Ethics

Episode: s5, ep 16

A fairly chewy episode with discussions of medical ethics, assisted suicide and ableism. Also competent women doing their work.

What Happens
Worf has an accident with some containers which crush his spine. His legs are paralysed, probably permanently. Dr Crusher brings in a neuro-specialist doctor, they have a friendly professional chat. Dr Russell works in research and prefers to keep a distance from patients, which Crusher understands. There's little medical research about Klingons in this state, as cultural bias means Klingon doctors normally let a patient die. Worf asks Riker to perform a ritual, which is basically assisted suicide. Klingon culture (unsurprisingly) sees those with physical disability as a burden and Worf is deeply shamed by being in such a condition. Crusher and Russell discuss Klingon anatomy, which comes with a lot of spare parts (useful for people that like hacking into each other so much). Russell suggests trying a fancy, DNA technique she's been developing, which would mean growing Worf a tailor-made new spine, I think. Crusher is impressed until she learns that it's only been tested in a lab before, she refuses to risk Worf with something so experimental.
Crusher is called to the Bridge, a Federation ship has hit an old mine and crash-landed on a planet. Faced with the large-scale, medical emergency Crusher takes over three shuttle bays for triage and calls up all medically-trained civilians on board. Riker and Picard discuss Worf's request, Picard presents the Klingon side of things, it's a cultural difference. Alexander wants to see his father, but Troi explains that Worf is embarrassed by his condition. Alexander (well trained by his mother) recognises that this is Klingon nonsense, he just wants to see his dad. Troi tries to get Worf to see Alexander. Crusher and Russell show Worf some kind of futuristic leg-brace implants that will give him mobility, but take some getting used to, he is not impressed. Then Russell suggests her procedure as an alternative. Outside Worf's room Crusher takes Russell to task for suggesting the procedure when she thought they'd agreed not to try it. Russell points out that as the patient would rather die than have implants, she sees it as an better option than suicide. Crusher sees it as using someone's desperation to try out her research, and preventing a patient from dealing with their situation. Their argument is interrupted by Picard telling Crusher they've got to the crash-site, it's all hands on deck to help the survivors. Russell offers her help, which Crusher gratefully accepts.
Worf allows Alexander to see him with the leg brace implants. It seems like Worf is really trying, but when his legs give way and he falls he can't take the shame and Troi sends Alexander away. Crusher approaches Russell and her deceased patient, it turns out Russell tried an alternative treatment she's been working on. Crusher is angry that Russell is using patients to test her theories. Russell thinks Crusher is angry that she can offer Worf a chance Crusher can't, and points out how valuable the data from these cases will be for developing medicine further down the road. Crusher relieves Russell of duty.
Picard discusses Worf's situation with Crusher, and again lays out the Klingon viewpoint, but Crusher doesn't accept the suicide idea or that he can't live as he is. Riker visits Worf, having read up on the ritual, and says he will not be a part of it. He points out that technically the eldest son should do it, so if Worf is going to stubbornly stick to Klingon ways then Alexander should be the one to help him die. Worf can't ask that of Alexander. Later, when Alexander visits, Worf tells him that he's going to break with tradition and try to live by undergoing the operation. He might still die, but it wouldn't be suicide. Crusher reluctantly agrees to help with the procedure. Before the operation Worf asks Troi to raise Alexander if he doesn't make it.
In the operating theatre Drs Crusher and Russell basically remove Worf's spine and grow a new one, during the few hours before he experiences brain damage. There are some issues scanning the spine/DNA/something because of Klingon stuff. The new proto-spine is implanted and at first it seems OK, then things go wrong. Everything is tense as Worf flatlines, and Crusher tries drugs to revive him, going past dosages that even Russell would use. Crusher declares time of death. Alexander is told, and wants to see his father. As the boy cries Crusher notices Worf twitch and starts up the medical machines again. It turns out one of those Klingon spare parts has kicked in and Worf will liver after all.


Oh Captain, My Captain
Picard is mostly used as a debate partner for Riker and Crusher. Eloquence is his power and has been used a lot previously, but here he feels unusually detached. Of course he has concern for Worf, but his role as captain is immaterial and for once he has no decision to make and so the moral dilemma isn't his. He's a good choice for this role, Worf (and likely many other Klingons) can only see the shame of situation and the traditions they adhere to. Picard has an understanding of Klingon culture and values, while also knowing why Will and Beverley are so horrified. Picard can point out that Worf's culture adds an extra, awful psychological weight to his incapacitated state.

Riker: adventurer, lover, middle-management
This is Riker as a friend who has been given a horrible duty. It is only due to Worf's huge respect for Riker that he even asks him (remember that Worf wanted to follow Riker if he ever left the Enterprise). Of course Riker is horrified by this request, as a human of the 24th Century he doesn't see physical disability as a weakness, and certainly not a reason to give up. Of course as a human of the 24th Century he probably also doesn't see the need to be battle-ready at all times. He doesn't consider infirmity or mobility problems to be a weakness, and it's nice that that's a common human view. His friendship with Worf means that, he needs to respect Worf's decisions about his own life -and death- even if riker hates it. If his friend truly is suffering should he deny his aid? Then Riker does some research and kinda rules lawyers Worf, by throwing his own traditions back to him. On the one hand this is very intellectually clever, and does point out some of the foolishness of these traditions (clearly forged in a more brutal desperate period of Klingon history), as well as forcing Worf to face what he was truly asking of Riker. On the other hand this wasn't very compassionate, what if the gambit had failed and Worf has insisted Alexander do it? I guess Riker knows Worf well enough.

Klingon Warrior
I've mentioned before that Worf's non-Klingon upbringing has left him with a bit of a chip on his shoulder when it comes to Klingon traditions. This is where that commitment to his heritage is tested and we find out where Worf's line is drawn. His own death doesn't cause him fear, he's a Klingon warrior and an honourable death in battle is basically an aim. Worf has already lived through a period where he was officially dishonoured, and it weighed heavily on him, but he accepted that status because he thought he was serving the Klingon Empire and he knew the truth himself. In this case Worf sees no change to his status, no potential improvement of lot, and so he is certain he cannot endure and nothing in his culture tells him that he should. It is only when Alexander is brought into the mix that Worf goes against both his cultural beliefs and personal preference. Alexander has already lost one parent and been moved on from his foster (grand)parents; Worf is all he has left. He tries to mobility aids for Alexander, although the shame of the situation is still too much for him and I expect Alexander witnessing him fall makes it worse. It may be relevant that Alexander is very skeptical about Klingon 'honour', presumably the legacy of his skeptical mother. When Riker points out that by Klingon tradition Alexander is already old enough to assist in his father's suicide, I expect that a Klingon-raised child would have been better prepared for such a duty, Worf knows Alexander has not been.

Doctor Doctor
It' a Crusher-heavy episode, yay! I liked this, even though it is very much people having ethical discussions in various rooms (perhaps to make up for the lack of formal staff meetings). The emotional elements work because we know Worf. Into this horrible situation comes Crusher, balancing professional and personal concerns with aplomb, like the highly competent badass she is. As well as Worf's injuries she also has a large scale medical emergency to deal with. She doesn't skip a beat and gives orders to prepare for treating up to 500 people, including commandeering cargo bays and calling up civilians with relevant skills. Crusher handles command with ease, and is neither hesitant nor showy about giving orders. Despite the increasing disagreement between her and Russell regarding Worf, she's happy to accept her help in the greater emergency. She only removes Russell from duty when she judges her to be a danger to patients. Of the three department-heads Crusher is clearly the best with people, and we see her working collaboratively with the medical staff a lot. The fact that she called in Russell as an expert in her specialisation shows that teamwork and collaboration is second nature to her. Worf has a variety of nameless security people whose job seems to be standing behind him or herding people towards him. Geordi's team includes some people with names (mostly Barclay), who are usually doing something in the background. I suppose medicine is a discipline requires people skills and bedside manner. I can see the medical staff having fun away days together, I don't know what Engineering or Security do.
The only person Crusher approaches with her concerns is Picard, partly due to his rank, but I suspect mostly because of their friendship. It would be unprofessional to complain about a patient to her subordinates. As a healer she does despair that Worf wants to throw away his life, and she fears that Russell is driven by research gains without thought of patient welfare. Picard is the one who (as with Riker) points out the cultural and psychological pressures Worf is facing. Crusher is ready to institute suicide watch, and I see why she wants to save Worf and why she's appalled at Russell's daredevil medical approach. The professionalism continues as she conducts a surgery she's wary about, with someone she doesn't trust. In the end her knowledge of Klingon anatomy is what saves Worf from the brink of death. She refuses Russell any credit for what happened, which I think might be a little harsh, but I can also see why she won't encourage Russell and why she fears her methods.

It's Not Easy Being Troi
Troi is there for Alexander after Worf is injured and refuses to see his on. She calmly takes the anger Alexander directs at her. She explains that Worf is embarrassed about his situation and Alexander's presence will make him feel worse. When Alexander is rude about Klingon traditions, she simply points out how important they are to Worf. Later she rebukes Worf for his refusal to see Alexander, clearly she agrees with Alexander's assessment of Klingon traditions. When Alexander is allowed to see Worf, Troi has clearly prepped him for how to behave and how Worf might react. It makes sense for Worf to ask Deanna to raise Alexander, she's given him the most parenting advice and is the main non-school adult Alexander seems to have contact with. It is due to her work with both of them that Alexander is able to respect his father's boundaries and Worf is able to accept his son's help.


Future is Better
Klingon society is super ableist and this must be difficult episode for anyone with paralysis/mobility problems. The references to the bad state of Klingon medicine are telling. Klingon culture discourages people from living in this condition, so there's been no real research done on improving their lives. Klingons have never struck me as a very research-intensive species, and so I'd assumed most of their technological advances were gained through conquest or similar. Apparently they haven;t bothered to loot or develop medical breakthroughs, palliative care, and physical aids. It sort of goes back to Russell's stance, if the research was there the improvements would come, but of course someone's got to do the research and there seems to be no desire for that among Klingons. I kinda feel like Geordi was conspicuously absent from this episode. I mean he's the one who has tackled/highlighted ableism in cultures they've encountered before. I suppose it might have muddied the point a bit, and it's not really Geordi's job to do that. I just feel like there could have been an alternative version where Geordi showed up and metaphorically beat Worf over the head with his visor.

Girl Talk
Drs Crusher and Russell initially have a relationship of mutual respect and happily compliment each other's work and contrast their different doctoring styles (research-intensive vs patient focused). Even later, when these approaches become the point of conflict between them, it's still all very professional, and the discussions relate to professional ethics. Theoretically the conversations are only Bechdel-Wallace passing when they're not talking about Worf (or that guy who died), but frankly I don't think the gender of the patient has any bearing here. It's clear why each woman is angry, and disapproves of the other. Crusher is in the position of authority, but she doesn't let her feelings about Dr Russell get in the way of their work.

The End
Russell congratulates Crusher that Worf will recover and asks her to acknowledge her part in that. Crusher is super cold with her and says she cannot approve of someone gambling with patients' lives to further their own research. Then Crusher oversees Worf getting used to his new spine. Alexander goes to help his dad, and even though Troi talked to him about giving Worf some space, Worf accepts help from his son.