Last night, I watched the Star Trek Voyager episode Critical Care. In it, the Doctor is abducted into a hospital that is undersupplied & understaffed. He immediately gets to work helping the sick and lambasting the inequity of the hospital's coverage. The rich and powerful get top quality care; the poor get beds to die on. It turns out the hospital's resources are allocated by a computer (the Allocator), which calculates scores for each patient based on a consequentialist rubric. If you're the CEO of a fertilizer factory whose death would result in the deaths of hundreds of thousands of people, you get a high score. If you're a warehouse worker whose death would only show up in your mother's thoughts, you get a pat on the back.

The analogue is ambiguous. Is the Allocator like private healthcare - humane treatment for those who can afford it? Or is the Allocator like a planned economy - oppressively reductive in its metrification of human worth? Whatever the case, the hospital's administrator, Chellick, argues that the Allocator is necessary: prior to its instalment, health outcomes for his society were worse. His role in the system is to own the fact that public health ethics requires ugly sacrifices.

The Doctor resists the logic of his captors, eventually infecting Chellick with a fatal-if-not-treated disease and altering his bio-signature so that the Allocator will place him into the no-coverage tier of society. It's a bold move for a digital embodiment of the prime directive x hippocratic oath, but the gambit works, and Chellick promises to reform the system.^🐊 The Doctor is then rescued, but his conscience won't let him off so easily - on what basis were his own unethical actions justified?

I think the episode worked decently well. I'm definitely thinking about it more than most Trek I watch, but in part that's because I don't think it does a very good job at resolving the problems at its heart: what is the right mix of deontology to consequentialism? If it's at least some of the former, is it right to intervene in the affairs of societies you don't belong to?

The Doctor's position is that it is, and that the system is not deontological enough. High value members of society are getting prophylactic life-extending treatments with medicine that could otherwise save the lives of sick children. This is wrong.

But is it wrong because the Allocator is malfunctioning, or because its version of consequentialism is actually just a POSIWID caste system?

1. If extending this engineer's life won't actually save more lives than the medicine otherwise could, then the Allocator is being stupid, and the Doctor could just make the consequentialist appeal to fix it.
2. If the Allocator is working correctly and it was convincingly demonstrated that more people will die because of the Doctor's interventions^🔮, would we still think of him as the episode's hero?

Ultimately, we don't see if things improve or worsen for the colony — perhaps because doing so would implicitly legitimize the consequentialist framing, perhaps because they ran out of time (as these episodes often do.)

It's a shame, because I think doing so would have sharpened the discussion around the episode in other reviews I've read. People could have debated whether or not the Doctor was wrong in deciding for others, or without sufficient evidence; or what the right virtue ethics is. Instead, most comments focus on the socialism vs capitalism Rorschach blot and whether or not Canadians are dying because the waitlists for treatment are too long.

Nevertheless, "deontologist fights for deontology by violating deontology due to consequentialist justification" is a pretty gnarly hook. I just wish they'd hung on it a little more.

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