Star Trek: The Next Generation

"Ethics"

3 stars

Air date: 3/2/1992
Teleplay by Ronald D. Moore
Story by Sara Charno & Stuart Charno
Directed by Chip Chalmers

Review by Jamahl Epsicokhan

An accident in a cargo bay crushes seven of Worf's vertebrae; Crusher tells Worf the injury may be permanent and that he may be a paraplegic the rest of his life. This is not good news for our resident Klingon (not that it would be for anyone, granted); he sees this injury as the effective end of his life — so much so that he wants Riker to help him perform a Klingon suicide ritual in the name of "honor."

"Ethics" a better episode than I had remembered from when I originally saw it, and also better than what I know from its reputation. Granted, there are some very silly notions in this episode, most of them beginning and ending with Worf and his beliefs. The notion of a Klingon warrior seeing honor in assisted suicide seems fairly absurd to me, especially since there are conventional treatment options that would give back Worf as much as 60 percent of his mobility.

Riker is appalled that he has been asked to kill a friend whose life is very far from worthless. If there's a saving grace to the story's notion of Worf's desire to die, it's that Riker argues vehemently against it more than once and denounces it as the selfish insanity that it is. The flip side of that coin is Picard, whose insistence on respecting cultural beliefs has him defending Worf's point of view — never mind that this ignores the fact that Worf is a Starfleet officer who has duties, and Picard is the captain of a starship that arguably should be looking out for the good of the community and not just this one person's wishes.

Enter into this fray Dr. Toby Russell (Caroline Kava), a surgeon who wants to try an experimental procedure to replace Worf's spinal cord with cloned tissue; there's a very good chance Worf would die on the operating table under this procedure, which has never been tried on a living patient. Crusher is not impressed with Russell's methods; Russell puts the acceleration of her research ahead of individual patients' welfare. In one scene, Russell treats a man with an experimental procedure rather than a conventional one, and the man dies. Would he have died otherwise? Probably, but Russell seems more interested in advancing her research than saving the patient. Crusher has a big-time problem with this, and rightly so. Their confrontations are a selling point here.

"Ethics" ends up being a fairly engaging hour that examines these arguments of personal responsibility alongside the beliefs that come into conflict. There's the two-pronged approach of doctors carrying out (or not) the Hippocratic Oath, as well as Riker as a man trying to balance the need to respect his own beliefs alongside those of his friend. There's a nice monologue where Riker calls out Worf for choosing such a selfish course of action that doesn't even consider that it would leave Alexander an orphan. (Worf makes for one awful patient, I must say. I also must say that the story acknowledges that point.)

The final act, where Worf goes through with the experimental procedure, over Crusher's objections — and actually dies (temporarily) on the operating table — is well executed, albeit shamelessly manipulative. And, of course, Worf — who is in what looks to be extended rehab by the end of the episode — will be magically 100 percent by the next installment. But for all its flaws, I found this episode solid because of its ability to argue the various sides of its issues, even if I didn't buy all of them.

Previous episode: Power Play
Next episode: The Outcast

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77 comments on this review

grumpy_otter
Wed, May 11, 2011, 6:29am (UTC -6)
Do you recall the first time you saw this one? When Worf died, I thought he might really be dead. They had killed Yar, after all.

I agree, they handled it well. I think I had a little tear in me eye when he came back.

Also wanted to say I like Caroline Kava in this episode very much--she played her part perfectly. They could have made her entirely a villain, and she wasn't at all. She DID care about her patients--just not quite as much as her own work. I loved her last look back at Crusher as she left the ship--I don't think her mind had been changed at all.

Having seen "Parallels," I was also thinking--"Hey, this is when Worf and Deanna first hook up!"

startrekwatcher
Wed, May 11, 2011, 8:11pm (UTC -6)
This episode definitely gives you a lot to reflect on. I thought Worf was the perfect person to use in this episode. I thought Deanna was used well and I liked that they brought in Alexander who I don't mind and I liked the idea of Worf wanting Troi to raise him. I appreciated the mention of dead crewmates with Yar and Marla Aster. I didn't have a problem with Picard's advocacy for Worf's point of view--it wasn't like he endorsed it just respected it.

Like I've mentioned elsewhere when I first saw this I wasn't up on actor contracts and so I genuinely thought Worf died.
Grumpy
Fri, May 13, 2011, 7:32pm (UTC -6)
Just occurred to me that a better choice for the accident victim would've been... Alexander. I mean, we *know* Worf's not going to die, but his son might. And if Riker is shocked that Worf would ask him to assist in his suicide, imagine how shocked Alexander would be when his dad tells him to off himself!
Elliott
Fri, May 13, 2011, 7:34pm (UTC -6)
This one is easily a 3.5 if not a 4. I find it hypocritical that you dismiss Worf's beliefs here as "insanity" and praise Bajoran religious doctrine which brings that coveted "grey area" into DS9. Actually, I cannot only empathise with Worf, I personally know people who feel the exact same way ("if I'm ever told I have to live on life-support, pull the plug"). It's not insanity at all. Is it clear-cut? No, no. It's reasonable and complex and makes great use of Crusher, Troi, Riker, Worf and even Alexander in one episode that also features a strong guest character. Picard's speech to Riker is exactly why he stands as the moral compass of the Federation and Star Trek in general. Love it. Possibly the best Crusher episode of the series as well. Her delivery here is chilling and engaging.
Josh
Sat, May 14, 2011, 8:12pm (UTC -6)
An interesting episode, to be sure, and I've always like the Dr Russell character - both in conception and execution. A few other comments: For a long time I'd always thought that Worf was actually paralyzed below the neck rather than the chest - this is probably because he is seen lying down in nearly every scene. Surely he could get to a chair! I'm also a bit more convinced by Worf's wish to die overall - yes, he could regain some mobility, but what of bowel/bladder/sexual function? All would surely have been affected as well.

Also, the surgery scene is about as ridiculous as most TNG "medicine" is. But I suppose that's par for the course.
SC
Mon, May 16, 2011, 6:06pm (UTC -6)
I don't really see what Picard should have done differently. Worf can resign his commission, if need be, but in his current state he'd be of minimal use to Starfleet anyway, so there aren't really any pressing justifications for denying him the chance to commit suicide. Picar strikes the right tone (unlike Sisko in "Sons of Mogh").
Plain Simple
Mon, May 23, 2011, 11:40pm (UTC -6)
@Grumpy: "Just occurred to me that a better choice for the accident victim would've been... Alexander. I mean, we *know* Worf's not going to die, but his son might. And if Riker is shocked that Worf would ask him to assist in his suicide, imagine how shocked Alexander would be when his dad tells him to off himself! "

Had they done that, it would've effectively killed Worf as a character. How could we, as the audience, continue to root for Worf as one of the good guys, if he instructs his son to commit suicide! No, it might've made for a powerful episode, but it would've been the end of the character of Worf on TNG.
pviateur
Tue, Aug 16, 2011, 2:50pm (UTC -6)
Pet peeve #356: Why is it that despite the ship being rocked and attacked every other episode, nothing is ever secured? I can't imagine a more dangerous situation than those stacked barrels in the storage compartment all unsecured! Okay, I'll buy no seatbelts, but absolutely nothing aboard is secured against sudden movement of the ship. In the instance of Worf's accident which was entirely preventable by the simple expedient of securing the barrels, Picard should have been investigated and court martialed or at the very least, Worf would have had an air tight case if he decided to sue Starfleet.
Amd speaking of Worf and Starfleet, if he takes being a Klingon so seriously (more seriously than any "real" Klingons on the show)why did he ever bother joining Starfleet at all?
Elliott
Tue, Aug 16, 2011, 2:57pm (UTC -6)
@ pviateur

There are no lawsuits in the 24th century because there's no money. Star Trek is never supposed to convince you of it's plausibility. It's an allegory for Christ's sake. Are these really the things people think about when they watch TV?
Jay
Sun, Sep 25, 2011, 6:35pm (UTC -6)
Interesting that in the time between when Worf "died" and when Alexander came in to gape at him, they dressed him and flipped him over on his back.
Captain Tripps
Tue, Oct 11, 2011, 1:45pm (UTC -6)
Suicide has been tied to honor in human culture since, forever, depending on the reasons and the methods. It kind of fits into everything else we know about Klingons as it is, and comes up again much later during DS9 with Kurn.

If I had been viewing this when it first aired, they would have had me convinced that Worf was actually going to die, they played that right to the end.
Chris
Sun, Oct 23, 2011, 8:59am (UTC -6)
Could they really have allowed Worf to die effectively from a barrel falling on him after all the fuss about Tasha's meaningless death?
Plain Simple
Sun, Oct 23, 2011, 1:09pm (UTC -6)
In some shows having a meaningless death would be called realism, but I guess it does not really fit the clean Star Trek universe. Unless you're wearing a red shirt, of course.
Jay
Fri, Nov 4, 2011, 12:31pm (UTC -6)
@ Chris...the mass of cargo that Danar knocked over onto Worf in S3's "The Hunted" seems much more significant then the barrel of whatever in this episode, but Worf wasn't even slightly injured by it.made the incident seem rather trivial and contrived.
Jack
Sun, Jan 22, 2012, 10:47pm (UTC -6)
Why couldn't they just put Worf in the transporter and rematerialize him using the pattern from the last time he used the transporter before the accident? That's exactly how they restored Pulaski in "Unnatural Selection"...
Plain Simple
Sun, Jan 22, 2012, 10:52pm (UTC -6)
@Jack: That's always been one of the wider problems when trying to see Star Trek as a whole: Technologies that magically save the day in one episode are conveniently forgotten the next week if the drama calls for a different solution (or lack thereof). I guess you just have to roll with it to enjoy the show. Sometimes it's quite jarring, but in most cases I don't care too much.
Jack
Mon, Jan 23, 2012, 9:58am (UTC -6)
True. Still, it's hard to grasp how "revolutionary" replicating a spinal cord is when the transporter essentially does the same thing, with the rest of a body attached, every time it's used.
Keiren
Thu, Apr 26, 2012, 5:51am (UTC -6)
Thats because the show is not about the answer, its about the questions... Thats why everything is reset every week, to ask more questions on a different subject.

However its still TV, so it has to attempt an interesting story also.
Tim
Tue, Jun 5, 2012, 12:03pm (UTC -6)
Interesting look at euphonasia, I can definitely see how Worf would go for this route. Thought that Riker just leaving the knife in his room was a bit odd though, and seeing as Worf knows Picard is au fait with Klingon customs, I'd have thought that he would ask Picard. But anyway, the doctors discussions were interesting, and I sure as hell wouldn't want to be left with winy Alexander (who was ok in this episode), so I thought Diana did a good job. Liked it.
John
Thu, Jun 21, 2012, 8:54pm (UTC -6)
I'm with Jack. 24th century medicine ain't what it used to be.
Glenn
Tue, Sep 11, 2012, 1:19am (UTC -6)
Agreed with the above about the lack of simple tie-downs for barrels stacked 15 feet in the air. An explosion that causes the barrels to fall is plausible, but simple unsecured barrels are yet another reason Picard should never be let near a starship after all he's let happen to his crew.
Jason
Tue, Oct 9, 2012, 4:50pm (UTC -6)
I've always wondered why they made Brian Bonsall wear blackface as Alexander. He's K'Ehleyr's son, and they didn't make Suzy Plakson do that.
Peremensoe
Tue, Nov 20, 2012, 1:42am (UTC -6)
The quibbles about unsecured cargo, and about medical capabilities, have merit.

The concept and characterization, on the other hand, seems just fine. The Klingon attitude toward suicide in such a case is perfectly understandable to me. How did you think Worf would feel about it?

And I completely disagree that making Alexander the victim would be a major problem. Worf actually did attempt to kill Kurn, who was *not* crippled, and that didn't "end" him as a "good" character. I don't see why contemplating--with great anguish!--killing his son should be a "bad" thing.
Peremensoe
Tue, Nov 20, 2012, 2:11am (UTC -6)
I mean, I think it's a better story this way--more character development for both Worf and Alexander, if he's the one laid low. I just don't think the contemplation of ritual death makes Worf a bad guy, whether it's his own death at hand, or Kurn's, or Alexander's. I'd be disappointed in him if he *didn't* want to do the honorable thing, by his lights--however much it hurt.
mephyve
Wed, Jul 24, 2013, 2:31pm (UTC -6)
Cool episode. Despite the fact that you knew they wouldn't kill off Worf or leave him paralysed, the story was a nice character study. Everybody was in character and behaved as you would expect, except for Riker. He studied the Klingon culture extensively and should have known Worf would want to off himself rather than live as only half a man, give or take ten percent. I had to laugh when Riker quickly said that Worf could ask 'anything' of him because I knew what Worf was going to ask.
Crusher as expected, was a stick in the mud. Too stuck on her own ideals to give the other doctor decent credit for saving Worf's life. Anyone else would have said, ' I don't condone your methods but thank you for saving my friend.' Beverly just had to take the sarcastic route.
William B
Sat, Jul 27, 2013, 1:46pm (UTC -6)
Like Jammer, I had not remembered this episode as being very good, but it turned out to impress me quite a bit. In fact, it impressed me more than Jammer. The big criticism I had of the episode when I was younger was that I couldn't understand why Worf and Crusher didn't both agree to Russell's procedure earlier. Surely if Worf was going to kill himself if he didn't get full mobility, there was no reason for Crusher NOT to do the procedure? And surely there was no reason for Riker to even consider participating in the suicide ritual when he could just have gotten Worf to do Russell's procedure? I couldn't quite understand where the characters were coming from, and chalked it up to a failure in the script. But now I have a different perspective.

I do think that there are still areas where the script could have spent a little time polishing the characters' perspectives, but I recognize now, more so than I had before, how rigid Klingon beliefs really are, and what that implies. The episode should have underlined this point much more, but it seems as if Klingon beliefs dictated that Worf should simply kill himself -- even kill himself rather than consider any procedure, even one that has a chance of restoring his full mobility. The process of recovering his mobility is itself an embarrassment, and every minute that Worf continues surviving with a paralysis is, by Klingon standards, "borrowed time." Picard points out, when he talks to Beverly, that Worf simply cannot and will not come all the way to accepting Crusher's perspective, but that he may make the compromise to try a procedure that has a chance at restoring full mobility, even though (as the episode confirms at the end) it will still require work, and some admission of failings and some willingness to "be a burden." I had not realized until this viewing, more than a decade after I had last watched it, that even this represented a step for Worf that Klingon custom would not dictate; that even this represents a consolation toward acknowledging his body's fallibility and living with it rather than accepting death as a release from the possibility of being other than the great warrior he sees himself as being.

Similarly, while I had not understood why Crusher didn't concede earlier on to do the procedure for Russell, I now get why she refuses to go through the procedure until she does. She does really believe she can simply restrain Worf from committing suicide for days, weeks, a year if need be; and her commitment to life and humanist principles is strong enough that she also simply will not believe that Worf will never come around, until Picard tells her straight-out that he won't. I do think that there is still a bit of a miscommunication in this story -- Riker never goes to talk to Crusher about performing the ritual in her sickbay -- but I suppose the way this makes sense is that had Riker agreed to perform the ritual, he would then have to go argue his case to Crusher, and if Worf had someone agree to perform the ritual he would eventually have to appeal to Picard (or some higher authority) to grant him exit from sickbay. Because, as it turned out, Riker never did agree to the ritual, and Worf could not bring himself to put Alexander through it, it was never really an issue that he and Crusher were in direct conflict, even though they were in indirect conflict to enough of a degree that they both had to compromise and move toward the centre.

What really works about this episode, then, is that Worf's injury spins off and creates several different stories, all of which are related but not strictly the same. They are all about ethics -- medical ethics in Crusher vs. Russell, cultural ethics in Riker trying to decide what to do about Worf's request (and speaking to Picard about it), parental ethics in Worf acceding to his responsibilities as a parent to Alexander, personal ethics in Worf weighing to what extent he should sacrifice his honour and the aspects of personal integrity (and personal autonomy) that come with that to the greater community. Ultimately, it's Crusher and Worf who are the biggest protagonists of the episode more than anyone else, and they are also the two who make the biggest compromises in their beliefs to come toward the centre, because they recognize, ultimately, that the circumstances demand it and that the people they care about require it. They don't compromise all the way; while it might have been brave to have Worf accept partial paralysis (the "60% mobility" solution), Picard's description of this being too far for Worf to travel is effective and believable, and Worf's willingness to choose to at least attempt to live when his Klingon instincts tell him to die because his son needs a father is an impressive display of honour. Meanwhile, Crusher has to participate in a procedure with little chance of working, going against the "do no harm" dictum, because her patient's beliefs make this the only option. The other characters ultimately, while they may face their own struggles, maintain the positions they started with -- Picard firmly believing in Worf's individual rights to choose what he does with his life, Russell fully committed to her scientific research and to the long game of possible benefits down the road, Troi devoted to Alexander's well being above all else, and Riker, while he struggled the most of anyone, finally finding a way -- through Klingon law -- to force Worf into acknowledging his responsibilities to live for his son. Not all these perspectives are quite as fleshed out as I would like, but all of them make sense, and there is time devoted to all of them and reasons to sympathize with all their positions.

The standard issue medical drama jeopardy made me roll my eyes. That Worf had redundant synaptic functions which saved him is supposed, I think, to demonstrate that Russell's disinterest in anything but her own research hurt her -- it is ironic that the redundancy Russell could see no value in is the very thing that saved her patient and thus her research. I appreciate that irony, but wish they had approached this with a little more subtlety -- having Worf simply be in great trouble in surgery and pull through as a result of these backup systems would be preferable to a long scene in which Alexander is informed of his father's death. There is the slightest implication that it was Alexander and Troi's return to Worf's room which reactivated Worf's synapses, or something, which is cheesy. Regardless of the intent, I was kicked out of the story for this portion of the episode, though I appreciate why it was important to the show to make the procedure seem dangerous and nearly fail. Possibly there was no way around this issue, but I still am not entirely happy with the result.

Overall, I think this is a 3.5 star show -- not quite top of the line, but very very good (and the best episode since "Darmok").
Cheyne
Mon, Oct 21, 2013, 6:40pm (UTC -6)
I thought Crusher was especially impressive here... she's come a long way, and is almost as interesting as Pulaski. Excellent!
Nissa
Fri, Jan 10, 2014, 11:39pm (UTC -6)
I actually really hated Dr. Crusher in this episode. If Worf wanted to try an experimental treatment, he should have every right to do so. After all, he doesn't regard his life as worth much at that point, and risking death means that the research can go forward and add meaning to his loss.
Andrew
Sun, Apr 27, 2014, 1:59pm (UTC -6)
I have one major problem with this episode. It seems like the crew isn't that distressed after Worf is paralyzed. Things only get tense as it becomes more and more about Worf's honor-suicide.

Maybe it's down to the directing, but shouldn't they be pretty upset over simply the fact that Worf was so gravely injured? They're kind of smiling and have the same tone as usual.

We don't get a scene of the crew together talking about the paralysis, or them gathered around Worf to support him. Kind of strange.
Picard from USS Phoenix
Tue, Apr 29, 2014, 2:50pm (UTC -6)
"The notion of a Klingon warrior seeing honor in assisted suicide seems fairly absurd to me, especially since there are conventional treatment options that would give back Worf as much as 60 percent of his mobility."

One, thing that really irritates me about those reviews is this arrogant anthropocentrism: "Of course is a silly custom, because we humans automatically know what's objectively wrong and right!" This same happened when Jammer was talking about "TNG Half a life" when he automatically said that Kaelon's custom is obviously stupid, without even considering why it even existed in the first place. If aliens exists, they are culturally different that us - do we have the right to judge them by human standards? And both episodes were, essentially about euthanasia. That's what klingon custom stands for; it's just an excuse to talk about this difficult issue. It's all about human dignity, wellbeing and utilitarianism as well. Worf never would be happy knowing that he is not what he used to be, as well he would undoubtedly think that he is useless and, that he is burden for others - even if this wouldn't be entirely true. Now, do we have moral right to take away Worf's freedom to choose and force him to live unhappy life, because we don't like his point of view? What I like about this episode is that all all parties involved - Worf, Crusher, dr Russell, Riker - have good arguments to support their position and writers of "Ethics" didn't forced you to agree with any of them - they allowed us to draw your own conclusions, and that's why it's one of the best TNG episodes.
Garrison
Sun, May 4, 2014, 2:22am (UTC -6)
Interestingly I happenend to watch this episode on BBC America the same day I watched DS9's "Sons of Morg" on DVD. Picard is seeing the death ritual from Worf's POV, while Sisko in no unsure terms refuses to allow Worf to assist his brother's suicide.
SkepticalMI
Sat, Jun 21, 2014, 11:59am (UTC -6)
Remember Me may be the best Beverly-centric episode, but this is certainly a worthy runner up. But it's not just Beverly, almost every character in the episode shines here. The title Ethics is quite appropriate here, as we get an examination of morality and how it intersects with everyone's culture. These sorts of episodes can be horribly preachy and completely destroy the narrative (see the next episode as an example). But here it was done well, mainly because nobody's views were shortchanged. We just got a great big mixup where nothing seemed easy.

The medical ethics was probably the most interesting part, thanks to some decent writing and good acting. Beverly is both naive and strong-willed; she has a stong basis in medical ethics and believes in them absolutely. She's right, of course, that the first rule is to do no harm. And she has some strong justifications in complaining about Dr. Russell's methods. In particular, Russell's actions at the conveniently timed emergency were fairly appalling. Mostly her lack of empathy and her ability to simply use people as experiments. Her complete uncaringness that one of her patients died is a strong rebuke to her position and is meant to make us despise her. And yet...

She's right about Worf! Beverly was wrong! Bev cared so much about her code of ethics that she didn't bother to consult with her patient's ethics. Like William said, she simply thought Worf would sit around waiting for a solution forever. In her rush to keep the Hippocratic oath, she forgot to look at Worf's side of things, and see that he would have gladly risked his life for an experimental procedure.

And at some point, don't experimental procedures need to be done? Don't we need to know if something like that would work? How many people need to die while we wait for FDA approval? And how many would die if we didn't wait for it?

So Bev has a point. But so does Russell. And in the end, it's Worf's ethics (that he can't stand living as a cripple, even if it's mostly a normal life for someone else) that forces Russell's way to be the right way. Or at least the right way in this case.

Meanwhile, Worf had some interesting problems too. He wanted to perform his ritual suicide, but didn't want to subject Alexander to it. But then he seemed at least willing to go with the treatment, or at least try to be rehabilitated until the shame got too much for him. But it did make it clear that he was conflicted, and it's quite obvious that he only doing it for Alexander. Once again, his Klingon ethics conflict with his desire to be a good parent to a decisively non-Klingon kid.

And that's not even getting into Riker's talk with Picard.

So on the whole, a pleasant, low key episode that works well.
dlpb
Tue, Jul 8, 2014, 1:46pm (UTC -6)
essentially about euthanasia. That's what klingon custom stands for; it's just an excuse to talk about this difficult issue.
======

It's not a difficult issue. If someone wants to end their lives in a dignified fashion, it is THEIR right. It is THEIR life. Anyone who disagrees with this is denying them their freedom. Especially when they will suffer needlessly as a result.

Unfortunately, Star Trek always seemed to side with the deluded anti euthanasia side.
msw188
Mon, Aug 18, 2014, 7:50pm (UTC -6)
dlpb,
I honestly don't want to start a fight, but your stance assumes that an individual has the right to consider their own wishes before the wishes of those around them. This is as much a 'cultural' assumption as any other, and is only 'freedom' in the sense of holding the individual higher than the family/community/society. That's fine and I think I tend to agree with you, but that doesn't mean the issue isn't difficult. Especially in the case of the individual having a dependent. I think this showcases why Alexander was very necessary to the story here.

I think this episode to me is like Darmok to Jammer. I want to love the episode and I respect what it was aiming for, but it fell short for me. McFadden gets some great material and none of the deliveries are poor, but some of the scenes seem to be missing that extra 'something' that great actors like Stewart can bring to the table. Speaking of Stewart, I appreciated the need for the early Picard-Riker conversation, but it felt jarring to see Picard take an almost confrontational approach seemingly from the start. Was the beginning of their conversation cut during editting, or just never written/filmed?

Anyways, I think the main thing McFadden is lacking here is the ability to portray true arrogance. Her looks of disbelief, disgust, and disdain for the other doctor (and even her disbelief at Picard's stance) are passable, but somehow I wanted more. Her stubbornness, in my opinion, comes from a certain arrogance whereby she recognizes herself as THE medical authority on the ship. In her mind, that includes the ethics of medicine as well. At least, that's the idea I get from the dialogue, and I like that idea. I just don't fully get it from McFadden's actual delivery. Instead, I get a sort of 'conviction' without quite the 'fire' of arrogance/authority. It's not bad, but it just doesn't get me very engaged in the material.

Finally, the ending feels over-wrought when the viewer knows that Worf will survive. I don't remember seeing this one when it aired, so I can't say if those scenes would have been tense without knowing the outcome. Watching this now, I'd probably go with a low 3 star rating, mostly for the concepts and questions brought up.
Taylor
Sat, Aug 30, 2014, 11:44pm (UTC -6)
"Ethics" - aka "Worf gets his spine crushed and Riker, Troi and Crusher give him shit for it for most of an episode."

While the whole Klingon honor thing gets to be a bit much in general, in this case it makes perfect sense to me a Klingon would have no interest in living with a severe physical disability. And thus it shouldn't be such a big surprise to Riker, either.

And Crusher mostly made sense, except that it made no sense she didn't want Worf to even hear about the experimental treatment - wouldn't it be her natural obligation to let him know?

I still liked the episode more than not - I just thought some of the character motivations served more to illustrate the extreme sides if the debate, rather than being so believable.
Lal
Fri, Oct 3, 2014, 12:28pm (UTC -6)
@pviateur: I was thinking similar thoughts when the barrel dropped on Worf. All they needed was an extra bar or two on that shelf, and no barrel would have dropped. But they had to have some clear-cut way to paralyze Worf, I guess.
Andrew
Sat, Oct 18, 2014, 9:29am (UTC -6)
The episode was good but I would have liked some more involvement from Riker (for his conflict with Worf to have gotten a bit more intense and to have had at least some sort of follow-up after the procedure) and Picard (for us to have seen the at least one conversation he had with Worf).
The episode is also hurt by that the series hadn't previously suggested much closeness between Worf and Riker, at least for some time, and had between Worf and Picard.
Robert
Mon, Oct 20, 2014, 8:33am (UTC -6)
I actually liked the choice of Riker and, in the very next episode, Worf risks his career to go down to the planet with Riker and save Soren.

When Riker was considered for the Ares Worf wanted to go with him and felt certain Riker would accept, especially since he viewed it as a dangerous mission.

In another episode (can't remember which) they were playing one of those Klingon holodeck programs together.

They weren't close friends perhaps in a human sense (like O'Brien and Bashir) but I think Worf felt Riker was the closest he had nearby to a "Klingon Warrior". It made a certain amount of sense.

Picard was his commanding officer.
Gustav
Wed, Nov 26, 2014, 12:55am (UTC -6)
What I would like to mention to everyone here who is saying that "people don't understand Klingon culture" in response to criticism of Worf wanting to commit suicide, is that Worf really is quite naive when it comes to Klingon culture. I mean, Riker knows more than Worf does, and he just did a very short tour of duty on one Klingon ship. So that whole argument seems very contrived to me.
$G
Thu, Mar 12, 2015, 7:45pm (UTC -6)
I didn't expect this episode to be so well received in here. Frankly, I didn't expect to like this episode at *all*. But, honestly, I agree with the posters who think this is the best hour since "Darmok". Everyone's mostly mentioned the good stuff, but I'd just like the echo the enjoyment for all the different story threads that plausibly resulted from what could have been a one-note premise. I particularly enjoyed the Crusher-Picard scene, which made me miss the dynamic of the starry-eyed Federation gal vs. the seasoned Fed diplomat from "Symbiosis". Crusher doesn't get enough good material.

One surprising thing for me was the Worf didn't pick Picard for the suicide ceremony. Considering how much he'd already done for him on Qonos, you'd figure he'd be a natural choice. I thought Riker did well, though.

Troi's role also worked for what it tried to accomplish. And while Alexander's role is always seems a bit Full House-y to me, I liked seeing her not only take care of him but nearly get choked up at the thought of Worf entrusting him to her.

3.5 stars for me. Solid overall, and goes way over and above what it needed to.
Peter
Tue, Apr 28, 2015, 10:35am (UTC -6)
This episode was really good and exemplified one of the main reasons I love Trek. Who else would do a popular TV episode about a dry, intellectual subject like medical ethics.

I did understand Worf's expressed desire for suicide in the context of his Klingon warrior nature. The 60-70% mobility restoration of conventional treatment would seem to be enough, however. But that's besides the point. The episode seemed to be skirting around the issue of assisted suicide in our own culture, but it did not go far enough in that regard, in my opinion. They seemed to make it a point to say that Worf was not in pain, he was fully expected to live (i.e., his condition was not deteriorating and ultimately terminal), so those conditions don't meet the standards for euthanasia in our society.

Before the episode could fall short on the medical ethics front, the character of Dr. Russell, with her risky experimental treatments, brought that back into focus. Her character was perfectly written and acted, as was Dr. Crusher's in this episode. It is so rare to see a Crusher-focused episode, and she's a character I really like, so that also made it a winning episode for me.

The young boy who plays Worf's son is also consistently good. I mean, he looks like he is all of about 7 years old and under a lot of makeup and prosthetics to boot. That the kid does such a convincing job is remarkable.

Troy
Mon, Jul 6, 2015, 12:55pm (UTC -6)
This is a 3 star episode, very well done. The tit for tat rivalry between the doctors is great and very plausible. Tge guest doctor was very well written and performed. Others have suggested that the injury being non-curable in the time of transporter technology are spot on, this is an Aesop fable about the 20th century, not the 24th. Repairing spinal cords can't be more than a century away and I suspect within a generation. But that is a small quibble for this satisfying episode.
Luke
Fri, Aug 14, 2015, 2:21am (UTC -6)
All right, let's talk about doctor assisted suicide, shall we? :P

Let me just put this out on the table before I go anywhere - I'm all in favor of it, with the caveat that the person choosing it needs to be in his or her right mind when deciding the matter. Personally, I doubt it is something I would ever choose for myself and I would certainly use any and all powers of persuasion at my command to convince someone not to go through with it. But, at the end of the day, who am I to force someone to conform to my beliefs on the matter? It's that person's life and so it should be that person's decision. I guess I'm like Bill Clinton when he said that he was "personally Pro-Life but politically Pro-Choice," even though he was talking about abortion. While I may not agree with Worf's decision to end his life, ultimately it's his decision to make, not mine or anybody else's. I may even disagree with the cultural tradition that Worf is invoking here (in fact, I think it's stupid), but (again) since he's clearly in his right mind, a.k.a. not delusional, he should be allowed to do it if he so wishes.

What I love most about "Ethics" is that it takes the time to examine the issue from many different angles. You have Picard taking what is essentially the same position I would take. You have Crusher who is adamantly opposed to the idea. And you have Riker who is torn between which side to come down on. And to that the fact that they didn't feel the need to drag the episode down with some unnecessary B-plot with a tech issue and you have a real winner of any episode! Heck, they even have Alexander acting like a normal kid (always a plus for Trek in my book) and a fairly decent use of Troi as a counselor.

The one sticking point for me is that they made Crusher WAY to obstinate in her opposition, in my opinion. Now, I've said it before and I'll say it again, I really like the character of Crusher and love it when they allow her to have the spotlight. Here, however, she's just so maddeningly inconsistent. She's absolutely 100% correct in her denunciations of Dr. Russell; the woman clearly puts her research ahead of her patients. And yet, she's 100% wrong when it comes to Worf. This exchange is particularly glaring....

PICARD: If he can't make a full recovery, Worf will kill himself.
CRUSHER: Not in my Sickbay, he won't! I'll put him in a restraining field and post security around his door before I let him commit suicide.
PICARD: And how long will you keep him there? A week? A month? A year?
CRUSHER: If I have to. Suicide is not an option.

So, suicide is not an option, but forced imprisonment because you disagree with me is? Geez, Beverly, you're not making your case look good. Then there's this line (from the same scene).... "The first tenet of good medicine is never make the patient any worse." So, she's never harm you, now off to your jail cell, you thought criminal! Thankfully she eventually sees reason, but the fact that Picard, nor anybody else, never calls her on this rather blatant hypocrisy harms the episode for me.

8/10
Niall
Fri, Aug 14, 2015, 5:45am (UTC -6)
My family and I thought the same thing when we watched it.
Mike
Mon, Sep 7, 2015, 5:31am (UTC -6)
The idea is OK but the script is awful.

Nobody acts in character, except unfortunately Crusher, who is the cliche life-at-all-costs doctor. Even the guest character makes her argument well in one scene and then jumps to experimenting on people.

The outline of the script is exploitative in, again, cliche ways. Who are these people Riker mentions as dying? Are they really gonna kill off Worf. May as well kill off the voice of the computer.
Robert
Tue, Sep 8, 2015, 8:11am (UTC -6)
"Are they really gonna kill off Worf?"

Come on... main character (or the ship) in peril is basically a staple of EVERY OTHER Trek episode. If you use that as an excuse to not "buy" the episode, you're probably not buying the entire series :)

I do agree with you that the guest character could have been more smartly written to be less crazy. Crusher's assessment that she's a nutjob that got lucky is spot on, the episode could have made her "greyer".

I do wonder who you think acted out of character though?

And as for "Who are these people Riker mentions as dying?"

Sandoval and Fang-lee - They were never in the show before. Likely random "red shirts".

Marla Aster - The mother of the son that bonded with Worf in "The Bonding" following her death on an away mission where Worf was in command.

Tasha Yar - I should hope you know that one :)
Diamond Dave
Sat, Sep 26, 2015, 11:23am (UTC -6)
For an examination of medical ethics and those surrounding assisted suicide this fall short for me. The characters immediately take entrenched positions at polar opposites, which means we only get to see black and white, and not the shades of grey. So Picard is the cerebral, culturally sensitive opposite to Riker's visceral, anti suicide reaction. Crusher is the classic first do no harm doctor, Russell the opposite risk taker for the potential future benefit.

That this all winds up in a frankly unconvincing death scene - when, let's face it, the only tension is how Worf will recover, not if - merely adds to the vaguely unsatisfactory air.

That's not to say that there are not some scene highlights - indeed the Worf/Riker and Worf/Troi scenes match those where Crusher and Russell clash. But overall, once again this series, it misses as many hits as it makes. 2.5 stars.
Nic
Fri, Dec 11, 2015, 10:08pm (UTC -6)
I agree with Elliott (!!!) This is a 3.5 star show, knocking down 0.5 stars for the manipulative surgery scene. Everything else was stellar.

I understood Worf's point of view, and Picard's, and Riker's and Beverly's, and Russell's. There are no easy answers in situations like this, and the episode acknowledges it.
Jason R.
Fri, Jan 22, 2016, 4:25pm (UTC -6)
Many humans would agree with Worf. There is nothing "absurd" about his beliefs and I found Riker's speech insufferably arrogant and self righteous. Worf should have punched him in the face.
stephen palmer
Thu, Mar 31, 2016, 8:26am (UTC -6)
I'd like to draw attention to Worf's debilitated condition at the end of this episode. It really looks like Worf would take a long time to fully recover from his injury, despite the "miracle cure".
And yet, next episode shows him clobbering aliens as though nothing had happened. What could have been a a tremendous opportunity to show Worf's character and courage in a new light (recovering with dignity, taking the opportunity to further bond with his son etc) is lost.
I guess the story editors felt that episode to episode continuity like that might make Star Trek too soap opera-ish, but it does trivialise the seriousness of Worf's physical crisis in this episode.
Ivanov
Fri, May 6, 2016, 4:45pm (UTC -6)
While I like this episode I never understood why Dr Crusher was so against the procedure. Didn't Riker tell her Worf was going to commit suicide if he couldn't walk?
3.5 stars.
Torridd
Tue, Jun 14, 2016, 3:11pm (UTC -6)
In the thread, there don't seem to be a lot of opinions on Dr. Russell. Someone wrote that she was uncaring though and I disagree with that. She had her own methods. Maybe she wasn't as dedicated as Crusher, but like she told Crusher she doesn't like losing patients either. I really like the tension between she and Crusher and the dialogue at the end. They both have very good points, but I can't fault Russell too much.
Dan
Fri, Sep 30, 2016, 1:24am (UTC -6)
I agree this is a great one. Makes really good use of the characters—the best we've seen from Crusher and Troi, and maybe Riker, all season. (There's been *a lot* of Troi lately, but not until her few scenes here did I feel like she really clicked. There's been very little Crusher, so it's refreshing to give her something this good.)

I also liked Half a Life more than the consensus—probably the last episode that had me saying "wow, this is good" (sorry, Darmok)—so I guess I've got a soft spot for ethical dilemmas involving suicide in alien cultures.
Beej
Fri, Jan 20, 2017, 1:31pm (UTC -6)
Grumpy_otter said: "Also wanted to say I like Caroline Kava in this episode very much--she played her part perfectly. They could have made her entirely a villain, and she wasn't at all."

Ha ha ha ha ha! What?! You could practically see her twirling the ends of her mustache as she rationalized her use of an experimental drug on that dude in the shuttle bay. I'm absolutely certain that scene was there only for the purpose of making her less sympathetic and Crusher more so. I rolled my eyes so hard I'll probably need an untested procedure to get 'em pointed right again.

In general I found Worf's point of view presented entirely unsympathetically. You'd think (well, I'd think) that in a Utopian future it would be unequivocally accepted that the right to die was a fundamental one. Instead apparently your doctor has the even more inviolable right to hold you prisoner indefinitely. Progress!

Tne one thing I did like about this ep is that at least a character outside the Enterprise bubble was allowed to do their job competently and "save the day". Dr. Pulaski would've pushed Dr. Russell out of the way and fashioned Worf a new spine out of spit and baling wire.
Jasper
Sat, Feb 18, 2017, 1:48pm (UTC -6)
Great episode. Some really moving scenes between Worf and Alexander. I don't like Alexander much, but in this episode the interaction between him and Worf was powerful stuff. Granted, the accident itself was silly, but otherwise a very clever episode about medicine, from a doctor's and from a patients view.
Outsider65
Sun, Mar 19, 2017, 2:20am (UTC -6)
Beverly was very unethical here, wanting to hide the experimental procedure from Worf and force him to accept her less risky but less effective alternative. What gives her the right to make that call for him? As a patient it is his right to decide on what treatment he is given and he should be given all the options. I've never been a huge fan of "doctor" Crusher but this is a little much even for her. Why did no other character call her out on behaving so unethically?
Jason R.
Sun, Mar 19, 2017, 8:32am (UTC -6)
"Beverly was very unethical here, wanting to hide the experimental procedure from Worf and force him to accept her less risky but less effective alternative. What gives her the right to make that call for him? As a patient it is his right to decide on what treatment he is given and he should be given all the options. I've never been a huge fan of "doctor" Crusher but this is a little much even for her. Why did no other character call her out on behaving so unethically?"

I strongly disagree. A doctor's ethical duty is not simply to present every "option" and let the patient decide while washing her hands of the consequences. The Hippocratic oath is no lightly satisfied.

While we, the audience, of course know that Dr. Russell's procedure was going to be successful (due to the fact that it was inconceivable that they'd kill of Worf), Dr. Crusher didn't know that - indeed, based on her assessment, it was basically an untested, highly experimental procedure with an unacceptably high risk of death being proposed by a doctor who had demonstrated a willingness to gamble with her patients' lives for personal glory.

Keep in mind Worf was not some terminal patient facing certain death. He was stable and with time could have regained much of his prior function. Again, we know that he was committed to suicide should he not regain his functioning, but Beverley didn't. Lots of human patients undoubtedly would have threatened suicide as well and yet changed their minds in time.

Even in countries where assisted suicide is legal, I doubt the procedure is simply to hand someone a needle (or a dagger) the instant they profess the desire to off themselves, within a couple days of suffering a catastrophic (but non life threatening) injury. This is the kind of thing that would probably require extensive psychiatric consultation over many months!

It takes Picard's unique insight into Klingon culture to convince Dr. Crusher that Worf likely cannot be swayed from his decision, and even then it's a borderline call for her since this procedure was extremely likely to kill him, notwithstanding Kilingon ex machina.
DLPB
Fri, Apr 14, 2017, 4:38pm (UTC -6)
Jason R. You're wrong. Watch the episode again. Crusher admits that she is prepared to lock Worf up and post guards to watch over him in order to keep him from committing suicide, which Picard explains is an inevitability should Worf not be fully cured.

That is wrong by any measure of ethical normalcy. She is deciding to supersede his culture, beliefs, and rights, because they conflict with her own. I am sure the writers didn't intend to portray Crusher as a crazy loon. But they did. Even more so than the hit job they did on the other doctor, simply to make Crusher's position look more sympathetic to the audience.

I have been bedridden before with severe pain after an operation. I knew it wasn't going to last. I remember thinking "If I had to live like this, I'd definitely want to be euthanized." I think a lot of people who defend Crusher and the anti-euthanasia stance would feel very differently if they themselves were in a hopeless position and forced to endure pain for the rest of their lives—whether that be mental or physical pain.

Peter G.
Fri, Apr 14, 2017, 5:11pm (UTC -6)
DLPB explains an utterly relativistic theory of medical ethics where a course of action may be moral depending on how comfortable you are when making it, following an absolute statement that someone else is wrong about the topic. Oh the irony abounds.
Tara
Fri, Apr 14, 2017, 8:09pm (UTC -6)
Peter g:

Not seeing the irony.

Dlpb is speaking up for a specific principle: patient autonomy. This is the accepted modern American model.

By my standards (I'm a doctor) Beverley was an ass.

By my standards as a TV watcher, the writers were asses. Respect for the myriad different values of different species was surely taught at Starfleet Med School. It would hardly be good for interstellar diplomacy if Beverley constantly felt entitled to pour blood into Jehovah's witnesses and lock up honorable suicide-minded Klingons.

in my practice, suicidal patients are watched around the clock and prevented from killing themselves. But that's because we are humans and follow the creed that suicidal ideation is proof of mental illness.

This creed is not true for Worf. As best I can tell, his wish to die is in line with Klingon values and he is expressing it in a clear headed and culturally appropriate way. If he is meant to be seen as deranged by depression and incompetent to choose his fate, the episode did a poor job of showing this. (They should have given us a wheelchair bound Klingon on the view screen saying "Worf, quit whining and live on with courage! Like a true Klingon!")
Chrome
Fri, Apr 14, 2017, 11:01pm (UTC -6)
@Tara et alt

It's interesting because this is the same stance Crusher takes in "The Enemy" when Worf refuses to give blood to a Romulan. I'm guessing here that the writers think Crusher's actions are those of an enlightened 24th century doctor or some such, believing that societal values outweigh personal liberties. Personally, I think that notion is garbage and Crusher should be reprimanded for putting her interests above a patient's wishes, no matter how noble her intentions are.

That said, if Dr. Russell failed to fully disclose the chances ands risks to Worf, as Crushers suggests, she's also in the wrong and doesn't deserve praise.
Peter G.
Sat, Apr 15, 2017, 1:18am (UTC -6)
@ Tara,

I'll try to be clear in my response, sorry if some of it sounds blunt:

"Dlpb is speaking up for a specific principle: patient autonomy. This is the accepted modern American model."

No, DPLB said that Crusher refusing to let Worf kill himself was "wrong by any measure of ethical normalcy," which is completely and unequivocally false. The modern American model is for doctors to follow the law, which can change over time. It is NOT to allow unlimited patient autonomy. If and when a state passes a euthanasia law allowing a crippled adult to seek death, and additionally where the doctor doesn't have to be a party to it, then you'd have a case for modern law suggesting that Crusher would be denying Worf some kind of moral right. And even THAT supposes that the law being such would in and of itself create moral rightness, which is a declaration that moral principles are based in nothing more than what is legal or allowed by the state (e.g. that the state is the moderator on morality). A lot of suppositions are required there to support Crusher being definitively in the wrong. And of course in Worf's case he isn't even seeking medical-assisted euthanasia, but rather just wants to commit suicide by any means possible, so the law would have to not merely allow for doctor-assisted death, but also give carte blanche to *anyone* wanting to commit suicide. Are you seriously going to suggest that American law (to say nothing of medical ethics) allows for this in our time? As a medical practitioner I hope you don't think so.

"in my practice, suicidal patients are watched around the clock and prevented from killing themselves. But that's because we are humans and follow the creed that suicidal ideation is proof of mental illness."

No, that's not why you do it. You are primarily obliged to prevent it because suicide is illegal, and because the law states that it can't be allowed if it's preventable. I mean, what you say may be why you personally believe in preventing patient suicide, but even if you flipped your position on whether suicidal desire is proof of mental illness (let's say it was proven eventually to be a false equivalence) it would change nothing. If the law disallows suicide and/or euthanasia then the medical notion of what does or doesn't prove mental illness would be irrelevant; the person would be prevented from killing themselves, period.

But I can go even more directly to your point by pointing out how Western-centric the idea is that an anti-suicide ethic is a distinctly "human" value, since it's false that all human societies have held this value. This is especially evident since the Klingon kamikaze mentality, honor system, and ritual suicide are blatantly lifted from the Samurai code. But you did specify that it's a psychiatric creed that suicidal thought is ipso facto a sign of mental illness, which of course is simply a circular way of saying that since suicide has been decreed to be unacceptable a priori that anyone desiring it is by definition mentally ill. The relevant factor here isn't whatever "ill" is supposed to mean in this context, but rather the supposition upon which it's based, which is that suicide is 'bad' in the absolute sense. So intrinsically your comment actually refutes what DPLB said anyhow, which is that one would change their mind on suicide if they were suffering - e.g. that the ethics of legalizing suicide should rest in the comfort level of the person asking for it, rather than any general principles. If this were true then it would make no sense to call someone asking for suicide "mentally ill", since it would then be seen as a perfectly rational thing to request. You can't have it both ways, which is why I called his comment ironic. He was taking an absolute stance backing a position that was relativist in its specifics.

And I'm not even going to get into whether euthanasia or suicide are "morally correct" in the absolute sense (moral realism), but I will point out that I think it would be presumptuous to believe that since the Western world is beginning to decide that assisted suicide should be allowed that this is a 'good decision' in the long run. It seem so now to many people, but the fact that it's becoming popular as a notion of course doesn't speak to whether it's a good idea. For all we know by the 24th century it will have been "proven" that it's very bad and will, by that time, have been disallowed again.

"This creed is not true for Worf. As best I can tell, his wish to die is in line with Klingon values and he is expressing it in a clear headed and culturally appropriate way."

Picard expressed multiple times over the series that Starfleet respects but does not operate under the rules and norms of other cultures. It no doubt tries to incorporate cultural elements from its member races, but does not allow behaviors that are otherwise illegal or unethical just because some race believes them. Sisko later said much the same thing on various occasions. If, for instance, suicide is illegal under Federation law, then Crusher is 100% correct in trying to preserve Worf's life. Picard's argument was that, regardless of the law, Worf would in fact end up dead if he wasn't given the experimental treatment, but in our present day and age such advice could easily lead to a prison term if the experimental drug hadn't actually been approved for use yet. It sounds like rational, down-to-Earth Picard logic, but legally speaking he was basically saying to hell with the rules. I can respect that, in a way, but can hardly fault the doctor who was abiding by the law.

By the way, I'm not the biggest fan of Crusher in this ep either, but that's mostly due to the fact that the writers failed to properly illustrate the issue I think they were going for. Crusher's position *appeared* to be much weaker than it really was due to storytelling error. The issue, to an extent, boils down to what the actual status was of this experimental treatment and whether it was approved for patient use. If so, and Crusher refused it on Worf's behalf, then that's not so good, but if Crusher was right that patient lives were being used for medical experimentation then there's no conversation. That these facts are not brought to light in the episode is one of its many weaknesses. The result is it ends up looking like a hit piece on Crusher when, on the balance, hers should have been the stronger position.
Tara
Sun, Apr 16, 2017, 4:53am (UTC -6)
Well, I won't rebut that whole thing, - would take forever. We can agree to disagree mostly.

One thing though: Your claim that suicide's illegality is what matters (in medical decision-making and ethics) is simply completely wrong.

Legality of patient behavior is never a consideration. We aren't cops, just like cops aren't doctors. Patients do illegal things all the time right in their hospital rooms.

If you are a doctor who learned a different version of medical ethics - maybe because you trained in a different era or another country - I'd love to hear about that.

Otherwise, I am perplexed by you attempting to correct me about my own job.
Jason R.
Sun, Apr 16, 2017, 9:04am (UTC -6)
Tara I find your distinction between Worf's decision to kill himself for cultural reasons and that of some of your human patients (for other, perhaps equally valid reasons) arbitrary. Why does culture trump but not, say, a considered choice based on personal values.

Yes Worf is a Klingon but as Peter noted there are some human cultures that endorse suicide in certain circumstances. If you encountered a patient with that culture would you be be fine with him telling you he planned to off himself in accordance with his culture?

Yes, as a doctor you aren't bound to enforce criminal law as a matter of course, but I'll wager whatever medical association that grants you your license, not to mention the hospital or clinic you work in have regulations about this sort of thing that you are bound to follow and if someone announces this intention, regardless of his cultural background, there are procedures to follow that probably begin with some kind of temporary involuntary commital. The alternative is you could risk being sued by the family of the individual I imagine.

Even in assisted suicide / euthenasia friendly jurisdictions I am pretty sure some kind of psychiatric evaluation is needed before you can just hand someone a dagger and say good luck.

Picard was hardly a certified expert in Klingon culture, nor was Beverly. But regardless, even if she had to concede she would be unable to prevent Worf's suicide in the long run because of his culture (I do think it is fair to say her threat to lock Worf up forever was a bluff) that did not require her to violate her medical ethics by turning Worf into a guinea pig for some half baked expiremental procedure. The Hippocratic oath still applied regardless of Worf's values.

Correct me if I'm wrong Tara, but as a medical doctor you can't just roll the dice on a patient's life with unproven dangerous experimental procedures, even if the patient's prognosis is poor or no other good alternatives exist.
DLPB
Sun, Apr 16, 2017, 10:38pm (UTC -6)
What I said stands for itself. It doesn't need a pillock putting his own meaning on it :)
DLPB
Sun, Apr 16, 2017, 10:40pm (UTC -6)
Also, have you noticed the same boring tactic people use when they don't like what someone has said? Always taking the argument to the person. Whether you like it or not, Crusher was prepared to keep Worf under house arrest indefinitely because his culture and beliefs did not gel with her own. That is exactly what the episode shows. Don't blame me, snowflake. Blame the writers.
Peter G.
Mon, Apr 17, 2017, 10:09am (UTC -6)
Tara,

"One thing though: Your claim that suicide's illegality is what matters (in medical decision-making and ethics) is simply completely wrong. "

If suicide was 100% legal and acceptable, I don't see how a doctor would have any business preventing a patient doing so. Medical ethics might suggest that a doctor can allow it but not assist, but a doctor couldn't disallow it. Likewise, if suicide were 100% illegal, a doctor would not be allowed to assist, nor would the patient be allowed to kill themselves if it could be prevented (as is the case in the U.S. now). Medical ethics and the law are not identical, as you say, but medical ethics cannot allow something the law deems illegal, and so this is a hard constraint. Patient suicide is prevented because of the law, not because of medical ethics, because the law is the stronger arbiter of its lack of acceptability. If suicide was legalized and medical ethics ruled that it must still not be allowed in a hospital, then you'd have a case for suicide prevention being strictly a medical ethical decision.

"Legality of patient behavior is never a consideration. We aren't cops, just like cops aren't doctors. Patients do illegal things all the time right in their hospital rooms. "

Right, but are you telling me that if a patient announced "I am going to kill myself" you would (a) do nothing about it, and (b) that if you did nothing and the patient did kill themselves, that there would be no legal repercussions for the doctor who allowed it to happen without notifying authorities? I don't think this is this case. If you correct me on this and tell me that you literally have zero liability or legal responsibility if a patient commits suicide under your care when you knew it would happen, then I'll drop this particular point. Note that I didn't claim that a doctor must enforce all aspects of the law, such as preventing a patient jaywalking or robbing a bank. I'm strictly speaking of the patient trying to kill themselves with the doctor passively looking on as it happens. As I understand it even a patient protected by confidentiality (under care of a doctor or therapist, for instance) must be reported if they make it clear they are going to kill someone else or themselves.

Assuming I'm correct in these statements, the issue is really what the law says about suicide, which in turn makes us wonder what Federation law says about this, which we aren't told. I find that a serious plot hole in the episode, since if Federation law protected a patient's right to suicide then Crusher would be totally in the wrong, whereas if it was illegal then 'committing' him to prevent it would be demanded by the law, and Crusher's position would simply be a reiteration of what the law demands.

Tara
Mon, Apr 17, 2017, 11:29pm (UTC -6)
Scenarios:

(1) A patient shows up covered in cigarette burns, saying "I am burning myself because Jesus keeps telling me I gotta burn Satan outa me."

Now, this is perfectly legal: you're allowed to burn yourself with a cigarette and you are allowed to listen to the words of Jesus whether real, imagined., or hallucinatory. But I would have the right (probably the obligation) to get a 72-hour involuntary hold on this patient, and then a forced psychiatric assessment. I would have to right to hold the patient against her will and even put her in restraints or post a sitter (guard) over her. If a psychiatrist found her mentally ill and a danger to herself, and a judge agreed, the patient could be held against her will in a facility for a long time.

This is not because the patient is a criminal. (Go burn yourself with cigarettes and tell a cop you did it on a bet; you will not be arrested!) It is because the law allows doctors to protect mentally ill or demented or otherwise incompetent people who are mentally unable to protect themselves. It's what a kind society does for its mentally infirm.

(2). A heroin addict is hospitalized with endocarditis (life threatening heart infection). After a day or two she says "fuck this; my check came in today and I am leaving the hospital to buy heroin, and I am going to party until my money runs out." (THis is a common scenario.) Assuming she is sane, I have no right in the world to hold her against her will, chase her down the street, or camp out on her doorstep begging "Don't do drugs!" That would be kidnapping, stalking, and criminal harassment on my part.

Yes, heroin-buying is a criminal act and yes she will probably die from her actions. But that's her choice and I can't stand in her way.. Sane adults have the right to break the law and risk their lives without their doctors impeding their liberty.

As for "Would I stop a suicidal guy?" - I already addressed that in my initial post. Please retread it. Yes, I would be obligated to hold him for evaluation because IN MY SOCIETY, suicidal ideation is considered PROOF of mental illness and therefore a scenario-one situation..

However, as I said: in Worf's Klingon culture it is implied that suicide is the culturally accepted, totally normal action of a sane Klingon paraplegic. In a Klingon, it does not prove mental illness. Therefore Worf's statement of suicidal ideation is a scenario-two situation.
Peter G.
Tue, Apr 18, 2017, 12:15am (UTC -6)
Tara,

Thanks for the detailed response. In your scenario (1) you're discussing holding a patient who will be a danger to themselves. The reason you state for the hold is because a kind society wants to protect people. I agree that this motive is in play, but my point isn't that this *isn't* a factor, but rather that it's the lesser factor compared to the law requiring death threats (even to oneself) to be treated in a certain way. Even if the medical establishment (hypothetically) was callous or a given hospital didn't care if a patient lived or died, the law would still require a certain response to a death threat. And it's not because the patient is a criminal, per se, but rather because a certain kind of threat must be dealt with in a certain way.

If a psychiatric patient disclosed to a therapist the intention to bootleg a film, they would be obliged to retain confidentiality, whereas if the intended crime was a murder they would have to report it. So it's not about crime in general, but strictly about a death threat or suicide. I already specified in my previous post that " I didn't claim that a doctor must enforce all aspects of the law, such as preventing a patient jaywalking or robbing a bank. I'm strictly speaking of the patient trying to kill themselves with the doctor passively looking on as it happens." Your scenario (2) seems therefore to be basically in agreement with what I said.

Regarding this comment:

"Yes, I would be obligated to hold him for evaluation because IN MY SOCIETY, suicidal ideation is considered PROOF of mental illness and therefore a scenario-one situation.. "

My point two posts ago (and I apologize for how long it was; in hindsight that was a mistake on my part) was that the linking of suicidal ideation with mental illness
is not a strictly human thing, but specifically an *American* thing. It may also be true in some other countries (such as Canada and European ones), but in each case it's because that's how the laws of those countries work. In feudal Japan the laws did not work that way, and so their culture normalized suicide. If a man from Canada wanted to commit suicide in feudal Japan (assuming the proper circumstances were met) they would no doubt understand completely, whereas if a feudal Samurai wanted to commit suicide in a hospital in America they'd put the involuntary hold on him that you mentioned. It's not the culture of the individual in question that applies, but rather the laws of the nation in which the event is going to happen. You might imagine a nation where murder is sometimes legal (like Ancient Sparta), but if an Ancient Spartan wanted to do so in modern America he would be arrested rather than having his cultural beliefs respected. So you see the beliefs if the land are what dictate what will be accepted or not, not the beliefs of the individual as regards killing and murder. Klingon culture may allow suicide, but Federation law might not, and this is the vague part of the episode. If both cultures allow it I would find Crusher's position to be inexplicable, and so I must somehow conclude that the Federation law about this is weird and has complicated clauses. Riker was speaking about killing Worf as if it was actually an option and that he was rejecting it, which strikes as odd yet again. Is it legal, or isn't it? What the writers seemed to be doing is using the personal beliefs of each crew member to get across what they personally make of the situation, and none of the seems to at all be concerned about what is actually allowed or what Federation policy is about it. This is cheating a bit, but (SPOILERS) Sisko makes it very clear later on that suicide on a Federation station is illegal, so I have to wonder, then, what else there is to defend in Crusher's position. If it is illegal, and she would put a temporary hold on him, that makes sense. And if the experimental treatment was illegal research, then she wouldn't submit Worf to that either without breaching ethics. It all seems to stand up. It makes more sense if we just assume that suicide is illegal under Federation law, and the using experimental trials is also not allowed under medical ethics.

So for Worf to want to commit Klingon ritual suicide on the Enterprise would seem to fall under Federation law (which respects but does not condone or assist with beliefs counter to its own), just as if Worf wanted to murder a crew member Klingon-style for questioning his orders, but it's not a Klingon ship and he doesn't get to employ Klingon laws on the Enterprise. Worf is on a Federation ship and so it's those laws that will be followed, not the Klingon ones. Picard has likewise stated even to Worf directly that he expects Federation conduct from him. In fact, when Worf killed Duras PIcard told him straight-up that this was in violation of Federation law, and men were on their way to stop him. *That* he has a belief that is held elsewhere is irrelevant when discussing what Worf is allowed to do in a Federation culture. Worf may not be 'mentality incompetent' according to his culture's standards, but by ours he is still breaking a law by threatening to kill (himself or others) and he's be committed either way. On a psychological scale if you wanted to declare him mentally unfit you could try, but since he's a Klingon you'd have to either use human logic on him, or else Klingon logic to declare him unfit. If you use his values, then he isn't "mentally unstable" by American standards, and yet must still be held temporarily so that the threat to himself or others can be evaluated. That wouldn't change at all, which proves my point that holding suicidal people isn't to do with the cultural norm of the patient but about the laws in the country in which the patient is treated.

The episode never established Federation policy here, whether the experimental treatment was legal to administer, and even whether there is euthanasia in the Federation. In fact I bet this omission was deliberate because they didn't want to open that can of worms, even though it was at the heart of the episode. I think they chickened out in the end and used the magic procedure to fix everything so that the individual objections never really had to be dealt with.
James
Thu, May 25, 2017, 7:44pm (UTC -6)
Why does that doctor who comes on board have the exact same hairstyle and wardrobe as 21st century Hillary Clinton?
Andrew
Sun, Jun 4, 2017, 7:02pm (UTC -6)
The way Worf, Picard and Riker all spoke and acted to me strongly conveyed that assisted suicide was permitted under Federation law but Riker and Crusher had a strong personal abhorrence to it, that it was a controversial request as most humans felt closer to Riker and Crusher's views than Picard's but not that Worf was asking that people and Picard accepting of act illegally.
Andrew
Sun, Jun 4, 2017, 7:11pm (UTC -6)
That Crusher admits and emphasizes, when Picard disputes the practicality of her restrictions, that she's talking about what she will permit in *her sickbay* (rather than what any doctor and medical establishment would do) suggests she is acting out of her personal ethical beliefs rather than having the law support her position.
Outsider65
Fri, Jun 9, 2017, 6:17am (UTC -6)
What I don't think is right is Beverly hiding a medical option from him and declaring she will hold him captive indefinitely to prevent him from his ritual suicide.

This is his life, and if he's willing to risk it to try an experimental procedure, that is his choice. Beverly's job was to tell him ALL the options, as well as the risks. You could argue that she thought the risk was too great, or that it would violate "do no harm". However, Worf is entitled to a second opinion, and to getting another doctor. Trying to keep him from knowing about the option or talking to the other doctor in order to manipulate him into doing what she wanted him to do was despicable. In fact, trying to prevent him from getting a second opinion was probably criminal.

Riker almost goes through with the ritual with Worf, indicating that it is not illegal, meaning Beverly has no authority or right to imprison him in sick bay. Even if she did have a legal grounds for keeping him there, she has no right to impose her will on him, to force her decisions and opinions on him, as she wanted to.

Writing this out made me realize why I detest Beverly. Well, in addition to her being insipidly bland, a horribly incompetent doctor who blatantly disregards patient rights, and the boyfriend talk with Troi. I hate Beverly because she's self-absorbed and manipulative. She's always trying to get her way, often through deception or coercion. Worf refuses to give blood to his sworn enemy? She runs to Picard, trying to use Picard's authority to force Worf into violating his own morals. And this despite the intended recipient vehemently saying he'd rather die than receive a transfusion. A family forbids her to perform an autopsy on their deceased son, but she really wants to? She does anyway, and runs to Picard. AGAIN. He basically shakes his head and says "I can't help you now." How many times has he gotten her out of trouble in the past?

There's something so horribly conniving and disgusting about the way she uses her friendship with Picard to her own gain, and the way she nags him when she doesn't get her way.

It's never, never about medical ethics with her, and always about her own desires and opinions. Her arguments are almost never rational or coherent, but always impassioned pleas based on her own ignorant standing. She never has a leg to stand on and isn't convincing even when she's right. She has no care for other people's cultures or circumstance, only her own ideas of what should be done. And she violates patients' desires, cultures, and morals left and right and declares them "stupid" without even attempting to understand them.

She's a weak, stupid character and an insulting two dimensional stereotype consisting of various "feminine" traits but no redeeming qualities. Weak, stupid, incompetent, emotional, irrational, ignorant, nagging, manipulative. These are all negative female stereotypes and they all describe her behavior. I've finally pinpointed why her very existence makes me angry. I find her extremely offensive.
Del_Duio
Fri, Jun 9, 2017, 9:52am (UTC -6)
@Outrider65:

In another episode she gives an alien an autopsy even though both the family members and Picard told her not to. Even my small daughter picked up right away on that and wondered why she didn't get in serious trouble (at the least).

How Bev's not in some sorta' doctor jail is anyone's guess.
Tara
Thu, Jun 22, 2017, 9:32pm (UTC -6)
@outrider65,

Bravo! Well said. Especially your sixth paragraph: I couldn't agree more. She's all braying emotion, and seems to lack even the capacity to calm down and apply reason and ethics. How did this idiot become CMO on the Federation's flagship?

I got the impression Worf doesn't really matter to her. She doesn't consider his point of view or have any apparent compassion for him; his body is pretty much a prop for her strutting self-important theatrics.

This behavior might have suited the Julian Bashir character in an early episode of DS9;, since he was portrayed as young and untried and egotistical in the first season. But Crusher is supposed to be a seasoned physician. And she's horrible.

Linda
Fri, Jun 30, 2017, 10:29pm (UTC -6)
Crusher or Pulaski, I actually don’t have a preference.

In the scene where Crusher and Picard discuss Worf’s medical condition, Crusher speaks of the lengths that she will go to keep Worf from committing suicide. She is clearly emotional, Worf is not just a patient but a friend. The tactics she speaks of using are tactics, which some feel are ethically debatable. But it’s all talk and possibilities on her part. They are not tactics that she ever engages. To me, she is talking through her problem, trying to wrap her head around Worf’s decision, and Picard helps her come to the decision not to employ them.

Riker brings the dagger to Worf and expresses extreme dismay and disgust at the request. He dramatically leaves the dagger as a signal that he, Riker, has no desire to be a part of this process. He leaves the dagger, on the bed at Worf’s feet. Would Worf’s injury prevent him from retrieving the knife from the foot of the bed where Riker left it? Apparently not. Later Worf gives the dagger to his son and tells him to bring it back to their quarters. Clever. Riker refused to participate in the suicide ritual, but gave Worf the ability to carry out the deed if he so wished.

To me the biggest problem I had with Crusher was that she tells Worf immediately upon his waking up after the accident:

Crusher: I'm afraid there's no way we can repair this kind of injury.

And yet the very next thing we hear is:
Captain's log, stardate 45587.3. Lieutenant Worf has been removed from active duty following a severe injury. Although a neuro-specialist has arrived, Doctor Crusher believes his paralysis may be permanent.

“May be permanent.” I’m thinking that Crusher essentially flat out tells Worf, we can’t fix this, you’ll always be like this. When really, she hasn’t finished assessing the situation yet. The diagnosis was premature.
Tempeh
Thu, Oct 12, 2017, 7:41pm (UTC -6)
I used to hate this episode because I thought it was too talky and it's obvious Worf is going get to get cured, but I just rewatched it and I think it's great. The medical ethics arguments going on between Crusher and the other doctor are thought provoking. Both of them have good points. I felt emotional when Worf was asking Deanna to be the kid's mother if some thing bad should happen. The only thing a little "off" was Picard's full support behind the idea that Worf's life is over. By the way when did Riker and Worf become good friend? It seemed to come out of nowhere. I don't remember them being together. 3 stars.

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