His medical ethics are insane (…by Earth standards, if you suggest there could be significant variation based on reason—I’m not so sure that is the case), but the episode was rewritten so Archer didn’t disagree at the end. Instead, Archer and the script eventually suggest that he’s right to withhold the treatment, and that this is the model situation that leads to the creation of the Prime Directive! Let’s get this straight: aliens launched a deep-space mission, specifically seeking aid from other spacefaring civilizations for a medical condition affecting much of their species. They find the Enterprise, and it takes them back to their world and offers to help. The Enterprise’s doctor comes up with a cure, but then that cure is withheld because giving it to the aliens would be “playing God.” And the logic here is…they would only have been deserving of medical treatment if—what? They had used a better drive to fly out into space to find the Enterprise? This is whacked-out, especially as after-the-fact justification, and even more so if we are meant to believe that it led to the establishment of Federation policy among such guidelines!

The episode’s a train wreck. But as previously stated, performances were not the issue. Writers who write scripts about “evolution” without having any idea what it means is not new in Trek (see “Threshold” for another classic example).