthand experience with this, and I'm telling you facts that I've had to learn the hard way over the past few months. This isn't a hypothetical Internet chat topic for me like it is for you. This is a very difficult part of my recent life. So please believe me, I know what I'm talking about here. You're just plain wrong about this. You're wrong on every conceivable level.

Christopher, I know what you are going through and I sympathize. I really do. Three years ago I had to dash to the far side of the country because my sister was in the hospital in terminal condition. My parents didn't feel that they were up to making medical decisions so it fell to me as the eldest child. Believe me, I know where you are coming from.

This has gotten way too personal.

 

[chelly]

I don't think anyone would have been in a sound mind if they thought they were going to get obliterated or worse be assimilated by the borg.

 

[ProtoAvatar]

The crusp of the argument is whether the suicidal patient was in a sound mind when he made the decision to commit suicide.

A clearly thinking person will commit suicide only when he has a VERY solid reason for this - when his future life will be filled with suffering.
For example, an ill person could choose to commit suicide when he suffers from an incurable ilness that guarantees any future will be filled only with pain, suffering and then death.
Arguably, a person could choose to commit suicide when his future prospects involve certain and continuous suffering due to his social conditions combined with a severe infirmity.

In 'Losing the peace', the S'ti'ach was a citizen of the federation.
His present situation might have been bleak due to personal losses and/or being in a refugee camp, but his future was quite promising.
In light of his decision to commit suicide, his mental state was highly suspect.
The correct course of action was to cure him, then provide psychological therapy to him; what decisions will he make then? Will he still choose suicide? If so, should one let him commit suicide?

 

[JD]

Well, if the shrinks and Dr.s do their jobs right, he won't want to. And as long as he does then obviously they haven't and will keep working with him until he does not. It kind of defeats the whole point of saving him if you're just going to let him kill himself as soon as he wakes up.

You're not seriously saying that suicide is really a legitimate solution for people with social problems are you? I can see maybe if you have a medical problem that will cause pain and death, but (and I'm talking as a person who has contemplated suicide in the past here) pretty much all social problems can be solved in an other way. I know looking back, I would have wanted to have been treated if I had actually gone through with what I was thinking about.

 

[Christopher]

I did some research into DNR and suicide. Basically, the general policy seems to be that if there's reason to suspect suicide or foul play, a DNR order should be revoked or disregarded, at least until those suspicions can be ruled out. In other words, suicide negates DNR. If a patient is clearly suicidal, as this S'ti'ach was, then the medical provider's obligation is to keep the patient alive even if he has a DNR on file.

So there's absolutely no question here. By every remotely applicable standard of medical ethics, Dr. Crusher's ethical obligation was to save the patient's life, NOT to let him die.

 

[kkozoriz1]

The hegh'bat is a Klingon ritual suicide. Tradition dictates that the eldest son, or a close friend, must assist. That person's role is to hand the dying Klingon a knife so that he can plunge it into his heart The helper then removes it and then wipes the blood off on their sleeve.

All Kaelons are required to perform suicide at age of sixty so that the elders won't stress the society.

Some Vulcans perform ritual suicide when they "reach a certain infirmity of age".

All references taken from Memory Alpha. http://memory-alpha.org/wiki/Suicide

Any time a doctor suspects suicide they must act to save that person? What about Eminiar VII and Vendikar? People willingly went into the disintegration chambers. It was not only permitted, it was expected. Crusher knew that Timicen was leaving the ship for the sole purpose of commiting suicide. Should she have used her authority as CMO to have him confined to sickbay?

Is it not possible that our ideas on suicide and assisting such could change in 300 years? Crusher seemed rather cavalier about it. If she encountered a Vulcan who has reached "reach a certain infirmity of age" would she be right to stop them as well? Not all Vulcans practice this ritual.

 

[JD]

Yes, but those are specific cultural things, and if something like this was a cultural thing for the S'ti'ach, who happen to be Federation members, I'm pretty sure Crusher or someone else would have known.

 

[Sci]

Yes, but those are specific cultural things, and if something like this was a cultural thing for the S'ti'ach, who happen to be Federation members, I'm pretty sure Crusher or someone else would have known.

Exactly. As I've said several times in this thread, the S'ti'ach are Federation citizens, and Crusher, a former head of Starfleet Medical (which, by the way, the previous TNG novel Death in Winter establishes to be the Federation Surgeon-General), would be familiar with the S'ti'ach's cultural requirements regarding suicide.

 

[kkozoriz1]

I can't imagine that Anyone short of Spock or Data would know all about all the races in the Federation. Crusher didn't even consult the computer. She simply said that he didn't want to use his natural healing ability and removed his ability to block it. Imagine all the various cultures on Earth. No multiply that by the number of Federation members. That's a lot to keep in mind. Even the best doctors have to look things up from time to time, especially if it's not directly related to medicine. Even the Vulcans have varying customs as shown in my previous post.

It just seemed very out of place when we've been shown cultures that not only accept but encourage suicide.

 

[Christopher]

The rationale behind your questions is incomprehensible to me. Why would you expect any medical professional whose name wasn't Kevorkian to default to letting someone die? That is anathema to the way doctors think. You assume your job is to save lives unless you KNOW beyond a reasonable doubt that your responsibility is otherwise. That's the whole frakking point of medicine! Assuming that you're supposed to let someone die when there's even a chance that you're supposed to save them is called malpractice. It's called criminal negligence.

And I can't believe that any remotely sane society would deem suicide to be desirable in every possible context. Any such society would lose so many of its members to temporary bouts of depression that it would be unable to function. I could see it being accepted in certain specific contexts, such as cases of terminal illness or terminal dishonor, but there's absolutely no reason to suspect that was the case here. There's no reason to believe this situation was anything other than it appeared to be -- a traumatized individual experiencing suicidal impulses as a pathological response to the trauma of injury. You're overcomplicating it needlessly. You asked an ethical question and got a definitive answer.

 

[kkozoriz1]

Normally I would agree with you Christopher. I do agree with you fully in the real world but we're discussing what it would be like in the Star Trek reality. The most obvious example of this is Half a Life. Timicin is expected to commit suicide or "the Resolution" simply because he is turning 60 years old. His entire culture is in an uproar because he tried to avoid it. They sent two warships to intercept the Enterprise. Strangely, Dr. Crusher only had one line in the episode. It's mostly a Lwaxana story. Even so, the crew seems to be quite content to allow him to beam down for the express purpose of killing himself. The culture is presented as sane enough for the Federation to send one of their largest ships to help them with a scientific program.

In the episode Ethics, Worf is quite prepared to commit ritual suicide in accordance with his culture. Dr. Crusher does not stop him from talking to Riker about it. Riker doesn't even refuse outright but finds a loophole that allows him to pass the burden to Alexander. If Alexander were more Klingon like in personality, it's quite likely that he would have gone along with Worf's request.

We're not dealing with human cultures here. We're dealing with aliens. If the S'ti'ach were a human I'd have no question that Crusher should act as she did. But she knows of at least two cultures where it's either considered an honorable death or even something that is not only allowed but expected.

If instead of Lwaxana it was Crusher that was involved with Timicin would she be in the right to step in and revive him? Would she be performing an ethical duty if she beamed him up to the ship and refused to release him as long as he was planning on doing something that is considered 100% normal by his culture?

What about McCoy shutting off the life support for him father? He said that a cure was later found, leading us to believe that his father would have been alive at the time it was found. Was that malpractice or genuinely believing that he was doing the right thing?

We're discussing 24th century ethics using 21st century terminology. What would be considered unethical 300 years ago?

 

[Stevil2001]

Any time a doctor suspects suicide they must act to save that person? What about Eminiar VII and Vendikar? People willingly went into the disintegration chambers. It was not only permitted, it was expected.

This works against your point, because our heroes shut this whole operation down because they found it grossly immoral!

What about McCoy shutting off the life support for him father? He said that a cure was later found, leading us to believe that his father would have been alive at the time it was found. Was that malpractice or genuinely believing that he was doing the right thing?

It's clear from The Final Frontier that he was wracked with guilt over this-- in fact, he feels more guilt over it than anything else he's ever done-- so assisted suicide certainly isn't something he finds easy and acceptable.

 

[JD]

Normally I would agree with you Christopher. I do agree with you fully in the real world but we're discussing what it would be like in the Star Trek reality. The most obvious example of this is Half a Life. Timicin is expected to commit suicide or "the Resolution" simply because he is turning 60 years old. His entire culture is in an uproar because he tried to avoid it. They sent two warships to intercept the Enterprise. Strangely, Dr. Crusher only had one line in the episode. It's mostly a Lwaxana story. Even so, the crew seems to be quite content to allow him to beam down for the express purpose of killing himself. The culture is presented as sane enough for the Federation to send one of their largest ships to help them with a scientific program.

In the episode Ethics, Worf is quite prepared to commit ritual suicide in accordance with his culture. Dr. Crusher does not stop him from talking to Riker about it. Riker doesn't even refuse outright but finds a loophole that allows him to pass the burden to Alexander. If Alexander were more Klingon like in personality, it's quite likely that he would have gone along with Worf's request.

We're not dealing with human cultures here. We're dealing with aliens. If the S'ti'ach were a human I'd have no question that Crusher should act as she did. But she knows of at least two cultures where it's either considered an honorable death or even something that is not only allowed but expected.

If instead of Lwaxana it was Crusher that was involved with Timicin would she be in the right to step in and revive him? Would she be performing an ethical duty if she beamed him up to the ship and refused to release him as long as he was planning on doing something that is considered 100% normal by his culture?

What about McCoy shutting off the life support for him father? He said that a cure was later found, leading us to believe that his father would have been alive at the time it was found. Was that malpractice or genuinely believing that he was doing the right thing?

We're discussing 24th century ethics using 21st century terminology. What would be considered unethical 300 years ago?

The problem here is that in all of these situations the characters were of sound mind, and able to make a logical decision regarding whether or not they wanted to continue living. It is very clear that this was not the case with Sasdren, he was very clearly severely depressed, and was very obviously not of sound mind.

 

[kkozoriz1]

Any time a doctor suspects suicide they must act to save that person? What about Eminiar VII and Vendikar? People willingly went into the disintegration chambers. It was not only permitted, it was expected.

This works against your point, because our heroes shut this whole operation down because they found it grossly immoral!

Only AFTER the Enterprise was listed as being destroyed.

Of course he was wracked with guilt but he had done it anyway. The guilt was from doing it too soon. If a cure had never been found he would not have felt as guilty. He would probably always carry some guilt with him regardless but at the time he believed what he was doing was the correct thing morally.

 

[kkozoriz1]

Normally I would agree with you Christopher. I do agree with you fully in the real world but we're discussing what it would be like in the Star Trek reality. The most obvious example of this is Half a Life. Timicin is expected to commit suicide or "the Resolution" simply because he is turning 60 years old. His entire culture is in an uproar because he tried to avoid it. They sent two warships to intercept the Enterprise. Strangely, Dr. Crusher only had one line in the episode. It's mostly a Lwaxana story. Even so, the crew seems to be quite content to allow him to beam down for the express purpose of killing himself. The culture is presented as sane enough for the Federation to send one of their largest ships to help them with a scientific program.

In the episode Ethics, Worf is quite prepared to commit ritual suicide in accordance with his culture. Dr. Crusher does not stop him from talking to Riker about it. Riker doesn't even refuse outright but finds a loophole that allows him to pass the burden to Alexander. If Alexander were more Klingon like in personality, it's quite likely that he would have gone along with Worf's request.

We're not dealing with human cultures here. We're dealing with aliens. If the S'ti'ach were a human I'd have no question that Crusher should act as she did. But she knows of at least two cultures where it's either considered an honorable death or even something that is not only allowed but expected.

If instead of Lwaxana it was Crusher that was involved with Timicin would she be in the right to step in and revive him? Would she be performing an ethical duty if she beamed him up to the ship and refused to release him as long as he was planning on doing something that is considered 100% normal by his culture?

What about McCoy shutting off the life support for him father? He said that a cure was later found, leading us to believe that his father would have been alive at the time it was found. Was that malpractice or genuinely believing that he was doing the right thing?

We're discussing 24th century ethics using 21st century terminology. What would be considered unethical 300 years ago?

The problem here is that in all of these situations the characters were of sound mind, and able to make a logical decision regarding whether or not they wanted to continue living. It is very clear that this was not the case with Sasdren, he was very clearly severely depressed, and was very obviously not of sound mind.

The problem is we don't know what his state of mind was. We know that he slashed his own arms and was not using his healing trance but we have no idea what he was thinking. Perhaps this is the normal way his species deals with a particular situation. For all we know it's acceptable or even encouraged if, for instance, your children die. It's an alien culture. We had not seen him before in the novel. We don't know is particular situation. Maybe it's something similar to Timicin and he had just had a birthday. If he had appeared earlier and we knew he was depressed then it would be more cut and dried. It's hard to get into someone's state of mind when the only time we see them they are unconscious.

 

[ProtoAvatar]

Well, if the shrinks and Dr.s do their jobs right, he won't want to. And as long as he does then obviously they haven't and will keep working with him until he does not. It kind of defeats the whole point of saving him if you're just going to let him kill himself as soon as he wakes up.

"Well, if the shrinks and Dr.s do their jobs right, he won't want to."
So, the only ones who want to commit suicide are either nut-cases or highly unbalanced individuals? This assumption on your part is debatable. Even more so in the trekverse, where 'normal' persons can commit suicide in vulcan, klingon, etc societies.

"And as long as he does then obviously they haven't and will keep working with him until he does not."
So, the individual is kept in a cell/under close supervision - in order to prevent him from comitting suicide - while he continulously undergoes therapy sessions, despite the fact that the tests show him as being 'normal' aka 'not unbalanced'?
This blatantly breaks this individual's right to freedom.

We DO have the right to live.
Do we have the obligation to live? in some cases, at least, my opinion is that we DO have the obligation to live.

You're not seriously saying that suicide is really a legitimate solution for people with social problems are you? I can see maybe if you have a medical problem that will cause pain and death, but (and I'm talking as a person who has contemplated suicide in the past here) pretty much all social problems can be solved in an other way. I know looking back, I would have wanted to have been treated if I had actually gone through with what I was thinking about.

I said social problems and an infirmity - being in a situation where the future will hold only more suffering. A situation which has similarities to being ill without any chance of a cure.

Of course, throughout history, there were situations where healthy, sane individuals commited suicide for a cause, in order to save loved ones, etc.