THE PRIME DIRECTIVE

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HOW MEDICAL PRIORITIES AFFECT THE PRIME DIRECTIVE

In [TOS: The Omega Glory], on a planet whose inhabitants have a primitive culture, Captain Ronald Tracey believes that violation of the Prime Directive is justified in order to attempt to unlock the secret of the Kohms' long lifespans in the hope of providing medical benefits to the Federation. His action leads to his using a phaser to protect the Kohm village against the Yangs, and he also kills Kirk's officer Lieutenant Galloway. Ultimately, however, Dr McCoy reveals that the reason for the Kohms' longevity is that over generations their bodies adapted so that it is natural for them. This means that there is no transportable medical benefit, and therefore that Tracey's crimes were for nothing. This is a clear instance where the desire to do good can warp the mindset, leading to wrongful acts being committed on the basis of 'the end justifies the means'.

In [TNG: Who Watches The Watchers], a Federation anthropological team is secretly observing the Mintakans, a primitive race of Proto-Vulcans, and are doing this from within a 'duck blind', that is, a hide whose appearance blends into its surroundings thanks to holographic technology. When the holotechnology fails due to a faulty generator, the 'duck blind' becomes visible until the generator is repaired. In the interval of visibility, the 'duck blind' is seen by two Mintakans, one named Liko and his daughter named Oji. Liko even climbs up and looks inside and witnesses two people vanishing — they are beaming up to the Enterprise-D. In his surprise, he touches the metal of the structure of 'duck blind' which is still conducting arcing electricity. Liko receives a severe electric shock, and falls off the rock ledge receiving mortal injuries. As the Federation personnel were responsible for his injuries, Dr Crusher beams him to the Enterprise-D sickbay. Picard rebukes her for rescuing him, and orders Crusher to erase his short-term memory but the procedure fails. Further details are in the episode entry for this story.

Crusher: "Before you start quoting me the Prime Directive, he'd already seen us, the damage was done. It was either bring him aboard or let him die." Picard: "Then why didn't you let him die?" Crusher, indignantly: "Because we were responsible for his injuries." Picard: "I'm not sure that I concur with that reasoning, Doctor, but, now that he's here, you must remove all memory of the encounter with the away team." Crusher: "By erasing short-term recall." Picard: "It has been accomplished before." Crusher: "I am familiar with Dr Pulaski's technique, but I can't guarantee it'll be effective on the Mintakan brain chemistry." [TNG: Season 3: Who Watches The Watchers]

In [Star Trek IX: Insurrection], the crew of the Enterprise-E encounters the Son'a race who intend to utilise the unique metaphasic particles within the rings of the Ba'ku planet. These particles have rejuvenating properties. The Son'a, an aged and dying race, want the particles in order to rejuvenate themselves. Since the planet is situated within Federation space, and the rejuvenation technique would double lifespans and provide medical benefits to billions, the Federation and the Son'a enter into an alliance. The allies plan to relocate the Ba'ku people, at first without their knowledge through the deception of a secret holographic re-creation of their village aboard a space transport vessel but then forcibly in detention aboard a Son'a vessel. Picard protests to the Starfleet Admiral in charge of the project that the dislocation of the Ba'ku people is an attack on the very soul of the Prime Directive, and he fears it will destroy the Ba'ku.

Picard: "I won't let you move the Ba'ku. I will take this to the Federation Council." Admiral Dougherty: "I'm acting on orders from the Federation Council." Picard: "How can there be an order to abandon the Prime Directive?!" Dougherty: "Prime Directive doesn't apply. These people are not indigenous to this planet. They were never meant to be immortal. We'll simply be restoring them to their natural evolution." Picard: "Who the hell are we to determine the next course of evolution for these people!" Dougherty: "Jean-Luc, there are 600 people down there. We'll be able to use the regenerative properties of this radiation to help billions. The Son'a have developed a procedure to collect the metaphasic particles from the planet's rings." Picard: "A planet in Federation space." Dougherty: "That's right. We have the planet. They have the technology, a technology we can't duplicate. You know what that makes us? — partners. ........ With metaphasics, lifespans will be doubled. An entire new medical science will evolve. I understand your chief engineer has the use of his eyes for the first time in his life. Would you take that away from him?" ........ Picard: "We are betraying the principles upon which the Federation is founded. It's an attack upon its very soul. And it will destroy the Ba'ku, just as cultures have been destroyed in every other forced relocation throughout history." Dougherty: "Jean-Luc, we're only moving 600 people." Picard: "How many people does it take, Admiral, before it becomes wrong, mmm? — a thousand, fifty-thousand, a million? How many people does it take, Admiral!" [Star Trek: Insurrection]

In [#151 Critical Care], the Doctor is forcibly integrated into the medical staff of a Dinaal hospital ship. A computer known as The Allocator runs the hospital in accordance with the administrative system established by Chellick of the Jye humanoid species known for being good organisers and capable of making the tough choices that the Dinaali feel themselves unable to. Ever since the Dinaali employed The Allocator system to distribute the limited medical resources, the Dinaali was a dying race, suffering eco-disasters and famine. The Doctor takes issue with the way that the medical resources are allocated. He believes that medication should be allocated on the basis of need whereas under the system of Chellick (and thus The Allocator) medication is provided to those deemed to contribute most to society. Each Dinaali is given a TC rating (TC stands for 'treatment co-efficient'), which is reached by various formulae based on their profession and considered worth to society. This results in a system of several different levels of care, with those on Blue Level receiving not only what treatment they require but supplements to boost their health and longevity, whilst those unlucky enough to have low TC ratings are doomed to be patients on Red Level where there are constant shortages of life-saving medicine. When the Doctor interferes, to impose his medical ethics on the system, he discovers that he over-allocated certain treatments, using up their ration prematurely. The Doctor decides to intervene once more, this time only enough to obtain life-saving treatment for certain patients, before he is rescued by USS Voyager. During his time on the Dinaali hospital ship, the Doctor does not ponder the Prime Directive principle of non-interference, ignoring the Prime Directive on the grounds of his own (and the Federation's) medical priorities.

 
cramped, dark, under-resourced facilities on Level Red,
but on Level Blue there are comfortable, spacious facilities, with priority call on medical supplies

Doctor: "I demand an explanation for the death of that boy." Chellick: "I'm responsible for thousands of patients. You'll have to be more specific." Doctor: "His name was Tebbis." When Chellick still looks blank: "Patient R12!" Chellick looks up the patient record on his personal computer: "Acute chromoviral disease." Doctor: "He was recovering." Chellick: "Apparently he developed complications." Doctor: "What kind of complications?" Chellick: "Secondary infection. It spread rapidly." Doctor: "How was it treated?" Chellick: "It wasn't. The patient had exceeded his medication allotment. It seems someone had given him unauthorised injections. Did you think I wouldn't find out?" Doctor: "Don't you have any ethical standards?" Chellick: "You are hardly in a position to talk about ethics. Lying, stealing - any other crimes you wish to confess?" Doctor: "I was trying to save lives." Chellick: "And I am trying to save a society! Do you really think patient R12 is going to help me do that?" Doctor: "His name was Tebbis!" Chellick: "He wasn't contributing, he was a drain on resources." Doctor: "You're not just rationing health care here, you're getting rid of the sick and the weak!" [Season 7: #151 Critical Care]

In [#168 Natural Law], so as not to compound the violations of the Prime Directive that have already occurred through interaction by herself and Chakotay, Seven does not (unlike Dr Crusher with Liko) beam up the injured Ventu girl but has a Starfleet medical kit beamed down to her so that the girl can be treated.