SF Debris: Star Trek (VOY) – Critical Care

Opinionated Voyager Episode Guide looks at Critical Care. A swindler swipes the Doctor and sells him to a hospital where patients are treated based upon personal value rather than need. And the opening shots of a war about universal health care is heard!

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42 comments

  1. Now it’s been awhile since I’ve seen this episode, but I seem to remember the Doctor’s main issue differently. It wasn’t that he had an issue with the idea of allocating medicine based on a meritocracy, it was that the system was corrupt. People were getting better treatment not based on skills, but on political power and money. Also treatments were being wasted on people on level blue. They were getting treatments that they didn’t require that could have been given to people on lower levels.

    From this perspective, the parallels with the healthcare system in America can be drawn fairly easily. People with more money and better insurance get better healthcare. Hospitals are run like corporations, so the allocation of resources is biased toward those who can afford it.

    I live in Canada though, and my healthcare system has saved the lives of family members in cases where the treatment would have ruined us financially. So you could say that this isn’t a problem that applies to me.

    • As memory serves, the Level Blue patients were also receiving treatments for aesthetic purposes over medical needs which deprived resources from lower levels. All on the grounds that the computer said that this was okay. One of the sub issues was that the system wasn’t being questioned. It didn’t need to be scrapped in its entirety but it had some serious but manageable flaws if they were willing to reprogram it even just a little. Like medicinal purposes over aesthetic ones.

    • What you described sounds just like him objecting to medicine being allocated via a meritocracy. A meritocracy is inevitably going to devolve to be about political power and money. That’s how they work, and why they are bad.

    • Yeah, I completely disagree, and so does the episode. The Doctor did not go too far, at all. He did was Kirk would have done, as we saw in the war games episode. He forced the rich and powerful to have to deal with the system where it is. I seriously doubt he was going to let him die. He gave him a disease he knew he could treat, and then bluffed him into listening. He didn’t do any actual “harm.”

      Also, BJ is not very convincing in that MASH episode. “Some things are just wrong!” is not an argument. You can say that about anything. Real morality involves weighing the good versus the bad. If all you have is to fall back on authority-based morality, you’ve got nothing. The moral action is ultimately the one that creates the most good. Sometimes it doesn’t seem that way, since a short term solution seems better, like killing one guy to save multiple other people–but that creates a society where you are just your body parts, which causes more harm in the long run.

      There was this case where these doctors forced this 17 year old to get chemotherapy when they didn’t want it. I treated it like torture, and said that, if they want to force her to be treated, they should have to take the equivalent treatment themselves, one that would make them feel just as sick.

      You can’t condemn someone to something horrible unless you intimately understand what you are doing. The Doctor was just facilitating that. There is a price to pay for being a bigot, in that society is better off letting you be treated poorly in order for you to learn to renounce your bigotry.

      • Sorry, that was supposed to go to the bottom. My bad. Please read my addendum:

        Of course, how poorly is debatable. You can debate that the Doctor was not causing the most good by his actions. But you cannot say “Some things are just wrong!” without qualifying the harm.

        I mean, in our society, we just treat bigots like scum, not jumping to medical treatment. But we also aren’t as bad as the scenario painted in the episode.

      • BJ is telling Hawkeye that he is crossing a line and his actions can justify other actions which the worst case is the Nazi doctors in the concentration camps.

  2. All economic social systems are based on the distribution of limited resources to those that need them. The trouble with capitalistic systems is that, more often than not, those most important end up going to those who already have the most resources. But with a state-operated system, those choices usually end up in the hands of government bureaucrats instead; what’s more, state-operated systems also consume some of those resources in the distribution process. Both systems are deeply flaws, largely because, no matter how efficient the distribution system in place, the resources themselves are still limited. What we need is an economic system that is geared, not merely toward the distribution of resources, but toward the production and improvement of resources.

    • While I don’t disagree, state-run systems still tend to work better than the capitalistic systems. They may not be perfect, for the reasons you state, but they are better.

      Ultimately, the real problem is the unelected bureaucrat, and the ability of the elected to position themselves where it is hard to get rid of them, no matter what their actions, making them quasi-bureaucrats themselves. If you can fix that, then you have a way to get rid of those who use the system for their own personal gain.

      • I disagree. I used to work for the government – in the military and in the Veterans Administration. The problem is that, with the government, there is little to no incentive to prevent waste except the threat of a cut budget. Unfortunately, the cut budget becomes pretty much how the doctor described it in the episode: just pad your budget with useless waste so that, when the threats of cuts come, you still have more than enough to work with. At least in a capitalist model, it is vital to cut waste in order to maximize profits.

        Capitalism used to be geared toward production but is now geared more toward distribution and consumption; too many malls and not enough factories. But government is ill-equipped to handle either. And believe me, I know this from the inside.

  3. What do you despise? By this are you truly known. and i needs me some dune

  4. Not only was the EMH program intended to run only in an emergency but even then it was a failure back at the Federation. The only reason it wasn’t a failure on Voyager was because they had no other doctor.

  5. I’ve really got to give a go to this Star Trek series. I only ever watched the original series, and The Next Generation. After that, I guess I was all Star Trekked out.

    …For a while, anyway.

    • Watch DS9. It’s way better than Voyager or Enterprise.

      • I actually really enjoyed Voyager. I don’t understand the hate.

        • I actually really enjoyed Enterprise. I do understand the hate.

          • Watch pretty much any of SFDebris reviews of Enterprise, Chuck outlines the problems with the series fairly plainly.

          • Salosandres, reread my comment again, “I DO understand the hate”

            I’ve watched all of SFDebris’ episodes but I still love enterprise and I’m not really sure why

        • Enterprise and voyager both shared the same major sin, the writers refused to take any real risks the majority of the series.

          You have a ship stranded far from home in Voyager, in uncharted space with limited supplies and half the crew was comprised of ex-federation citizens turned terrorist outlaws. Yet these major setting elements were almost entirely ignored, the maquis crew effectively forgotten iin the majority of the series.

          As for being far from home with no support.. One episodes entire plot hinged around obtaining energy, showing the ship in dire straights with people rationing supplies, not only did they fail to find a source of new supply but they lost more of what little they had in the attempt. The very next episode completely forgets about the fuel crisis and everything is status quo again. Also voyager must have a giant hanger sized replicator given it never runs out of shuttle craft.

          One of the Voyager writers (might have been Ron Moore, I don’t remember) said in an interview the writing staff was actively told to ignore continuity in the show as the brass simply didn’t care about it. The “Reset Button” became a cliche on the series with few plot threads mattering for more than two episodes.

          Then you have elements like Chakotay, a border line racist caricature so poorly utilized the actor actually said publicly how much he hated the role and Neelix.. who.. well it was Neelix…

          Finally you have voyagers deballing of both the Borg and the Q Continuum.

          I actually grew up on voyager, I liked it as a kid and tuned in every week. But the show really was awful. half the dialogue is meaningless techno-babble and there’s no character growth for anyone but the Doctor (Robert Picardo was great) or Seven of Nine.

          SFDebris review of “Threshold” pretty much highlights most of the series over all issues. Also his review of the episode “Tattoo” goes into the rather bewildering backstory on the creation of the Chakotay character.

          • Ron Moore wasn’t really a writer on Voyager. He wrote mostly for TNG and DS9. He was with Voyager for a few weeks (maybe months). He wanted there to be more continuity and ran into a lot of problems with the other writers. That’s why he left. Apparently, it also hurt his friendship with Brannon Braga.

            There’s a really interesting old interview where he talked about the problems with Voyager and predicted a lot of the problems that happened with Enterprise.

        • That’s part of why I watch Chuck. He helps me understand the hate. For example, I actually liked Neelix, but I now get why people didn’t. You see, I took him at face value.

          • I did too when I first watched the series growing up honestly. I think I was just to young to understand how much of a annoying prick he actually was (especially to Kes). I was happy to take him as the bumbling buffoon.

            It wasn’t until I was much older that I really saw the blatant problems in the character (and the series).

  6. Janeway and Seven sigh 🙁

    • I never quite got that ship. It’s like shipping a girl with her mother. That’s the role Janeway always played.

      I always shipped Seven with the Doctor. Both outside of humanity in their own way. Though I understood people who shipped her with Harry Kim, as well.

      • That’s what I thought would happen. THe Doc and Seven seemed like they were setup as an obvious couple. The 7/Chakotay thing seemed so out of left field and random, even as a kid, I wondered if I had missed episodes.

        • they did reference it in a single episode in a previous season. Once. in a holodeck.
          But the only conclusion to draw from that is “Seven has a crush on Chocolateday”
          The problem is the writers had perpetual ADD and actually seemed to remember doing things they never actually did.
          For example, they were convinced until the very last season that they had killed of Lieutenant Kerry long ago, and thus only had him appear in flashbacks.
          Then they remembered that, no, they didn’t kill him…and promptly killed him.

        • sophronia_chaos

          Robert Beltran and Jeri Ryan had a HORRIBLE relationship in person/out of character and some (including Mr. Beltran) speculate that C7 was written in just to mess with him. Also I love Voyager, but its continuity sort of…isn’t. My favorite mistake of the writers’ is the fact that Naomi Wildman’s mom Samantha survived the events of the episode in which she went missing, and then Samantha never showed up again so Seven could be Naomi’s surrogate mom. (Which was, admittedly, adorable.)

          There was setup for EMH/7, I agree, but after the events of “Body and Soul” and “Tinker Tenor Doctor Spy”, it seemed pretty clear to me that the Doctor didn’t respect Seven’s boundaries or bodily autonomy, which I…sort of understand considering the dude doesn’t actually have a body. But after “Body and Soul” I couldn’t help but headcanon that the EMH had developed new “ethical” subroutines that were actually unethical as shit but undetectable on scans since he had developed them naturally…or photonically, if you will.

    • sophronia_chaos

      I ship J7 so hard it hurts. I never really saw Janeway and Seven’s dynamic as mother/daughter, especially near the end of the series. Complicating matters is the fact that I’m an abuse victim who doesn’t know what a healthy mother/daughter relationship even looks like. And I see femmeslash everywhere, as long as the characters aren’t blood related and are both of age.

  7. Of course, how poorly is debatable. You can debate that the Doctor was not causing the most good by his actions. But you cannot say “Some things are just wrong!” without qualifying the harm.

    • If you have to have somebody explain to you why injecting somebody with a fatal disease, as the Doctor did in this episode, is wrong then there is something wrong with you sir.

      • TragicGuineaPig

        Primum non nocere. “First, do no harm.” The problem is that Hawkeye’s approach is to cause harm in order to prevent further harm, but in the process, he actually breaks the first rule of medicine.

        • But technically, a lot of medicine requires the doctor to cause harm in order to prevent a greater harm. For example, amputation and chemotherapy cause a ton of harm but you have to take that risk or something worse would happen. Similarly, a lot of drugs have bad side effects.

          • thespecialneedsgroup

            That sort of medicine, however, is harm caused under controlled conditions with the understanding that failing to act will result in severe bodily harm or death. When amputations are preformed in the field, it’s usually done because the patient’s life is in immediate danger if the limb isn’t quickly removed. When they’re done in the hospital, it’s usually either done to prevent a localized infection from spreading to the rest of the body, or removing a damaged limb to improve a patient’s quality of life. The doctor and the patient understand and have accepted the risks; unless it’s an emergency situation and the patient isn’t able to give consent; in which case medical staff can give any treatment that a reasonable person would agree to in order to save his or her life.

            The Doctor gave a man a disease to coerce him into. The Doctor had no way of enforcing the agreement, making it worthless–especially seeing as it was made under duress. Also, the Doctor most likely didn’t know the man’s medical history. For all he knew, Chellick might have had a severe reaction to the blood factors the Doctor injected him with and died in minutes. Or Chellick might have been immunocompromised for some reason, leading to his agonizing, lingering death from the massive, unchecked infection over the next day or so. Folks ’round my neck of the woods have a term for situations like that: aggravated murder. Ironically, if I were to do what the Doctor did and it went horribly wrong, it could lead to the state giving me a less-than-healthy injection against my will.

  8. I am pro donkey magic.

  9. That bit about the resources allocated to those that use them more reminds me of MULTIPLE stories I’ve heard from people in the military. Who’ve had to scramble to use up ammunition issued for training purposes, so that they keep getting the same amount the following term.

  10. I think donkeys shouldn’t be allowed to perform magic shows. They don’t have sleeves!

  11. The MASH refernce is right. The Doctor like Hawkeye is confronted on what steps he should take to save more lives.BJ was the voice of reason that you don’t correct a wrong with another wrong when the end result did not change anything. This episode is like the TNG episode I, Borg on how far do you want to go.

  12. Of course this will never be brought up again since Voyager has the same continuuity as an 80s cartoon series. As usual, it’s all Neelix’s fault!

  13. you know what’s hilarious about Voyager? They set up a system so absurd that there is no way it can be seen as an allegory for anything real. I mean, look at how hilariously BROKEN the Allocater’s system is: A patient comes in with a condition, he is entitled to a certain amount of medicine/treatment by his life station, it won’t cure him or even improve his condition significantly but it’s all he gets. When he dies a few days later what medicine you DID give him is totally wasted! It would have been better to NOT treat him at all, because then you didn’t waste your resources, which could have been applied instead to actually saving another persons life! I mean, not to say it’s a good thing to let people die, but if you have 2 jobs you may as well abandon one of them to do the other well instead of doing a failing job at both. I mean, distributing resources to the best possible efficiency is what the Allocater is FOR right?

    Also, there IS a possibility that the blue level not using as much medicine would not result in the red level getting more. If they aren’t using as much medicine in blue they may simply not make as much of it at all, the Allocater may decide that the resources and space needed to get the ingredients and manufacture the medicine can instead be spent in other areas, such as maybe construction or food production. I mean, that sounds stupid but as I mentioned before this thing is already wasting resources by giving poor people SOME treatment but not enough to save their lives.

  14. Since it has not been mentioned on one of the most nerdy sites on the internet, and since Chuck reviews Star Trek I’ll will just say this: Rest in peace Leonard Nimoy. He died friday February 27th. He lived long and prospered, but I wish he could have stayed with us longer.

    Resources were already wasted on blue deck, many of the patients there didn’t need the treatment they got. The EMH is my favourite Voyager character, so I’m always happy watching a EMH-sentric episode.

  15. I would be interested to hear what SF Debris has to say about STVOY: Sacred Ground. I found that ep to be an obvious attempt at new-age moralizing.

    I also notice that many people who like the episode look well-past the storyline flaws and see beauty in the premise of faith serving as answer to a challenge. Moreover, most of these people I know are predisposed to modern religious traditions. It’s almost as if the ep invokes a knee-jerk bias in certain individual minds.

    The story itself seems like a large waste of time, as Janeway later doesn’t seem to possess any of the convictions of faith that define the climax of Sacred Ground.

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