Medical ethics in the future

Discussion in 'General Trek Discussion' started by Kor, Oct 30, 2017.

  1. Kor

    Kor Admiral Admiral

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    Medicine is a special field, with unique concerns that don't have exact analogues in any other professional field. It involves very difficult and sensitive decisions, sometimes with potentially life-altering or life-or-death ramifications, and we have seen this a number of times across the Trek TV series and films.

    There are also questions of propriety when it comes to a doctor having a romantic relationship with a current or former patient, or even just being friends on a social level with said patients. I would say the latter is probably impossible to avoid, and nobody seems to criticize McCoy and Boyce for being drinking buddies with their captains, who are also their patients.

    In nearly every discussion of medical ethics in Trek, whether the issue is destruction of non-sentient clones, doctor-patient romance, end-of-life decisions, administering a treatment that the patient would object to without the patient's consent, etc., the Hippocratic Oath is usually invoked in short order, as if it's some kind of absolute and unchanging law.

    True, the general concept of "do no harm" has been invoked by doctors in Trek on a number of occasions. But what do the specifics entail? The medical field changes a lot over time. Today, the physician is less and less somebody who holds "authority" over patients, as we have instead moved into an era of patient empowerment, education and informed consent; as well as advance written directives and powers of attorney that doctors must be subordinate to when they administer treatment. The physician may be seen as more of a service provider.

    Even the original Hippocratic Oath has plenty of things that are completely irrelevant and disregarded today: swearing before gods that nobody believes in anymore, taking care of your medical teacher's needs (which assumes that a physician would have had only one teacher, instead of a whole medical school faculty), and teaching that teacher's kids the art of medicine for free, not performing surgery on people (because at the time only barbers were "trained in this craft" and not doctors), etc.

    Today, medical schools that administer the Hippocratic Oath use a modernized version, and many instead use something different such as the Declaration of Geneva, or a particular oath that they came up with themselves. Such oaths are not legally binding, and there is ongoing debate among medical professionals about how appropriate and relevant they are, as many are just vague formal platitudes that are arguably inadequate in addressing the complex realities of contemporary medical practice, and don't really even hold physicians accountable for acting contrary to the oath.

    And moving forward four hundred years into the future, any oaths that doctors may take at that time would likely be different again. So how relevant should our 21st-century concepts of medical ethics really be in the bizarre universe of Star Trek?

    Kor
     
  2. sbk1234

    sbk1234 Rear Admiral Rear Admiral

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    As with all Trek, you have to take today's belief structure as a starting point. While I agree that there are parts of the Hypocratic Oath that are no longer relevant, and won't be in 300 - 400 years, the basic idea of "do no harm" should remain a constant. However, even with that, there seem to be ethical changes since now. McCoy euthanized his extremely ill father, which seemed not to negatively impact his career in any way. Worf was also able to request an assisted suicide, although it was Riker who had the ability to refuse.
     
  3. Tenacity

    Tenacity Rear Admiral Rear Admiral

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    Bashir should have been called upon to explain dating people he was actively treating.

    While anyone on the station might be a potential patient, Bashir was romantically involved with patients who were recieving life altering treatments (vs a twisted ankle or some such).
    I've alway taken that to be something that Sybok inserted into McCoy's memories while mind raping him, and not anything McCoy actually did.
     
  4. Timo

    Timo Fleet Admiral Admiral

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    Bashir shoots people dead with phasers and photon torpedoes for a living. Sometimes this would have to include his patients, too. "Doing no harm" would appear to have to be fairly limited in its applications.

    Taking today's ethics as a basis may not work too well, considering that Trek makes itself possible by invoking jumps of all sorts. Trek physics exist because they abandon today's physics. Trek history in turn features drastic events that would be likely to alter ethics rather directly. Eugenics today is directly affected by WWII more than by anything else. Trek ups that particular ante, and has Soong and Archer actually put into words the practical effect: healing patients is evil if it involves things relating to eugenics, no matter how tenuously.

    Medical ethics is interestingly screwed at a more abstract level, too: reviving the dead is quite practical and practicable, but the doctors speak against it. Other things also have ethical norms emerge once they become practical: cloning is doable, but it follows that killing one's clone is fine and well (unless you're on Bajor or being arrested by Odo). Etc. etc.

    In short, it would be pretty futile not to say that anything goes. That is, anything may be possible and should not be judged on plausibility - but of course we can thereafter argue about consistency when the issue repeats in the fictional universe..

    Timo Saloniemi
     
  5. The Wormhole

    The Wormhole Admiral Admiral

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    It would not have been McCoy's pain if it weren't something he actually did. That's kind of the whole point to the scene.
     
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  6. USS Triumphant

    USS Triumphant Vice Admiral Admiral

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    And I, for one, really didn't take Sybok to be a BAD guy, even if he was sort of the bad guy. That seems a bit beyond what he would do.
     
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  7. The Wormhole

    The Wormhole Admiral Admiral

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    And it doesn't make sense from a practical point of view. Okay not a lot in the movie does, but bear with me. Sybok takes away people's pain, and in exchange they serve him. It doesn't really work if their pain is just something he planted in their heads. If he can do that why even create a fake pain for them to overcome? Why not just mentally manipulate them into serving him right away?
     
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  8. Tenacity

    Tenacity Rear Admiral Rear Admiral

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  9. Tenacity

    Tenacity Rear Admiral Rear Admiral

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    Sybok mind rapes people against their will in-order to gain control of them.
    That's what he was doing.
    Think about it, Sybok remove people's pain solely out of the goodness of his heart, and they (Sulu, Uhura, etc) all co-incidentally abandon their loyalty to Starfleet and Captain Kirk, and do anything Sybok just happen to want them to do?

    Really?

    Sybok uses mind rape to turn people into his highly controlled thralls.
     
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  10. sbk1234

    sbk1234 Rear Admiral Rear Admiral

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    I always saw it as a little of both.
     
  11. The Wormhole

    The Wormhole Admiral Admiral

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    But if it were "mind rape" then why doesn't it work on Spock and McCoy? Even after this showcase of their pain they still stay loyal to Kirk, indeed, if you accept deleted scenes, then Spock actually goes through the process twice, and still stays loyal to Kirk.

    Furthermore, if Sybok really was "forcing himself" unto the people he liberates of their pain, why did he allow Kirk to turn down the process? Kirk is high value, a priority target. If Sybok is mind-raping people with falsified memories into serving him against their will, then he's going to want a Starfleet captain in his thrall. Instead, Kirk refuses to let Sybok explore his pain, and Sybok drops the matter.

    Sybok isn't really an evil guy. He genuinely believes he's helping the people he frees of their pain, but expects something in return from them. And yeah, Sulu and Uhura probably did shirk their responsibilities and loyalties because of Sybok freeing them of their pain. Sybok is more meant to be a charismatic leader who can inspire his people to do anything for him, not someone enslaving everyone he meets into being his pawn. And his ultimate end goal was to find God, literally. He had no nefarious scheme, he was not seeking power or control. If he were there are so many other thing he could have done than stage a hostage crisis in the quadrant's armpit.
     
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  12. Kor

    Kor Admiral Admiral

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    So, ahem... as to the topic of medical ethics, I don't think McCoy's action of removing life support actually qualifies as euthanasia. That would have been if he actually administered something that would end his father's life, i.e. a lethal drug.

    Kor
     
  13. Nyotarules

    Nyotarules Rear Admiral Rear Admiral

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    The assumption is in 300-400 years Federation laws and medical ethics will be based solely on 20th century Earth cultural norms, especially Western ones.....that's pretty arrogant.
     
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  14. JirinPanthosa

    JirinPanthosa Vice Admiral Admiral

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    I think in Trek they interpret 'Do no harm' as only covering morally black and white scenarios such as intentionally giving patients harmful medical procedures against their consent. We learn from Ethics it is considered immoral to test unproven medicines without patient consent in the field, and it follows it is unambiguously immoral to, for example, intentionally expose people to diseases to study the diseases.

    Social ethics of today obviously don't apply. In Trek we only see them apply to individual cultures. We never see any kind of cross cultural ethics apply. Trill only apply their cultural ethics to other Trill.
     
  15. Tenacity

    Tenacity Rear Admiral Rear Admiral

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    Disagree, YMMV.
     
  16. Bad Thoughts

    Bad Thoughts Rear Admiral Rear Admiral

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    How about the part of the modern oath which deals with patient privacy, something which is further elucidated in the laws of most industrialized nations?
     
  17. Kor

    Kor Admiral Admiral

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    I think that in Starfleet, there would be exceptions to patient confidentiality standards in cases where a medical condition could be considered a threat to the mission, the crew, etc. Just like real militaries.

    Kor
     
  18. Bad Thoughts

    Bad Thoughts Rear Admiral Rear Admiral

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    That may hold for SF members, but not for the non-SF people whom are treated by their doctors. There are people who are not told their diagnoses, whose diagnoses are discusses with non-doctors, and who in some cases, receive treatments when there is no disease present.
     
  19. The Wormhole

    The Wormhole Admiral Admiral

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    But consistent with the rest of Star Trek.
     
  20. Give-a Give-a Give-a Garland

    Give-a Give-a Give-a Garland Vice Admiral Admiral

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    Fascinating premise, the consideration of medical ethics in the future.

    I've got very little idea of how society will be in the future. Medical policy is almost always tightly dictated by social norms and conventions, and politics. We could have a very pious future, or a very chaotic one. My instinct is that it will be the latter. Once medical professionals cross the line and begin to alter the human genome for the purposes of enhancement, not just correction... as those with money that line the pockets of politicians to weaken policies to enable it... Pandora's box will be wide open. It will be an extremely dangerous time, as all it takes is someone with the right amount of money to buy the equipment that will permit medical procedures that would be considered illegal today.