Ethics (TNG): Almost Great

"Ethics" (TNG) is a very good episode. It comes close to being a great episode, but I think misses this, for reasons I will discuss.

Worf's spine is shattered in an accident[1] and he becomes a paraplegic. Even in the 24th century this is apparently beyond their ability to fix, but 60% of function can be restored by electrical stimulators controlled by the brain. In Worf's Klingon culture, that isn't enough. It's time for ritual suicide.

This gives rise to two ethical dilemmas. Worf wants Riker, as his friend,to assist in the suicide ritual, but Riker is shocked and disapproving, Secondly, a visiting expert medical researcher, Dr Russell, proposes a radical experimental therapy. She reckons it has a 37% chance of success, but if it fails, he would die. Initially she agrees with Dr Crusher that this is too risky when Worf has other options, but when Worf makes it clear he will kill himself, she suggests the plan to him, to Crusher's annoyance.

The Enterprise has to pick up a lot of survivors of a disaster—this is just so that Dr Russell, helping with triage, can try an experimental treatment, and the patient dies. Dr Crusher regards this as unethical because she didn't try the conventional drug. Dr Russell does make the case that the conventional drug wouldn't have worked anyway (though it is unclear whether this opinion is well-founded), but mainly she defends herself by emphasizing the long-term benefits of research over the immediate risks. Crusher is furious and bans her from work aboard the ship.

Back to Riker. It's an unusually good episode for him—instead of his usual shallow charm we see some real soul-searching. He consults Captain Picard, who tells him he has to decide, but is clearly trying to get Riker to understand that Worf has a different world-view, and he can respect it without agreeing with it.

Eventually Worf has Dr Russell's operation, and it's successful, though at first they think he's died—his amazing Klingon physiology has back-up systems and he pops up again.

There is a type of SF story of ideas which Isaac Asimov once discussed in detail. Alternative ideas are represented by different characters. The author uses their conflict and debates to explore the issues. The author may come down on one side, but for best effect the other side needs to have a strong case—the reader should see both sides and understand why the proponents believe in them. "Done properly, the two opposing ideas should represent not black and white, but two grays of slightly different shades, so that the reader cannot make a clear-cut decision but must think and come to conclusions of his own."[2]

In "Ethics", this works for the Riker story. Riker expresses his belief in life impressively, reminding Worf of their dead comrades who had fought to the last. He doesn't pretend to sympathize with Worf's cultural requirements: in this he is notably different from Picard (who admittedly has been deeply involved in Klingon affairs). But he decides he would do it—except that he discovers Worf himself is cheating on his Klingon culture. It's actually the duty of his son Alexander, but Worf has a human-like concern the boy is too young. So Riker's side of the debate is well developed, though perhaps Worf's side isn't given adequate exploration: we just get his usual "I'm so Klingon" stuff,[3] which Troi tries to "call out" as they say now. This doesn't really matter though because we have a pretty good idea by now of Klingon attitudes. After Troi's intervention, Worf is, rather surprisingly, persuaded to try the stimulators, but when he falls in front of Alexander (a matter of shame for him) any chance of this as a solution is finished.

The Crusher/Russell story is a similar conflict of ideas, but it doesn't give Dr Russell a fair go. We do see Dr Crusher's inability to see that her "ethics" are becoming a way of imposing her values on Worf. Even after the operation, Dr Crusher still won't accept that it was the right option: "You gambled, he won." She still cannot see that the alternative was not some other, more "responsible" treatment, but Worf's certain death. Thus the case is somewhat different from the triage. Interestingly, though, Dr Russell doesn't try to argue this point; rather, as with the triage, she emphasizes the importance of the research.

Dr Russell is very well played by Caroline Kava, who manages to convey the researcher's attitude and commitment to her own cause. At the end Dr Crusher says to her "Enjoy your laurels" but this is unfair—Dr Russell isn't in it for the glory. She wants to save lives too, but has a very different perspective on the ethics of research.

If Dr Russell and Dr Crusher had been in a closer contest, as Asimov advises, it could have been a great episode, with two deep and troubling ethical dilemmas, each of which would leave things sufficiently open for viewers to continue arguing. But Dr Russell's case is not sufficiently good.

Worf's dilemma is connected to real-life ethical questions about new treatment. Medical research ethics rules were established partly as a response to appalling abuses such as the Tuskegee experiments on Black people. No one questions their necessity. However, once they became established, there were some cases where (as with the Prime Directive) the letter of the rules precluded things that otherwise seemed beneficial. The most obvious case is, what happens if someone has a condition that, with existing treatment, is certain to be fatal, such as rabies? In the 1980s, the ACT-UP AIDS activists challenged the FDA for what they argued was an inappropriate approval system. At this time AIDS was 100% fatal, so they argued that the ethics of limiting access to possible treatments was debatable.

Later, "Right to try" laws in the United States established a rule that a patient with a life-threatening illness may request access to an unapproved treatment independently of scientific trials.[4]

It might have been interesting for the episode to have raised the parallel with the Prime Directive directly.

Worf's dilemma may also be interpreted in the context of debates about assisted suicide. However I find it somewhat unsatisfactory for that purpose. Worf's reasons for suicide are quite different from those which are normally raised in real-life discussion of assisted suicide.[5] This sort of displacement is a classic science-fiction technique for discussing issues in society without raising all the peripheral and contingent questions. Worf does not have a life-threatening illness in the usual sense, but he does have a condition that in Klingon society implies his death. However, in this case the debate is essentially a cross-cultural one. Human culture says one thing, Klingon culture another. There's also the factor that for Worf ritual suicide is an action belonging to the tradition of his culture and unambiguously approved by his society.

So, a good and memorable episode, but not one of the all-time greats.