Thursday, November 24, 2011

The Next Generation, Season 5: Ethics

The Next Generation, Season 5
Airdate: March 2, 1992
115 of 176 produced
115 of 176 aired


Lt. Worf is gravely injured by a falling barrel in one of the cargo bays, rendering him paraplegic. When presented with the prospect of a marginal recovery, Worf opts instead for Klingon ritual suicide, asking Commander Riker to help him. This is where Dr. Toby Russell steps in, offering Worf an untried and exceedingly dangerous experimental procedure to fix his spine. But her approach to medicine leaves Dr. Crusher with grave misgivings. Whose approach will win out, as Worf's life hangs in the balance?

The ethical quandary sends shivers down Dr. Crusher's spine...


Matthew: So, the title of this story is "Ethics." Naturally, then, the writers (somehow related team Stuart and Sara Charno, with a polish from Ron Moore) try to cram every ethical debate they can think of into the script. I detect no fewer than 4 discrete instances of ethical quandary. First is assisted suicide. Then of course we have medical experimenting on human(oid)s. Third is another stab (heh, heh)at the cultural relativism debate. Finally, we get Geordi's cheating at poker. Yes, Geordi, it is still cheating if you look at peoples' hands after they muck them. You could get shot in 21st century Earth for doing so. Frankly, I think they should have excised one or two of them and developed just one of them fully. The assisted suicide story never develops fully - they just sort of mildly accept that it is OK, simply not in the case of a paraplegic injury. The cultural relativism story, in which Riker must choose whether to swallow his discomfort, also fails to materialize, because he cops out by pushing it off on Alexander - and then Worf decides against it anyway. So neither of these threads is really developed or pushed to their ultimate points, and the stakes are never raised and then paid off. Finally, we have the medical testing thread. It was... confusing to say the least. So for some reason, Dr. Crusher is playing the role of Kantian moralist, arguing that the ends don't justify the means, and that expediency should not trump a Doctor's duty to act ethically. Huh? Seems to me she's been in favor of breaking all sorts of rules in order to save lives. Dr. Russell, on the other hand, is a strict utilitarian - making sacrifices now could well result in thousands of saved lives in the future. Crusher accuses her of taking short cuts "right through living tissue." I can maybe see her beef in the triage scene. But with Worf? The story makes Crusher's argument look dangerously weak. Worf is a consenting adult with full knowledge of the risks. Why does Crusher want to hide potential treatments from him? Why should she care if he opts for a dangerous technique? Why should she be against suicide? Then, to muddy things, further, Worf dies. OK, so now we're supposed to absorb the homily about unproven techniques? But then of course, he comes back to life, thanks to his redundant physiology (telegraphed pretty blatantly in a "Chekov's Gun" scene at minute 9). What the hell is the lesson supposed to be here? Experimenting is wrong, except on species that have spare parts? It was just sort of a mess. An interesting mess? Sure. Satisfying? Not to me.

Kevin: I like the idea of this episode a great deal, but I forced to agree with Matt that none of the individual sub-parts gets the development it deserves. Medical ethics and decision making are issues that play out in American hospitals, courtrooms and legislatures all the time, so I felt like this was one of those times they really needed to call a lawyer and just get a spot check on the issues and how they were developing them. Central to the way we handle medical decisions is the idea of "informed consent." Only if a patient is fully aware of the risks and rewards can the procedure go forward. But that competes with another impulse, to protect patients from charlatans. In our world, there are some procedures that are so risky or unproven that no degree of informed consent could overcome the problem. In practice, a sick (and therefore vulnerable) patient is simply not in a place to adequately weigh the risks, especially when being presented them by a doctor with a potential interest in the outcome beyond the care of their patient. And I think that could have been an interesting way to hang the conflict of the episode. In this example, even with the best of intentions, Dr. Russell could downplay the risks or oversell the chances of success because she both wants Worf to get better and because she wants a real world trial of her technique. Worf was contemplating suicide a few moments ago. I think Dr. Crusher has a solid, non-absurd argument to make that in this case her patient's consent is void because of his mental state and the stakes involved in the decision. That would actually have dovetailed nicely into the other half-plot of the show. Is Worf's intention to commit suicide inherently irrational? Our society intervenes when someone tries to kill themselves assuming the person doesn't really want to die; there is a pathological or situational reason that when remedied will remove the suicidal impulse and they'll be happy we saved them. Is that the case here? Does his suicidal desire allow Doctor Crusher to keep him restrained in sick bay and force feed him indefinitely? It would in our society. Does his Klingon-ness make him sufficiently different to change the analysis? Is a Klingon capable of rationally choosing suicide where a human couldn't? Compliance with cultural values certainly wouldn't restrain us if he were intent on harming someone else? Should it when he is going to harm himself? Focusing the episode on the reasons for and the validity of his consent to a dangerous procedure would have actually focused three major themes of the episode, as answering any one of them would have revealed a character's position on the other two.

Matthew: The way you mention law makes it sound as though there could have been a court-room scene or something. There could be a competency hearing for parenting privileges. There could be an involuntary committal court-room scene. This would have been a really great way to develop the suicide story.

Kevin: The triage scene also nagged me too. First, Russell's data would be worthless in even a sketchy research sense. Maybe your dude was allergic to the drug. Maybe he huffed a bunch of happy spores before boarding the Denver. There is a reason the ads on buses for participants in studies have so many conditions. You have to eliminate differences in your patients to control for anything other than the effects of your treatment. Also, good research in drug testing requires a "double-blind" where neither the patient nor the administering doctor knows if the patient is getting the real thing or a placebo to account for the placebo effect in the patient or confirmation bias in the doctor. That being said, there is a genuine and complex debate to be had here. Remember that whole "informed consent" thing? Well, you can't give it if you are unconscious. In a trauma situation, even finding relatives to consent is impossible, so modern law operates to say that an unconscious person is presumed to consent to live saving intervention. But how far does that consent extend? There have been some interesting incidents in recent years of tests of synthetic blood for trauma victims and just recently, a procedure being test in Philadelphia where severely injured trauma patients are frozen to give the doctors more time to stop bleeding, but with a (allegedly minimal) risk of brain damage. In both these situations, the procedures are tested where conventional blood is unavailable or patients who are bleeding too profusely presumably for conventional methods work in time, so the procedures are being done in good faith with the intent of saving the patient, but would that patient have consented to an unknown treatment if they were awake? If they are the unlucky who suffer a negative side effect, do they have a right to remedy where someone who knowingly gave consent would not? On a more societal level, there's simply no other way to test the procedures. You can't engineer a trauma situation in a lab, short of going all Sweeney Todd on your lab assistants. Actual trauma patients are all you've got once you get to human testing. How far off from Dr. Russell are we really? I know I've been going on for a while about modern American bioethics, but I think the episode does set up some interesting avenues for discussion, and I just wanted to flesh some of them out, and point out, again, that even a lawyer with only passing knowledge of the mechanics of these rules could have shored up the script. You have a science consultant (Hi, Andre!), get a legal one is all I'm saying.

Matthew: I find it rather odd that Riker, the sybaritic sex fiend, is not culturally relativist, while Picard, the stern  Kantian moralist who believes in the unshakably sovereign dignity of all sentient life, is. I also find it odd that Worf asked Riker to help with his suicide in the first place. Why not Picard, who has been so intimately involved with his life, and clearly understands Klingon ritual? It felt forced. It did precipitate a nice scene in which Riker mentions Marla Aster and Tasha Yar in an attempt to shame Worf out of committing suicide. I also really enjoyed the role Troi was put in - both a professional counselor seeking to help Worf and Alexander, but also a friend who need to bust Worf's balls a bit with regard to being selfish. This was undercut a tad by the fact that Troi makes her decision to essentially adopt Alexander awfully quickly.

Kevin: The continuity odds and ends were nice, but overall, it was a bit of a copout. Asking Picard would have been more interesting, and been an even nicer continuity nod to his Klingon connections. And I agree completely on Troi. This Alexander/Worf arc has really given her some juicy scenes. She's all competent and compassionate and hasn't sense pain, loneliness, or deception in a while.

Matthew: Surgery drama scenes are always fun, if a bit formulaic. The arbitrary-ish "time limit to brain death" was just one of the tropes at play. Still, it gave Crusher a good chance to be competent on screen, as opposed to her positively labyrinthine moral position. As much as her positions failed to make sense to me, they did give a good actress some lines to chew onscreen. So I appreciate that. She also got to use lots of drugs, including Voyager favorite Inaprovaline, and TOS classic Cordrazine (but not TNG update tri-cordrazine, for some reason).

Kevin: I liked the actual medical science discussion a lot. It was a fun, if deus ex machina-laden, look into Klingon anatomy and culture, and the idea of growing your own replacement organs is certainly a popular one today, and it was neat to see it get a Star Trek test drive.

Matthew: We got yet another instance of Alexander being given a deadly weapon and told to wander the halls of the Enterprise with it. "Take this GIANT KNIFE back to our quarters, my under-ten child with a history of discipline problems." WTF, Worf? Isn't there a DCFS on board to deal with this stuff?

Kevin: This felt out of place at the top of the review, but I wanted to chime in on Geordi. THANK YOU, Matt for saying it. That has always bothered me. For anyone who doesn't know, if someone calls your bet in poker, and you know you are going to lose, you can choose to fold without showing your hand. It's called mucking and it's a tactical decision. Geordi didn't pay to see the cards, so he doesn't get to know if Counselor Troi is bluffing. I can't believe they've done that many poker episodes without realizing that.


Matthew: You know me, I love me some Dr. Crusher. Any chance to get more Gates McFadden on screen is A-OK with me. We are rewarded by a nice performance by McFadden - she seems both absolutely livid with Russell, as well as deeply chagrined by the idea of Worf's position on suicide. She delivers her lines with aplomb, and plays a great "future Doctor" with all of the gear and the technobabble in her surgery scenes. Similarly, Patty Yasutake is always welcome on screen as Nurse Ogawa.

Kevin: Agreed. When she walked into Alexander's quarters, my heart broke into a million tiny pieces. I loved her angry stage whisper about Russell's research "not being a comfort to his family." I also liked the way she went into triage mode, converting shuttle bays and conscripting civilians with medical training. It all read as very real, and reinforces my opinion of her as a competent doctor and administrator.

Matthew: I found both Frakes and Dorn to be a bit one-note here. Riker came painfully close to the "Shouty Riker" that I dislike. Dorn didn't do much to get me inside the head of his character's thought processes. Is it the fault of the script or the actor? Probably the former. But the actor didn't rise above. Brian Bonsall was decent as Alexander yet again. I'm not saying I want to see more of him. But I didn't want to lapse into a coma when he was on screen. I wondered during his scene with dead Worf, will Alexander do "the scream?" Thank goodness, no. Marina Sirtis was the second anchor of this episode after McFadden. She played the role of counselor so well, but also showed some fire when she chastised Worf.

Kevin: I agree on all counts. It felt almost random to give Riker the job of suicide-helper. I thought Worf's scenes with Alexander were actually pretty good, but still, overall, it did read a little flat.

Matthew: Caroline Kava cut a very "Dr. Pulaski-esque" figure as Toby Russell. She struck me as an ambitious but cavalier risk-taker. Pretty much perfect for the role. I would have liked to see more of her, for her character to have been a bit deeper. Alas, the script was pulled in too many other directions.

Kevin: The script made her slightly incompetent. Like maybe her wonder-drug could have saved three out of four patients in the cargo bay or something. It would have added some teeth to her "good of the many" argument. Otherwise, I agree with the Pulaski comparison, and wonder if it was intentional.

Production Values

Matthew: There was a really nice holographic effect of Worf's spine. It still looks better than a lot of the phony CSI-technology stuff we see on TV nowadays. Also really cool in the medical scenes were Okudagrams and surgical props. On the other hand, while I appreciate the continuity of using the surgery outfits from "Samaritan Snare," ... BARF! Gawd, what a terrible look.

Kevin: When Crusher takes off the...whimple...I guess...I thought she looked pretty good. It's a good color on her, and with a slightly more flattering neckline, could be quite fetching.

Matthew: The scenes in the triage bay were really good looking. There were loads of convincing extras and with good injury make-up work. Worf's injury gave us a chance to see ridgy Klingon backs and feet. They looked fine. The Potemkin was portrayed by the Excelsior model, which is always welcome. Dr. Russell's casual wear was kind of blah. Alexander and Troi were playing one of the pyramid games from Ten Forward - I was disappointed at not being able to see the graphics. I imagine them looking like an old Vectrex.


Matthew: Am I being a philosophy snob? I don't think so. I think the story was muddled in its conception, leading to a dearth of drama and payoff, but it was solid acting and production that salvaged it to a 3. The Voyager episode "Nothing Human" was a more interesting take on the medical story (Thanks to Kelly for reminding me of it), while the suicide story received short shrift. Several other episodes from multiple series have tackled the issue of cultural relativism better. And Geordi should never, ever look at the faces of opponents' poker cards with his VISOR.

Kevin: I agree with the three. As evidence by my treatise on bioethics here, there is a lot of meat in this idea. They just tried to do too much and ended up not doing much of anything. Still, the acting is solid to above average. So, that makes a combined 6 from us.

1 comment:

  1. Frankly I found the whole opposition to assisted suicide a bit strange for a society as enlightened as what we see in the world of Star Trek.Now I understand why someone's friends and loved ones would not want a person to die on an emotional level, but legally and ethically, there is no reason this should have been a problem. This was clearly a 20th century problem transplanted in to the future.

    Respecting and upholding a person's agency and full bodily autonomy is what any enlightened society does. As long as someone;s action do not harm another, they should be allowed to make decisions as pertaining to their body, health, life and death and it is no one's business. So for these people to even have this debate seemed strange to me. But ok they went down that route so well take it as a given.

    Picard lecturing Riker was more for the audience it seems; the writers were basically playing out the debate for the audience via riker and Picard because I believe Riker knows Klingons and Worf well enough that he didnt need to be enlightened by Picard. He knows how much all that warrior and honor crap means to a klingon, so for him to be baffled that Worf wants to end it, seemed strange and forced, as you guys say.

    Picard summarized it the best (and i didnt find it incompatible with his views thus far): "if you were dying, if you were terminally ill with an incurable illness and facing the remaining few days of your life in pain - wouldnt you come to look on death as a release?" For all intent and purposes here, Worf only having 60% of his mobility is equal to living a life in agonizing pain. So while the cultural relativism played a role here, i think the same discussion could have been had if they were talking about any member of the crew facing a life in agony and wanting to end it.

    I also dont think a court room scene a la LA Law was needed. The Federation and earth in the 24th century dont strike me as entities in the business of regulating the personal lives of their citizens. On the contrary, they strike me as entities respecting a person's autonomy and agency. See, today when someone wants to be able to kill themselves (assisted suicide) it has to be done via a court order and the entity objecting is the state, the people. I cant imagine the Federation or Starfleet or even the earth government here standing before a judge and making a case against assisted suicide. On whose behalf? the people?

    As to Crusher: I think she just felt that the other doctor was reckless, irresponsible, that she wanted to bypass procedure at the expense of her patients and she didnt like that. And i agree with her. I would not have wanted to be a patient under such a doctor's care. she gambles with people'; lives, she is irresponsible.

    That said, given that the alternative for worf was death, how bad could that spinal business have been? If he hadnt done the spinal thing, he would have been dead so he may as well do it casue if it doesnt work, the outcome will still have been death, but at least they tried.