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The Prime Directive in Extraterrestrial Medical Ethics

“Lessons from Earth history do indeed give us reason to expect bad outcomes from intercultural encounters and the uncertainties involved when encountering extraterrestrial “patients”, and cultures do indeed give us reason to avoid case-by-case rulings.”

Imagine that you are a medical doctor on a spaceship and encounter a tribe of aliens that suffers from a fast-spreading disease that is deadly to them, but can easily be cured by you with your advanced knowledge and technology. What do you do?

The most famous literary rule for this kind of encounter in space is Star Trek’s Prime Directive. This rule tells us not to interfere, but is frequently broken.

The most well-known set of rules in medical ethics on Earth is the Hippocratic oath, which tells you that it is your duty to help the sick wherever you go. On the other hand, that is made for Earth, not for space and even on Earth, things get complicated when different cultures are involved. When a new culture is discovered, it is common practice to stay away in a fashion reminiscent of the Prime Directive. Not interfering in the internal affairs of other countries is also a basic pillar of international law. Even so, it does, as we know, still happen.

What is the thinking behind these principles of non-interference? In the case of non-interference in the internal affairs of other countries, the main reason is probably that it would be impossible to get any country to sign any agreement if it could lead to a situation where other countries get permission to interfere in the affairs of that country.

This way of thinking cannot be the reason behind the Prime Directive and the Earth equivalent of staying away from tribes that have previously not been in contact with more technologically advanced societies. We do not have any mutual agreements with these groups, and we do not have to be afraid that they will invade us if they disagree with our domestic politics.

Instead, it seems to have something to do with the way such encounters have ended previously in Earth history. Very often, they have not ended well for the less technologically advanced part, even if the intentions from the more technologically advanced part have been benign, which, of course, far from always has been the case.

Still, here we have a group of extraterrestrials who are dying en masse, but who you could save fairly easily. Is non-interference always the right decision?

To answer that question, let us dig a bit deeper into the ethics behind the Prime Directive. What are the moral intuitions behind the directive and do they work? Which moral principles and theories would provide the best support for the directive, and what do they tell us about your predicament when you stand at the Holodeck pondering your decision whether to help or stay away?

Those who argue that no country should interfere in the affairs of another country, even if the latter, for example, refuses its citizens basic human rights, discriminates against a minority group or performs ethnic cleansing, sometimes claim that what is right in one culture is not necessarily right in another and one culture should not force their values on other cultures. This is called ethical cultural relativism, and the basic idea behind this reasoning is that there is no other basis for ethics than the culture; hence, different cultures have different ethics.

Could this be the ethical basis for the Prime Directive? Some instances in some Star Trek episodes point in this direction, but most of the time, the crew of the Enterprise seem to assume that there are, after all, some things that are morally right that cannot be ignored. Philosophers on Earth have also pointed out repeatedly that ethical cultural relativism is just not a viable theory. It often leads to counterintuitive conclusions. It implies, for instance, that the moral status of a woman changes when she crosses the border between two cultural spheres, and that people who helped run-away slaves in the 19th-century USA were, in fact, acting immorally while the slave owners were morally impeccable.

What is more, using ethical cultural relativism to argue that no country should interfere in the affairs of another country is simply not working, since it may well be that interfering in others’ business may well be a strong ethical norm in the culture of the interfering country. If there is no other basis for ethics than culture, then there is just no way of condemning one culture’s interference in another. It could, of course, be the case that non-interference is a strong part of the culture of every member of the Federation, but on the other hand, if we look at what actually happens in most Star Trek episodes, it does not look that way.

Some have compared the Prime Directive with a categorical imperative, a concept coined by the German philosopher Immanuel Kant (1724-1804). Kant’s categorical imperative comes in different formulations. The most famous formulation is probably the one stating that “Act only according to that maxim whereby you can at the same time will that it should become a universal law”. The problem here is that a categorical imperative is – categorical, and as we have seen many times in Star Trek, the Prime Directive is apparently not. Even though it is true that it is often stated in categorical terms and even talked about as being categorical, the crew on the Enterprise certainly does not act that way.

One way of dealing with this could be the principle of double effect. A principle dating back to Thomas Aquinas. It states that it can be acceptable to do things that are otherwise deemed immoral under special circumstances, namely, if the act as such is not immoral in itself independently of its consequences, if it leads to more good than bad, if the bad effects are not intended even if foreseen, and not used as a means to the good and intended effect.

Applied to our scenario, helping the sick cannot be wrong in itself, and we intervene with the intention of helping, even though we foresee that intervening implies some risks for the extraterrestrials. We assess the possible negative outcomes as less serious than the disease, and we are not actively pursuing the negative outcomes as a means to stop the pandemic. We do not, for example, plan to kill off all the contagious individuals, but we do foresee that some will die from side effects of the treatment. It thus seems that the principle of double effect could work in these particular circumstances, though it might not in other circumstances. Another problem is that it is a rather controversial principle that some proponents of Kantian ethics see as cheating or as a way of smuggling in consequentialist ethics.

Others think that consequences are the only thing that ultimately counts in ethics, and that it makes no relevant difference whether a consequence is intended, used as a means, or just foreseen. They also deny that some actions are wrong in themselves. If this is the case, neither the Kantian-style categorical imperatives nor the principle of double effect will provide any help.

The most well-known version of consequentialist thinking in ethics is utilitarianism, which states that there is always one right answer to all moral dilemmas, namely, to do whatever leads to the greatest good for the greatest number. In its original, act-utilitarian form, this does not work as a basis for the Prime Directive, since act-utilitarianism tells us that we need to calculate the value of all available options and choose the best one, while the Prime Directive tells us to always act in the same way: Do not interfere!

Another reason why act-utilitarianism will not be very helpful in our case is that assessing the value of all available options is really difficult, even on Earth, and in our scenario, we are dealing with an alien lifeform and an alien culture, which makes it even more difficult, or even impossible. This is seemingly also an important reason why the Prime Directive was instituted in the first place. That is, as a way of handling a type of situation where the uncertainty is just overwhelming and the outcome of either option, to intervene or not, is impossible to foresee.

Another version of utilitarianism is rule-utilitarianism. It states that since it is practically impossible to assess the value of all available options even on Earth, it is better to make some general assessments and set up some rules that lead to the best outcome most of the time, even if they do not lead to the best outcome all the time. Some believe this is cheating and a deviation from the basic idea of utilitarianism. Others think it is the only practical way of reaching the aim of utilitarianism.

Would the Prime Directive be a rule under rule-utilitarianism? Assessing exactly what will happen if we choose to intervene and help sick extraterrestrials in an alien culture is practically impossible, but maybe it is possible to make an overall assessment based on our own history? On Earth, encounters between cultures on different technological levels rarely end well for the latter, even if the intentions of the more technologically advanced, intervening culture are morally praiseworthy. This seems like a good reason to implement a general rule against intervention. References to negative outcomes of historical intercultural encounters on Earth are also sometimes mentioned in Star Trek as a basis for the Prime Directive.

Lessons from Earth history do indeed give us reason to expect bad outcomes from intercultural encounters and the uncertainties involved when encountering extraterrestrial “patients”, and cultures do indeed give us reason to avoid case-by-case rulings. Both these facts point towards rule-utilitarianism as a good basis for the Prime Directive. One thing remains, however. What about all the cases in Star Trek when the crew decides to override the Prime Directive after all, for reasons that in that context actually make good eth

Rule-utilitarian rules, contrary to Kantian categorical imperatives, are based exclusively on the expected outcomes from following the rules. In one way, however, the two systems are similar in that both rely on strict rules instead of on deciding the right act for each specific situation, as in act-utilitarianism. As we have seen, there are both pros and cons to this approach. Being too flexible invites uncertainty and misuse. Being too strict means missed opportunities to help where help could be given with very low risk for negative side effects. Is it possible to keep the Prime Directive as a general rule, but make it a bit flexible when the situation demands it?

In Star Trek, it is handled by setting up a very strict rule, but then turning a blind eye when a Starfleet Captain uses his own judgment and overrules the rule. A better alternative would be to make the Prime Directive a bit more nuanced and specific. Doing that would, of course making less catchy and memorable, and thus less suitable for a TV show, but if we want to make something out of the idea behind the Prime Directive that we can use in an actual situation, it could make sense.

First of all, we need a reformulation akin to the following: Do not make contact with a pre-Warpdrive culture without first studying it thoroughly. In addition, we need to add different paragraphs for what to do given certain outcomes of the study. Some suggestions present themselves, but need to be further studied and discussed.

One such paragraph could be: Never interfere without explicit consent. This makes good sense, and the same principle exists in medical ethics on Earth. Some questions that need to be considered are whether we should ask if they want our help or if we should wait for them to ask for help. Another important question is whose consent we need. The consent of the patients seems obvious, but what about the tribe elders or similar governing body, and what if they differ? This question is particularly important and difficult if the epidemic is due to, for example, bad sanitation and thus has to be handled on a societal level.

Another possible addition could be: Never do anything that affects internal hierarchies or relations between groups. This also makes good sense. There are several episodes of the Star Trek franchise that deal with this particular issue. However, what if the hierarchical structure or relations between groups are the root of the problem? Maybe the disease is spreading so fast because of an ongoing war, or because the part of the population in which the disease is spreading is extremely poor and exploited, and medical aid is deliberately withheld? Don’t we have a duty to intervene?

To sum up, there are several contenders for the role as the ethical basis for the Prime Directive, but the theory that seems to be most in line with what is stated about the directive, and how it is practised in the franchise, seems to be a flexible version of rule utilitarianism. It is based on the basic moral intuition that the outcome is what counts, paired with a massive collection of cases from Earth history where good intentions have resulted in bad outcomes.

How to make the Prime Directive work as a flexible rule-utilitarian rule is a real challenge. We believe the most important step is to include an observation, understanding and adaptation requirement. That is, observe and make sure to understand the culture and the context before you intervene, then adapt the intervention to the context. If you are not able to fully comply with one or more of these requirements, then do not intervene.

About the Author

Maya Mishra is a current medical student at New York University's Grossman School of Medicine. Her work sits at the intersection of outer space, biology, and medicine, and she hopes to practice aerospace medicine one day. In her spare time, she enjoys distance running and dabbles in writing her own speculative fiction. Erik Persson is an Associate professor of Philosophy at Lund University. He is also co-director of the Space Humanities Lab and leaads the European Astrobiology Institute's working group on Historical, Philosophical and Societal questions in Astrobiology. His primary research focus is on philosophical questions regarding environmental issues, emerginng technologies and space exploration. He is also, of course, a sci fi nerd.

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