How Star Trek Approaches Healthcare Services
By Biz Hyzy
When grand debates overtake the news, I always turn to my favorite source of open-minded, forward thinking discourse to give me perspective: Star Trek! This week, we’ll recap a few episodes that explore how Starfleet approaches health services.
In Gene Roddenberry’s utopian future, humans live peacefully on Earth and work with the United Federation of Planets to learn about alien cultures and spread goodwill. Starfleet provides free care to everyone—humans, aliens, patients, strangers—because they believe in the sanctity of life. However, they often revise their moral codes when confronting communities whose systems operate differently than theirs. To analyze situations where Starfleet must weigh an individual’s health against group prosperity, revisit these six episodes. I almost exclusively highlighted episodes from Voyager and Deep Space Nine. If you can think of any relevant examples from TOS, TNG, or ENT, please leave a comment below!
I, Borg (TNG Season 5, Episode 23)
When the crew of the U.S.S. Enterprise discovers a malfunctioning Borg drone, Dr. Beverly Crusher insists on treating him. As the Borg stabilizes, Chief Engineer Geordi La Forge and Lt. Commander Data realize they have the means to disable the entire Borg Collective. If they implant an unsolvable formula into the drone and then reconnect him to the hive mind, the formula will spread like a virus, destroying them. However, this already questionable plan becomes more complicated when cinnamon roll Geordi La Forge befriends the Borg, naming him Hugh.
The debate: Guinan and Captain Jean-Luc Picard, both victims of Borg ruthlessness, want to use Hugh to dismantle the Borg. Meanwhile, Crusher and La Forge question using Hugh as an instrument in genocide.
The resolution: After speaking with Hugh, Guinan and Picard realize he is now an individual, especially when he uses the word I instead of we and because he refuses to assimilate his new friends. Although Hugh wants to stay with the Enterprise, he knows that would place them in danger. Virus-free, he returns to the Borg, hoping his individuality will subvert the hive mind.
Phage (VOY Season 1, Episode 5)
A terrible disease called the Phage has plagued the Vidiians for centuries. To survive, they steal organs from other beings to replace their own degrading parts—their most recent acquisition: Neelix’s lungs. Knowing little about the Talaxian species, the Doctor cannot perform a transplant or replicate lungs for Neelix. However, after placing Neelix in a coma, he crafts holographic lungs. Although they technically keep Neelix alive, they cannot accommodate movement, rendering him paralyzed.
The debate: Captain Kathryn Janeway demands the Vidiians return her crewmember’s lungs. The Vidiians refuse because they need the lungs to survive. Since this is season one and Voyager is still learning how to survive in the Delta quadrant, they lack the means to incarcerate the aliens. Morally, Janeway doesn’t want to resort to killing.
The resolution: Janeway releases the Vidiians in the hope that the Doctor will, one day, make progress with Neelix and revive him. She clarifies that if the Vidiians attack again, she will retaliate with force. Grateful for her mercy, the Vidiians share their medical knowledge with the Doctor. With this information, Kes donates a lung, which the Doctor alters to fit Talaxian physiology.
Critical Care (VOY Season 7, Episode 5)
The Dinaali use a complex formula called TC (Treatment Coefficient) to determine how to allocate their medical supplies. High TC means that person has a higher education and is expected to serve a great purpose in society, allowing him/her to receive one-on-one attention from his/her doctor as well as preventative medicines. Meanwhile, patients with low TC are denied that same medicine—even if that means saving them from death.
The debate: The hospital administrator, Chellick, believes the Dinaali should use their medical resources on the people that will contribute the most to their society. The Doctor believes patients with the direst conditions deserve immediate care.
The solution: The Doctor steals Cytoglobin from the privileged patients on Level Blue (high TC) to save the dying patients on Level Red (low TC). He also teaches another doctor how to work the system so that he’ll receive larger shipments of medicine in the future. Lastly, the Doctor infects Chellick with the chromovirus (harsh!). The allocator recognizes Chellick as a patient with low TC, forcing him to reprioritize his morals.
Hippocratic Oath (DS9 Season 4, Episode 3)
BFFs Dr. Julian Bashir and Chief Miles O’Brien land on Bopak III to study a subspace magneton pulse only to discover the planet is run by rogue Jem’Hadar. Goran’Agar, the Jem’Hadar First, captures the Starfleet officers. He enlists Bashir’s help to cure his unit’s addiction to ketracel-white, a drug that the Vorta use to ensure Jem’Hadar loyalty. When Goran’Agar crashed on Bopak III years before, he did not die from withdrawal, so he believes the planet has something to do with the cure.
The debate: Bashir wants to help the Jem’Hadar, believing that if they are no longer addicted to ketracel-white, they can be as independent and merciful as their leader. O’Brien, however, plots an escape, convinced the Jem’Hadar will always be killers, addiction or not. (For a similar debate about one species keeping another addicted for personal gain, watch TNG’s “Symbiosis.”)
The resolution: Bashir discovers that Goran’Agar was never addicted to ketracel-white due to a genetic mutation and therefore cannot cure his comrades. Since the Jem’Hadar do not have any more ketracel-white, they will experience painful, aggressive withdrawal symptoms, ultimately resulting in their deaths. After leading Bashir and O’Brien to their runabout, Goran’Agar stays behind to kill his men, hoping to bestow a less painful exit from this world.
The Quickening (DS9 Season 4, Episode 24)
Two centuries ago, the people living on planet Teplan attempted to resist the Dominion. To punish them, the Dominion infected them with the Teplan Blight, a virus characterized by dark veins that turn red when the disease reaches its terminal stage. To spare a dying person from his/her pain, Trevean, a native, euthanizes him/her with herbs. Bashir attempts to cure the Teplans of their disease, but he soon discovers that the electromagnetic fields from his medical equipment make the virus mutate and quicken faster.
The debate: Trevean believes there is no cure to the blight and wants Bashir to stop giving his people false hope. Meanwhile, Bashir and a pregnant woman, Ekoria, obsess over finding a cure.
The solution: Bashir induces Ekoria, now quickened, so that she can give birth before she dies. The baby is born without lesions or dark veins; although Bashir did not invent a cure, the medicine he gave Ekoria vaccinated her baby, who is now immune to the blight. Although his work will save the next generation of Teplans, he continues to study the disease on DS9 in the hopes of liberating the adults too.
Extreme Measures (DS9 Season 7, Episode 23)
When Constable Odo escorts Captain Benjamin Sisko to Earth in “Homefront” and “Paradise Lost,” unbeknownst to them, a covert organization called Section 31 infects Odo with a morphogenic virus. Assuming Odo would once again join the Great Link (which he does), Section 31 expects him to spread his disease to the Founders, killing Starfleet’s greatest enemy and ending the Dominion War.
When Bashir recognizes this conspiracy in, “Extreme Measures,” he tells Starfleet he’s discovered a cure for Odo—a lie that tricks them into sending a Section 31 operative, Luther Sloan, to DS9 to destroy the formula. When Sloan realizes Bashir plans on extracting the cure from his mind through illegal Romulan mind probes, he kills himself. Barely stabilizing the operative, Bashir and O’Brien use a multitronic engrammatic interpreter to explore Sloan’s mind, hunting for the cure.
The debate: Like Picard in the beginning of, “I, Borg,” Section 31 believes that killing an entire species—including their ally, Odo—is worth all the lives they’ll save in war. Bashir and the others want to save their friend and are ethically opposed to genocide.
The solution: Bashir and O’Brien discover the cure in Sloan’s mind and use it to save Odo. In “What You Leave Behind,” Odo links with the Female Changeling, curing her. Because of this generous act, she tells the Jem’Hadar and Breen to surrender, thus ending the war. Odo then returns to the Great Link, which transforms from a sickly green to a healthy gold.
In The Wrath of Khan, Spock famously says, “The needs of the many outweigh the needs of the few,” yet Star Trek’s health-centric episodes tend to value individuality. Only when the Starfleet officers recognize their patients as fully-realized persons—not just an alien or an enemy or a resource—do they insist on saving them. As the plots unfold, we—in true Star Trek fashion—understand and sympathize with both sides of these debates: Sometimes, we justify hurting a person to bolster a group. Other times, we’re willing to risk a group to help a person. Too complex for easy answers, these situations always require compromise. In the end, we root for the characters that make altruistic choices. Everyone deserves a chance to live fully, but they can only do so if they’re healthy first.