Worf is injured and his spine is irreparably damaged, leading to Dr. Crusher bringing in a neurological specialist, who she finds has questionable ethics, to save him.
- Bizarre Alien Biology: Dr. Russell calls the Klingon body "over-designed"—citing such things as 23 ribs, two livers, and an eight-chambered heart. Beverly says that Klingons see it as a contingency—if a given organ fails, a backup immediately kicks in.
- Chekhov's Gun: Early on, it's noted that the Klingons have extra internal organs so that if one fails, there's still another that can take its place. This sets up the Death is Cheap moment later, where Worf recovers due to a second synaptic system.
- Cloning Body Parts: The treatment proposed by Dr Russell is cloning his spinal column, an untested procedure.
- Continuity Nod: Riker brings up Marla Astor and Tasha Yar in his list of officers who continued to fight even after being critically wounded.
- Death is Cheap: Worf dies on the table and comes back later due to a backup synaptic system.
- Driven to Suicide: Worf asks Riker for help in a Klingon ritual suicide. Naturally, Riker refuses to help him.
- Riker does note that despite his personal feelings, he would help Worf commit suicide if it was his place. Unfortunately for Worf, the Klingon ritual suicide is pretty specific about who has to help Worf.
- Foreshadowing: Beverly's talk of Klingon's backup systems in their bodies.
- Freudian Excuse: Alexander cites his mother's dismissive view of Klingon honor when objecting to Worf not letting him visit in sickbay.
- Harmful to Minors: Riker correctly anticipates that this is why Worf won't ask Alexander to take part in the ritual.
- Honor Before Reason: Deconstructed with Worf, as he gets a lot of grief for it. He would rather die than live on as paralyzed, but Riker calls him out on what an affect that would have on the people around him. Worf also spends much of the episode being too proud to ask for help, initially refuses to let Alexander see him in his current state, and resists a implant treatment with limited results in favor of a riskier procedure with better results in the long term. In the final scene, though, Worf acknowledges that it'd be better for both himself and Alexander if he swallowed his pride and let him help in his recovery.
- Jerkass Has a Point: Beverly chastises Dr. Russell for broaching her treatment to Worf, despite the dangers. While Beverly is right that she only did so to test a treatment that Starfleet previously rejected, Dr. Russell is right that proposing her treatment is preferable to Worf committing suicide. Picard pointing this out to Dr. Crusher is the reason that she eventually relents, and helps with the procedure.
- Living Is More Than Surviving: Worf says the ritual is for cases when a Klingon can no longer function as a warrior and becomes a burden. Riker is against helping Worf commit suicide—saying he's not suffering. Picard says that's a human perspective and understands the Klingon perspective on it.Picard: You and I could live to learn with a disability like that, but not Worf. His life ended when those containers fell on him. Now, we don't have to agree with him; we don't have to understand it, but we do have to respect his beliefs.
- Loophole Abuse: How Riker gets out of the ritual. He studied up on it and found that it is the place of a family member (such as the oldest son) to carry this out. When Worf says Alexander is just a boy, Riker notes how Klingon males are considered men the moment they can hold a weapon.
- No OSHA Compliance: Worf would probably have been alright if those barrels had been properly secured.
- Noodle Incident: During The Teaser, Geordi discusses a recent poker game in which Troi beat Worf at a hand. Geordi says she successfully bluffed him and that he knows because the deck was transparent to his VISOR.
- Oh, Crap!: The look on Worf's face when Dr. Crusher tells him he's actually not being restrained: his spine is severed and he's now quadriplegic.
- "The Reason You Suck" Speech:
- Dr. Crusher delivers one to Dr. Russell.Crusher: I am delighted that Worf is going to recover. You gambled, he won. Not all of your patients are so lucky. You scare me, Doctor. You risk your patients' lives and justify it in the name of research. Genuine research takes time. Sometimes a lifetime of painstaking, detailed work in order to get any results. Not for you. You take short cuts. Right through living tissue. You put your research ahead of your patients' lives. And as far as I'm concerned, that's a violation of our most sacred trust. I'm sure your work will be hailed as a stunning breakthrough. Enjoy your laurels, Doctor. I'm not sure I could.
- Riker's last scene with Worf is basically this in a tough love sort of way.Riker: Do you remember Sandoval? Hit with a disruptor blast two years ago. She lived for about a week. Fang-lee, Marla Aster, Tasha Yar—how many men and women, how many friends have we watched die? I've lost count. Every one of them, every single one, fought for life until the very end.
Worf: I do not welcome death, Commander!
Riker: Are you sure? Because I get the sense you're feeling pretty noble about this thing. "Look at me. Aren't I courageous? Aren't I an honorable Klingon?" Let me remind you of something: a Klingon does not put his desires about those of his family or his friends. How many people on this ship consider you a friend? How many owe you their lives? Have you ever thought about how you've affected the people around you, how we might feel about your dying?
- Dr. Crusher delivers one to Dr. Russell.
- Sadistic Choice: Riker has to choose between his friendship with Worf and his disgust with him wanting to commit suicide. He concedes he probably would've helped Worf in the ritual if not for finding a loophole.
- Take a Third Option: What Riker does in the end.