This story takes place in the shared universe of "Faces in the Flames," but has no spoilers for that story.
Please note that I may not be fully accurate in the scientific details here, but I think this will suffice.
A Gentler Mercy
University of Culat, Cardassia Prime
That was what the Moabites called the venom of the fursnake. Or the business end of a gun.
For Doctor Latreka Ginak, that was the most galling aspect of what the Moabites offhandedly referred to as "the Syndrome." Not the fact that it had come about from botched genetic engineering. Not even the unimaginable degree of pain, which managed to outdo even end-stage Yarim Fel Syndrome in its almost deliberately malevolent resistance to painkillers.
It was the acceptance of this condition--the resignation that led to such things as sending the afflicted on the worst missions their military had to offer. To large segments of the population not bothering to get screened until they were already bearing children, or doing so regardless. Irresponsibly, Ginak thought to herself. She hadn't been one for the forced killings of 'unfit' children--sometimes before birth, sometimes after. But to knowingly breed when you knew you were very likely transmitting the traitor's gift of a short life of horrible pain to your own child--a life to end by the 'mercy' of poison or a bullet...it flew against every fiber of the medical professional's being.
Admittedly, the situation hadn't been helped by some disastrous clinical trials conducted by the Moabites in the colony's early days, and some feeble, even seriously misguided attempts by the Federation that had only added horror to an already cruel end. But to just give up...
It would take a massive public education and screening effort to put an end to all but the rare cases no screening would ever catch, or the incidence of de novo mutations that might still occur due to the centuries of genetic isolation from the rest of humanity. Ironically, the scientist mused, the miscegenation the propagandists of the old state and the True Way so liked to rail against would likely be a supply of badly needed genetic diversity to help lower the chances of the disease markers coming together again, over time. New-species blood would help to hasten the process.
But that was too long for the current generations to wait. Currently, the disease markers and processes were proving devastatingly difficult to fully profile--there were so many variables and so many deadly combinations...the perniciousness one typically only saw in things made by sentient hands.
What in all the universe was this perversion ever supposed to be in the first place? A genetic patch, or augmentation gone wrong? Or an enemy of their people's last laugh?
That was why when her colleague, Dr. Tejal Corsek, approached her with the proposal, Ginak couldn't help but shudder. Was this really the best Cardassian medical science had to offer?
"I know how to stop the pain in the Stage Threes," Corsek said.
As soon as Ginak's eyes lit upon the screen, they went wide. "No. Oh, no, do you know what the side effects of that will be?"
"The inability to feel any pain," Corsek stated, matter-of-fact, "including the pain of injuries and secondary illnesses. There are some humans with a genetic condition that prevents them from feeling pain. It's really quite shocking that only a single gene deadens all of the nocioceptors in the peripheral nerves. Once that's done, you've stopped the nervous system from feeding back on itself...and in not long, once the other nerves stop receiving the constant pain signals, the pain subsides to nothing. I know it's not a cure. It's palliative care. But it will be an improvement over the choice between pain and lethal poison."
Ginak's eye ridges knitted. "That may be, but what does this do for the seizures? Or the endorphin-receptor damage? You're either going to have your patients die from unnoticed injuries, from status epilepticus, or from the chance to off themselves painlessly. And don't you think there won't be suicides, because if they have no endorphin receptors functioning, that's a recipe for lethal depression. You'll just be putting a powered disruptor into their hands. And they already have a culture of suicide. What is this really supposed to accomplish?" She was not one of those death doctors. She was not about to become one.
"I hear you," Corsek replied. "I am far from recommending this as a universal treatment. In fact, I would recommend strict psychological testing before allowing doctors to use it on a given patient. I am thinking mainly of highly objective-focused patients. People with a very clear idea of how they intend to use their final weeks. And that's the timeframe we would most likely be looking at, because either the seizures will take them or an injury will. An artist or author would have a chance to finish their final work, or put together instructions to have it completed posthumously. Someone determined to travel to one last place--maybe to see someone they've missed, or maybe just return home to die, instead of dying in a strange place, and possibly even at the end of a stranger's gun. For the determined, this is a last chance. A final wish.
"There is one more group that could benefit: the victims of early-onset DNSS."
At that, Ginak had to shudder. The standard, and by far most common course of the disease was an early enough onset, even when the tragically short human lifespan was taken into account. Early onset meant children.
Children that wound up killed by their own parents, put down like a riding hound.
She was beginning to see Corsek's argument.
"If we go to trial...we will have some very difficult obstacles to overcome," Ginak warned. "Some of the experiments the Federation did...they were so bad, caused so much prolonged suffering, that it only fed the suicide culture. It made many of them fearful of outside medical intervention. Getting volunteers could be a difficult task."
"True," Corsek acknowledged. "But I suspect some of the same driven individuals who fit our profile are the same people who would risk volunteering."
"What about distribution and control? It looks from this like you're looking at some kind of antisense therapy, a single-gene knockout from which pain cessation is achieved. That's powerful and permanent. I can see this becoming a black-market treatment for people who don't fit the profile, or even for people without DNSS who don't understand the importance of properly functioning nociception." And that, in the hands of a people with so little cultural capacity for long-term planning, that live-fast-die-hard attitude, could create a medical nightmare. Or they might fight over access to it, refusing to accept the reasons that some received the treatment and some were denied.
Corsek crossed her arms. "It has to be a heavily controlled treatment; that's for sure. And we'd need cooperation from public authorities to enforce the laws and educate people as to what this is and is not. This is an advance in palliative care. Not a cure or treatment."
"I just hate that this is all we have."
Corsek nodded. "We won't stop looking. But this is at least a start."
Last wishes and a gentler mercy. It would have to be, until the battle was won.
Do you like story-based Foundry missions? If so, please check out my mission, "Finding Lascaux."
And that prompted me to do a little research. Turns out there are five different single-gene mutations that can result in the inability to feel pain; it looks like this research is intended to emulate HSAN5, which alters the function of Nerve Growth Hormone (NGF) such that it does not bind to pain nerves, preventing transmission of pain signals. It's distinguished from most of the other varieties in that it doesn't have any notable secondary effects (most are also associated with loss of other sensory input and/or mental retardation).
I used science to an extent...I expect that IRL this solution wouldn't really work, but I'm an author, not a doctor.
Well, not IRL, but in Trek Science, which like Comic Book Science allows a change in the genetic structure to affect the current generation rather than descendants, you hit the palliative nail on the head.
"You're as crazy as the people on Twitter!" - Samuel L. Jackson