Medical Consent in the Federation

[Mr. Laser Beam]

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.

If you're referring to the scene I think you are:

Spoiler: Collectors

It's when Agent Dulmur is injured in an attack shortly after he, Lucsly and Jena Noi reach the 'alternate' 3051, amirite?

Here's how I interpret that: The 31st century has medical technology that Dulmur and Lucsly can't even begin to imagine. Dulmur did say how great he felt after being 'trans-replicated', but another person put in his situation may not have been comfortable with being treated with that kind of technology. Not even if it heals them from death. And perhaps this is one reason why some people may want to instead live on one of the 'traditionalist' colonies that Christopher spoke of (and which I'm very grateful to him for including, even if it was a throwaway line).

Or to put it another way: I fully believe in eternal life - just not the kind that 31st-century med tech could give. (And if I was treated that way without my consent, I might be rather upset at that.)

 

[suarezguy]

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.

While I suspected that the Romulan refusing the donation would lead Worf to agree to give it, to show that he was better and didn't have such prejudices, and was especially surprised when he still stuck to his stand.

 

[Christopher]

^But that's just it -- once the Romulan refused, the decision was out of Worf's hands. He didn't "stick to his stand," because he no longer had a choice in the matter. The episode pretends otherwise, but that's just not valid.

 

[chrinFinity]

Thank you all, this is very helpful.

 

[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.

If you're referring to the scene I think you are:

Spoiler: Collectors

It's when Agent Dulmur is injured in an attack shortly after he, Lucsly and Jena Noi reach the 'alternate' 3051, amirite?

Here's how I interpret that: The 31st century has medical technology that Dulmur and Lucsly can't even begin to imagine. Dulmur did say how great he felt after being 'trans-replicated', but another person put in his situation may not have been comfortable with being treated with that kind of technology. Not even if it heals them from death. And perhaps this is one reason why some people may want to instead live on one of the 'traditionalist' colonies that Christopher spoke of (and which I'm very grateful to him for including, even if it was a throwaway line).

Or to put it another way: I fully believe in eternal life - just not the kind that 31st-century med tech could give. (And if I was treated that way without my consent, I might be rather upset at that.)

Yep. That's the correct scene, and thank you for your post.

 

[Christopher]

^The thing is, "healing from death" depends on one's definition of death. Death is actually a gradual process, and as medical science has advanced, it's enabled us to bring people back from further and further along in the process -- so that today's resuscitation technology could seem like resurrection by the standards of a century or two ago. That's why we have the concept of "clinical death" -- because our accepted definition of death is based on old assumptions that are no longer really valid given modern medicine.

Basically, true "death" is the point of no return, the point beyond which the body's shutdown cannot be reversed. And that point keeps moving forward as medical science advances. Recall TNG's "Code of Honor," where 24th-century medicine was able to revive someone who was dead by Ligonian conventions and legal definitions. Crusher didn't actually bring Yareena back from the dead, she just prevented her death -- or prevented her clinical death from reaching the point of irreversibility.

Presumably the difference between 24th- and 31st-century medicine is the same. Nobody's being resurrected or yanked out of the afterlife; they're just being caught before their death becomes irreversible. But the more advanced technology has moved that point of no return even further forward. I don't see how that's any more ethically or spiritually questionable than present-day techniques that can preserve the lives of people our ancestors would've written off as dead.

Heck, you don't even have to go back centuries. Think of how incongruous it is to watch Dr. McCoy just briefly examine someone and declare them dead, without any of the resuscitation efforts that are routine in present-day medical dramas. Even in the '60s, the point of no return was assumed to be much earlier in the process than it's now understood to be.

 

[Mr. Laser Beam]

Still, though, I would hope that it is still up to the patient - assuming they're awake and able to answer questions, of course - as to whether or not they want to be treated with such fantastic medical technology.

Spoiler: Spoiler for The Collectors

(There is that bit in The Collectors where, after Dulmur is healed, the doctor actually asks him if he wants any further 'alterations', so I'm guessing that consent is as important in the 31st century as it is in any other we've seen. And I'm also assuming that 'trans-replication', as practiced in that time period, doesn't grant the body any new abilities or immortality or anything like that - it just fixes existing damage. If that's so, I'd have no problem with it. I may look forward to eternal life, but I wouldn't throw away my existing one!)

 

[Wadjda]

Wasn't there a VOY episode where the doctor was forced to practice medicine on an alien space station or something?

 

[Enterprise1701]

Wasn't there a VOY episode where the doctor was forced to practice medicine on an alien space station or something?

http://en.memory-alpha.org/wiki/Critical_Care

 

[Kilana2]

Wasn't there a VOY episode where the doctor was forced to practice medicine on an alien space station or something?

http://en.memory-alpha.org/wiki/Critical_Care

Yes, but that´s not the episode that comes to mind regarding to the initial question.


There is another VOY episode: Nothing Human


The Doctor was forced to cooperate with Crell Moset. They wanted to remove an alien creature from B´Elanna Torres, who was unconscious at that time. The succeeded, but B´Elanna was angry. Not unusual, given the fact that Moset conducted experiments on the Bajorans without their consent.

 

[The Wormhole]

Wasn't there a VOY episode where the doctor was forced to practice medicine on an alien space station or something?

http://en.memory-alpha.org/wiki/Critical_Care

Yes, but that´s not the episode that comes to mind regarding to the initial question.


There is another VOY episode: Nothing Human


The Doctor was forced to cooperate with Crell Moset. They wanted to remove an alien creature from B´Elanna Torres, who was unconscious at that time. The succeeded, but B´Elanna was angry. Not unusual, given the fact that Moset conducted experiments on the Bajorans without their consent.

That episode didn't really think through the dilemma very well. First of all, the information used comes from the Starfleet Medical Database, which presumably is obtained in an ethical manner. The Doctor's holographic friend only has the Crell Moset form because he is apparently considered the leading exobiologist in the Alpha Quadrant. It is thoughtless of the Doctor to use a Cardassian for his assistant, given a percentage of the ship's crew, including the patient belong to a terrorist group fighting against them, but whatever.

But even if they were referencing notes from the actual man written while he was doing his barbaric experiments, information itself is not evil, and if it can be used to save a life, shouldn't it? That does not make someone complicit in the evil done to attain the information, nor are they condoning it by using it for a positive goal.

Then the episode has the weird subplot of the young Bajoran who tries to resign when he learns of the Moset program. Yeah, I get it, Moset did things to the guy's family and he's obviously pissed to see even a holographic representation of him. Obviously he has every right to make a complaint on the matter, but does the existence of the hologram actually offend him so much he'd rather leave the ship and spend the rest of his life in the Delta Quadrant?

 

[Idran]

That episode didn't really think through the dilemma very well. First of all, the information used comes from the Starfleet Medical Database, which presumably is obtained in an ethical manner. The Doctor's holographic friend only has the Crell Moset form because he is apparently considered the leading exobiologist in the Alpha Quadrant. It is thoughtless of the Doctor to use a Cardassian for his assistant, given a percentage of the ship's crew, including the patient belong to a terrorist group fighting against them, but whatever.

But even if they were referencing notes from the actual man written while he was doing his barbaric experiments, information itself is not evil, and if it can be used to save a life, shouldn't it? That does not make someone complicit in the evil done to attain the information, nor are they condoning it by using it for a positive goal.

To be fair, that debate exists even in real life: whether or not it is ethical to use medical information obtained through unethical means, as there are many historical examples of precisely that being done. There are many medical researchers in real life on either side of the issue. On one hand, there are many that argue as you do; on the other hand, there are those that argue that does, in a sense, condone the methods by which the information was obtained, in that you are basically saying "you shouldn't have done this, but now that you have, we'll use it anyway".

Check out this AMA opinion piece, for example; the AMA's position is that such information should only be used when it is provably and beyond any shadow of a doubt necessary to save lives and no other resource exists, and otherwise, it should never be touched in practice nor cited in research.

 

[Taelon]

What about that episode of TNG where Data befriends a little alien girl and Crusher performs an invasive medical procedure to destroy her memory? I'm pretty sure there wasn't any consent there.

 

[Idran]

That was definitely really questionable, yeah. Was it invasive, though? I don't remember surgery being involved.

Oh, and it was Pulaski, not Crusher; that was a second season episode.

 

[Taelon]

It was technically brain surgery, so I doubt you can get more invasive than that.

All I remember is throwing a cushion at the TV and turning it off in disgust.

 

[The Wormhole]

That episode didn't really think through the dilemma very well. First of all, the information used comes from the Starfleet Medical Database, which presumably is obtained in an ethical manner. The Doctor's holographic friend only has the Crell Moset form because he is apparently considered the leading exobiologist in the Alpha Quadrant. It is thoughtless of the Doctor to use a Cardassian for his assistant, given a percentage of the ship's crew, including the patient belong to a terrorist group fighting against them, but whatever.

But even if they were referencing notes from the actual man written while he was doing his barbaric experiments, information itself is not evil, and if it can be used to save a life, shouldn't it? That does not make someone complicit in the evil done to attain the information, nor are they condoning it by using it for a positive goal.

To be fair, that debate exists even in real life: whether or not it is ethical to use medical information obtained through unethical means, as there are many historical examples of precisely that being done. There are many medical researchers in real life on either side of the issue. On one hand, there are many that argue as you do; on the other hand, there are those that argue that does, in a sense, condone the methods by which the information was obtained, in that you are basically saying "you shouldn't have done this, but now that you have, we'll use it anyway".

Check out this AMA opinion piece, for example; the AMA's position is that such information should only be used when it is provably and beyond any shadow of a doubt necessary to save lives and no other resource exists, and otherwise, it should never be touched in practice nor cited in research.

Well, all that aside, given how pious Starfleet tends to be, if it's included in a starship's database, chances are someone has already done the hand wringing over ethics and morality and decided possessing the information isn't evil. Which eliminates much of the episode's moral dilemma right there.

 

[JoeZhang]

That was definitely really questionable, yeah. Was it invasive, though? I don't remember surgery being involved.

Oh, and it was Pulaski, not Crusher; that was a second season episode.

Data: Do not worry Doctor, since it is a pre-warp planet, you do not have to concern yourself with parental consent nor the fact that your procedure carries no medical purpose at all.

 

[Kilana2]

In the Demora Sulu Story of "Tales from the Captain´s Table" Demora´s grandmother Shimizu Hana refuses to be brought into a nursing home for elderly or a care facility, despite inappropriate living conditions in her small hut in a rural area on a planet with a self-sustaining colony (if I´m not mistaken).

 

[Timo]

We might probably do well to also include all those TOS stories were crime was considered a mental illness and cured. This was clearly without the consent of the patients, and we never heard of an alternative to the treatment (say, the patient having the choice of instead going to jail, losing a leg, being deported, executed, whatnot).

Similarly, TNG features many plots in which the memory of a patient is wiped in various ways, completely without consent; the DS9 story "Sons of Mogh" has ample precedent, then.

The definition of "medical" clearly has to be extended somewhat in Trek.

Timo Saloniemi