Ethics (episode)

After Worf is paralyzed by a freak accident, his only hope may be a visiting doctor with questionable medical ethics.
== Summary ==
===Teaser===
Lieutenant Worf and Lieutenant Commander Geordi La Forge are in Cargo Bay 3 investigating strange readings. Their tricorders are unable to detect the exact problem. Worf is preoccupied with his loss to Counselor Deanna Troi in a poker game, and no one realizes that a large, heavy container sitting on a high shelf is leaking. Another similar container is sitting on top of it. Eventually, enough of the material leaks out that the lower container begins to buckle under the weight of the upper container. The two containers fall, and the upper container hits Worf in his back. La Forge rushes over to the immobile Worf and summons emergency medical assistance. Worf wakes up in sickbay and at first he believes he is being held by a restraining field to keep him from leaving. Grim faced, Dr. Crusher informs him that his spinal cord has been crushed, resulting in paralysis.
===Act One===
:"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."
In the transporter room, Dr. Toby Russell, a neurological specialist who Dr. Crusher has called in, is beamed aboard. She has been brought to the by the . The two doctors find themselves in uncharted territory: in Klingon medicine those who are paralyzed are allowed to die. Thus, the Klingons have virtually no research conducted on neurological trauma. Klingons with these injuries would often commit Hegh'bat, the Klingon ritual suicide. Dr. Russell is amazed by Klingon anatomy, which has twenty-three ribs, two livers, and an eight-chambered heart. For Klingons, this is called the brak'lul, meaning every vital function has a backup system, though Russell notes that this also means there are many more ways it can go wrong. 
Commander Riker goes to visit his friend in sickbay. At first, Riker believes that Worf's paralysis is only temporary, but Worf assures him it is permanent. Shocked, Riker takes a seat near Worf's biobed. Worf then decides to ask him for a favor. When Riker tells him to name it, Worf asks Riker to help him perform the hegh'bat ritual. Riker is shocked and repulsed by what Worf is asking for – basically to hand him a knife and leave him to stab himself in the heart. Worf insists that there are no other options, and not wanting to continue to live with pity and shame as a Klingon, pleads with Riker to help him end his life with dignity and honor.
===Act Two===
Dr. Russell proposes a new surgical procedure for Worf to Dr. Crusher. She believes that she can use what she calls a genetronic replicator to create an entirely new spinal column for Worf. But it would be the first time she had done this on a living being, having only conducted tests of this new procedure on holographic patients and claims the success rate is now up to thirty-seven percent. Dr. Crusher refuses to consider it; not only is the success rate too low but they will need to remove Worf's entire spinal column and, given their limited knowledge of Klingon biology, if something goes wrong they won't be able to reattach it and he'll die. Dr. Russell agrees to drop the idea.
Meanwhile, the Enterprise diverts to render aid to the , after the latter struck a Cardassian gravitic mine left over from the Federation-Cardassian War while transporting over five hundred colonists. Dr. Crusher sets up triage units in the shuttlebays, and accepts Russell's offer for assistance. 
While on the bridge, Commander Riker asks to discuss Worf's request with Captain Picard in his ready room. Inside, Riker tells Picard that, although he always tries to understand and respect the traditions of other races and cultures, the idea of assisting Worf in suicide disgusts him especially as Worf could still live a full life despite his injury. Picard however is more understanding of Worf's request, explaining to Riker that while a Human could adapt with an injury as severe as Worf's, when a Klingon is unable to stand and fight they consider their life to be over. Picard can't make Riker's decision for him and understands how frustrated he feels over the situation, but encourages him to make it based on his friendship with Worf. Klingons choose their friends very carefully, and if Worf didn't know if he could count on Riker he wouldn't have asked.
Alexander is upset over his father's accident, and even more upset that Worf will not allow Alexander to see him in his condition. Counselor Troi tries to reason with Worf over this.
After Troi leaves sickbay, Russell and Crusher have Worf try using devices to transmit impulses to the appropriate muscles. But when it is revealed that Worf would not have full mobility, he refuses to use the devices. Against Crusher's wishes, Russell proposes the genetronic procedure to Worf, who intently listens to her.
=== Act Three ===
Doctor Crusher takes Russell aside and argues with her that they had already talked about and ruled out the procedure, and, furthermore, giving him that option is taking advantage of his desperation. Russell is picking up on Worf's frustration with his condition and is convinced he would want it. Crusher says she checked on her proposals at Starfleet Medical, seeing they were denied three times for humanoid patients. They get interrupted when Picard calls to inform her that the Denver survivors will soon be beaming aboard.
Troi brings Alexander to see Worf, who has propped himself up to a standing position next to his bed, and is seen standing with the neurological devices strapped to his thighs. He begins to discuss the situation with Alexander, telling him there will be difficult times ahead, before he loses his balance and falls. Feeling humiliated, Worf gruffly orders Alexander to leave. Troi assures Alexander that it will be all right and that she will stay behind to help his father.
After meeting the other ship, the Enterprise medical staff begin treating casualties. Dr. Crusher discovers that a patient under Dr. Russell's care had died after Russell tried an untested, experimental treatment, borathium, despite a chance standard treatments like leporazine or morathial would have saved his life. Outraged by Russell's reckless choice of a radical approach over conventional treatment, Crusher relieves Russell of duty, and tells her that she will not be permitted to practice medicine any longer while on board the Enterprise.
===Act Four===
Picard meets with Dr. Crusher in her office after he learns that she has relieved Russell of duty. To Crusher's utter bewilderment, he tells her that she should consider allowing Russell to perform the genetronic operation. Even though Crusher knows Worf could have a full life even with this paralysis, Picard explains that Worf's society says that his life was over the moment he was struck by the container. To ask him to accept living without full mobility despite a lifetime of differing values and beliefs is realistically just too difficult. He could possibly be convinced to forgo suicide and take a chance with Russell's procedure, as risk is something Klingons know all about. The only way to save Worf's life is to do this because otherwise, Worf will eventually kill himself. Crusher says that Worf is basically healthy for the time being, but that if he went into surgery he could die. Picard tells Crusher that it may not be good medicine, but it is Worf's only choice.
Riker visits Worf again, explaining that he has studied the hegh'bat in detail and bluntly finds it despicable in the way it tries to "cloak suicide in some glorious notion of honor". Worf protests to Riker that each of them must die in their own time. Riker forcefully reminds him of their fellow crewmates who perished while serving with them on the Enterprise – Sandoval, Fang-lee, Marla Aster and Tasha Yar, to name a few, who all fought for life until their last moments. Riker then tells him that even though he strongly disagrees with the Klingon custom, he would most likely assist Worf except for one detail. He finds in his research that Worf's son Alexander – his only immediate family member – would need to be the one to assist in the ritual. Worf protests that his son is a child, but Riker counters that "the son of a Klingon is a man the day he can first hold a blade." It is not Riker's place to help Worf commit suicide, and he's figured out that it would be too hard for Worf to ask his son to watch him kill himself. 
In light of this, Worf summons Alexander to sickbay and informs him that he has chosen not to kill himself, but instead wishes to live and to try the surgical procedure suggested by Dr. Russell.
===Act Five===
:"Chief medical officer's log, supplemental. After further consultation with Starfleet Medical, and a great deal of soul searching, I have reluctantly granted Lieutenant Worf's request to undergo the genetronic procedure."
Worf goes into surgery. Before going, he asks Counselor Troi if she would raise Alexander if he does not survive the operation, and she accepts. Russell and Crusher remove the old spinal cord. They use the gentronic scanner to try to scan Worf's spinal cord, but the main scanner has trouble reading the cord. Russell scans the remainder of the cord herself. Once that's done, they begin generating a new spinal cord. Everything seems to go right until the end of the operation, when suddenly Worf crashes. Nurse Ogawa can read no vital signs from Worf and he has died on the operating table.
Crusher, with tears in her eyes, goes to sickbay to sadly tell Alexander that Worf has died. Alexander demands to see his father. While they are viewing the body, Worf's synaptic functions suddenly reactivate; his brain also apparently had a backup system, which has allowed him to survive the operation. Soon his body begins functioning again.
While thrilled that Worf will recover, Crusher is disturbed by Russell's attitude of "the ends justify the means." Crusher tells Russell that she gambled with Worf's life and won, but real research is a slow and painstaking process and should never be put ahead of patients' lives. Crusher tells Russell that she hopes she enjoys her laurels, as she does not think she could. Crusher looks away from Russell and goes back to work while she leaves without saying a word.
After the operation, Worf begins the process of physical therapy. The process is slow as it takes time for Worf's body to adjust to signals from the new spinal cord; Worf stumbles while he re-learns to walk. Watching his father stumbling, Alexander starts to move to him, but Troi reminds him of the Klingon stoicism about which she's spoken to him. Surprisingly, Worf asks for Alexander's help, and tells him that they will struggle together. With that, Worf begins his long journey towards recovery.
=== Log entries ===
* Captain's log, USS Enterprise (NCC-1701-D), 2368
* Chief medical officer's log, USS Enterprise (NCC-1701-D)
== Memorable quotes ==
"No question about it: she was bluffing, Worf."
"Bluffing is not one of Counselor Troi's strong suits... It would have been unwise to call. Yes, my hand was not strong enough!"
"You had Jacks and eights; she bluffed you with a pair of sixes!"
"How did you know what I had?"
"Let's just say I had a special 'insight' into the cards..." (points to his VISOR) "Maybe next time you should bring a deck that's not transparent to infrared light."
: - La Forge and Worf, discussing a recent officers' poker game
"I've done dozens of holo-simulations. The success rate is up to 37 percent."
"Even a holographic patient would balk at those odds."
: - Dr. Russell and Dr. Crusher, discussing Dr. Russell's experimental surgery
"He's been injured and he's embarrassed. And to have anyone see him now would make him feel worse. Even if it were you."
"This is part of that Klingon stuff, isn't it? My mother always said Klingons had a lot of dumb ideas about honor."
"That Klingon stuff is very important to your father."
: - Troi and Alexander, discussing why Worf wouldn't see his son in his injured state
"Do you remember Sandoval? Hit with a disruptor blast two years ago. She lived for about a week. Fang-lee, Marla Aster, Tasha Yar! How many men and women, how many friends have we watched die? I've lost count. Every one of them, every single one, fought for life until the very end."
: - Riker, arguing with Worf about his decision to commit ritual suicide
"Will you or will you not help me with the hegh'Bat?"
"You are my friend. And in spite of everything I've said, if it were my place, I would probably help you. But I've been studying Klingon ritual and Klingon law, and I've discovered that it's not my place to fill that role. According to tradition, that honor falls to a family member. Preferably the oldest son."
"That is impossible! He is a child!"
"'The son of a Klingon is a man the day he can first hold a blade.' True?"
"Alexander is not fully Klingon! He is part Human!"
"That's an excuse. What you really mean is that it would be too hard to look at your son and tell him to bring you the knife, watch you stab it into your heart, then pull the knife out of your chest and wipe your blood on his sleeve."
: - Worf and Riker
"There is much to discuss. There will be difficult times ahead. You must be strong."
: - Worf, to his son Alexander after his accident and subsequent paralysis
"You want me to raise Alexander?"
"I have come to have a great respect for you, Deanna. You have been most helpful in guiding me since Alexander's arrival. I can't imagine anyone who would be a better parent to my son."
: - Troi and Worf
"Ok, 25 cc cordrazine."
"That'll kill him."
"Looks like we've done a pretty good job of that already, Doctor."
: - Dr. Crusher and Dr. Russell, attempting to revive Worf
"I am delighted that Worf is going to recover. You gambled. He won. Not all of your patients are so lucky. You scare me, Doctor. You risk your patients' lives, and justify it in the name of research. Genuine research takes time. Sometimes a lifetime of painstaking, detailed work in order to get any results. Not for you. You take shortcuts, right through living tissue. You put your research ahead of your patients' lives. And as far as I'm concerned, that's a violation of our most sacred trust. I'm sure your work will be hailed as a stunning breakthrough. Enjoy your laurels, Doctor. I'm not sure I could."
: - Dr. Crusher, confronting Dr. Russell
"We will work together."
"Yes, sir."
: - Worf and Alexander Rozhenko, as Worf begins to learn how to walk again (last lines)
== Background information ==
=== Production history ===
* Final draft script: 
* Filmed: 11 December 1991 – 20 December 1991
* Second unit and insert footage filmed: 
* More second unit and insert footage filmed: 14 February 1992
* More second unit and insert footage filmed: 21 February 1992
* Premiere airdate: 
* First UK airdate: 
=== Story and script ===
* Ronald D. Moore found writing the episode difficult. He remembered, "I wasn't a big fan of doing medical shows to begin with, and that particular one had a ton of medical jargon and technology and medical ethics." (Star Trek: The Next Generation 365, p. 245)
* Herbert J. Wright suggested that the experimental procedure be more grotesque, with small creatures released into Worf's bloodstream, eating away damage to his body. The idea was rejected so that science fiction elements did not distract from the drama. (Captains' Logs: The Unauthorized Complete Trek Voyages, p. 240)
* There were internal debates among the production staff about how to handle the issues of euthanasia and living with a disability. To Moore, Worf's position was obvious. He argued, "That wouldn't matter to Worf. He wouldn't want to live like that. He's a Klingon, and a Klingon would want to be killed." (Star Trek: The Next Generation 365, p. 245) However, for both Worf's dilemma and the conflict between the two doctors, he endeavored to show the different positions fairly. He commented, "The balancing act was to make sure both sides of the argument had validity, were compelling and real positions." (Captains' Logs: The Unauthorized Complete Trek Voyages, p. 239)
* Michael Piller remarked, "I love grays. I don't love black and whites. I don't like answering questions so easily for the audience […] with 'Ethics,' again, we went out of our way not to make it easy for the audience to know what the right thing to do was." (Captains' Logs: The Unauthorized Complete Trek Voyages, p. 239)
=== Production ===
* Director Chip Chalmers revealed that the scene where Riker and Worf argue was originally even more heated, with the two actors yelling "nose to nose". At the last minute, this was cut, as it was felt that it had gone too far. (Captains' Logs: The Unauthorized Complete Trek Voyages, p. 239)
* "Ethics" was filmed between Wednesday and Friday on Paramount Stage 8, 9, and 16. It was the last episode to be filmed in . Between and , the production went into company holiday. Second unit and insert shots were filmed on Tuesday on Paramount Stage 9 and 16, on Friday on Paramount Stage 8 and 9, as well as on Friday on Paramount Stage 9.
* During most of the surgery, Worf was played by Al Foster, the photo double for Michael Dorn. ()
* The containers which fell onto Dorn's stunt double Rusty McClennon were made of styrofoam. (Call sheet)
* The call sheet for Wednesday reminded the crew to bring in baby photos for the contest on the following Friday.
* Medlab 4 and the Operating Theatre appear to be filmed on the same set.
=== Continuity ===
* Dr. Russell makes reference to a paper Dr. Crusher has written regarding cybernetic regeneration, which Crusher had previously mentioned developing a workable approach on in .
* While describing his disdain for the hegh'bat ritual, Riker makes mention of the deaths of Marla Aster () and Natasha Yar ().
* In an alternate reality shown in the 7th season episode , Worf and Deanna Troi fall in love after his operation, and the couple soon marry.
* Unlike , it was not clarified if this form of ritual Klingon assisted suicide would allow a Klingon soul to enter Sto-vo-kor (though it can perhaps be inferred as such, from the fact that it is an accepted ritual of the Klingon culture).
* While Commander Riker was encouraged by Captain Picard to carry out the ritual of hegh'bat, Worf himself was arrested by Odo and berated by Sisko for attempting a similar ritual on his brother Kurn in .
* When asking Riker to help him by performing the hegh'bat ceremony, Worf says "help me end my life as I have lived it". Seven years later, Kor repeats that phrase to Worf, word for word, when asking him to help him undertake his final mission in .
* During this episode, it is revealed that Klingons have visible ridges on their spines and feet as well as their foreheads.
=== Reception ===
* Chip Chalmers commented, "[F]or the first time that I can remember, there have been some serious inter-personal conflicts on the ship. That's one of the rules, nobody gets in each other's face. We had some pretty serious conflicts, and I think that was of huge redeeming value to that particular episode, because for the first time people saw Riker and Worf yelling at each other. We also saw real tears and real emotions." (Captains' Logs: The Unauthorized Complete Trek Voyages, p. 239)
* Michael Piller stated, "I think we succeeded pretty well with that one. We wanted to explore the issue and it's only fair to explore it if you give both voices the equal fairness that their voice and opinions deliver." (Captains' Logs: The Unauthorized Complete Trek Voyages, p. 239)
* A mission report for this episode, by John Sayers, was published in .
=== Apocrypha ===
* In the A Time for War, A Time for Peace, the is being inspected by a Starfleet team and Dr. Russell is inspecting the medical department. In another argument between Russell and Dr. Crusher, Crusher remarks again about genetronics. Russell is amazed that Crusher is still upset about her procedure, which was successful; Crusher remarks that it only barely worked and that was because of the unique nature of Klingon physiology. Crusher also notes, much to Russell's irritation, that in the decade or so since Worf's surgery, after the initial wave of articles about it, nothing has ever been heard again regarding genetronics.
* In the Warpath Doctor Simon Tarses refined the procedure used to heal Worf. Using nanites he was able to successfully repair the damage to Lieutenant Ro Laren's spine after she was attacked by a Jem'Hadar.
=== Video and DVD releases ===
* Original UK VHS release (two-episode tapes, CIC Video): Volume 58, 
* UK re-release (three-episode tapes, Paramount Home Entertainment): Volume 5.6, 
* As part of the TNG Season 5 DVD collection
== Links and references ==
=== Starring ===
* Patrick Stewart as Capt. Jean-Luc Picard
* Jonathan Frakes as Cmdr. William Riker
=== Also starring ===
* LeVar Burton as Lt. Cmdr. Geordi La Forge
* Michael Dorn as Lt. Worf
* Gates McFadden as Dr. Beverly Crusher
* Marina Sirtis as Counselor Deanna Troi
* Brent Spiner as Lt. Commander Data
=== Guest stars ===
* Caroline Kava as Toby Russell
* Brian Bonsall as Alexander Rozhenko
* Patti Yasutake as Alyssa Ogawa
=== Uncredited co-stars ===
* David Keith Anderson as Armstrong
* Rachen Assapiomonwait as 
* Lena Banks as operations ensign
* Bowman as sciences officer
* Michael Braveheart as Martinez
* Debbie David as Russell
* Denise Deuschle as sciences officer
* Margaret Flores as medical aide
* Grace Harrell as operations ensign
* D. Kai as sciences officer
* Alex Landi as civilian
* Mark Lentry as sciences lieutenant
* Tim McCormack as Denver dead body
* Michael Moorehead as sciences ensign
* Joycelyn Robinson as Denver dead body
* Sissy Sessions as operations ensign
* John Tampoya as command ensign
* Christina Wegler Miles as Denver dead body
* Unknown performers as
** Fifteen wounded Denver colonists
** Four wounded Denver crewmembers
=== Stunt double ===
* Rusty McClennon as stunt double for Michael Dorn
=== Stand-ins and photo doubles ===
* Mikki Acedo – stand-in for Patti Yasutake
* David Keith Anderson – stand-in & photo double for LeVar Burton
* Al Foster – photo double for Michael Dorn
* Melba Gonzalez – stand-in for Marina Sirtis
* Johnny Hayden – stand-in for Brian Bonsall
* Tim McCormack – stand-in for Brent Spiner
* Lorine Mendell – stand-in for Gates McFadden
* Richard Sarstedt – stand-in for Jonathan Frakes
* Sissy Sessions – photo double for Patti Yasutake
* – stand-in for Caroline Kava
* Dennis Tracy – stand-in for Patrick Stewart
* Dru Wagner – photo double for Caroline Kava
* James Washington – stand-in for Michael Dorn
=== References ===
2366; 24-hour clock; active duty; Adelman Neurological Institute; afternoon; alkysine; anatomy; anomaly; argument; artificial implant; ; back; base pairs per second; bed; belief; Beloti sector; bio-active interface; biobed; biomonitor; blade; blood; BP; bluff; body; Borathium; brak'lul; brain; brain dysfunction; brain stem; bureaucracy; Cardassian war; cardiac arrest; cardio-aid; cargo bay 3; cargo container; case history; cauterization; cc; centimeter; cerebral cortex; ceremony; cervical vertebra; ; chlorinide; chloromydride; choice; civilian; class; closed-mindedness; colonist; conversation; cordrazine; corpse; corridor; cortical spinal tract; cortical stimulator; CPK enzymatic therapy; cranial segment; crush (injury); culture; cultural bias; custom; crash land; crew complement; cybernetics; cybernetic regeneration; damage; ; day; death (dying); decade; ; desire; detronal scanner; dignity; disability; disgust; disruptor blast; DNA; DNA based generator; DNA sequencer; ; door; dorsal root ganglia; dozen; drechtal beam; Duras, son of Ja'rod; dynoscanner; Earth; electrical impulse; embarrassment; emergency triage center; empirical knowledge; enemy; encoding sequence; exoscalpel; expectation (expect); family; Fang-lee; friend; friendship; genetronic replicator; genetronic scan; genetronics; gravitic mine; hand; heart; heart rate; Hegh'bat; higher brain function; holosimulation; honor; hour; Human; humanoid; hypothesis; idea; inaprovaline; incurable disease; infrared; injury; isocortex; ; ; K'Ehleyr; Klingon; Klingon Civil War; Klingon database; Klingon Empire; Klingon law; Klingon Medical Division; Klingon ritual; knife; laser scalpel; leg; leporazine; life support; liver; living tissue; machine; medical emergency; medical ethics; medlab 4; medical log; Mericor system; Mericor system planets; microtome; month; morathial series; morning; motor assist band; motor control; multiplication; multiplications teacher; muscle; neural conduit; neural metaphasic shock; neural transducer; neurogenetics; neurological medicine; neuro-specialist; Number one; objectivity; odds; open-mindedness; opinion; organ; oxygen; pain; pair; paper; parallel bars; paralysis; paraplegic; paraspinal muscle; patient; percent; person; pia mater; pity; playing card; pleasure; poker; polyadrenaline; ; proximal nerve; pulse; question; reading; ; rejection; research; restraining field; result; rib; ribosome infusion; risk; rite of death; ritual; road; Romulan; ; ; rybotherapy; Sandoval; Sector 37628; shame; shock; shuttlebay; sickbay; sleeve; spinal column; spinal cord; spinal injury; spinal tract; spine root; starboard; Starfleet; Starfleet Medical; steri-field; straw; stress simulation routine; subspace message; success rate; suicide; supposition; surgical procedure; surgical support frame; survey; synaptic response; synaptic stimulation; tailor; terminal illness; thalamic booster series; theory; thinking; torso; tradition; training device; transport ship; treatment; triage; triage team; tricorder; value; VeK'tal response; ; vertebra; VISOR; vital signs; warp coil; warrior; week; worry; ; year
==== Unreferenced production material ====
Kelnaria region; Mylaira system; Starbase 27
=== External links ===
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de:Die Operation
es:Ethics
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ja:神経医療エキスパート ドクター・ラッセル（エピソード）
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Category:TNG episodes