It was a decent episode (yeah, I saw it), and the high point was, of course, the complex relationship between Woods and the Ally Walker character. I didn't really find his "Richard Feynman-esque" teaching all that convincing, and while the episode was decent in itself, it still felt like "old hat" to me -- ER does one of these "Bring in a noted older guest star to play a person at the end of significant health problems" tales every year, and we've even seen the "one of the current docs cares for his/her mentor" thing before. So even when the show happens to be good (which I still maintain is very infrequently), it does so by recycling its old ideas.
I think you're setting the bar awfully high. For a single-setting show like ER that must revolve around the hopsital, the notion that after ten years they shouldn't be "recycling old ideas" is pretty limiting. It almost sounds like you are saying that *no* show ER-like show should go on past, say, six seasons or so, given the inevitable recycling that sets in. While we may have seen other mentors, and other famous-people-playing-terminally-ill-patients, I have never been moved by an episode of ER as much as I was moved by this episode. And to be able to say that 10+ seasons in is impressive, no matter how you slice, dice, or puree it.
I further noted that I just wasn't moved, because the episode, while very well done, was severely undermined by the fact that ER has done this kind of story many, many times in the past. The question then arose about whether TV series should go off the air in sixth or seventh years, as opposed to chugging along into eleven years, simply by virtue of running out of stories to tell.
The answer is, of course, yes. And no.
For me, ER isn't even close to being fresh anymore. I've written about this before, so no sense dragging it out, but the show is fraught with boring characters, boring stories, predictable outcomes, nothing new by way of production design or values, no sense of invention or innovation. Even the James Woods episode, while told in compelling flashback style, is undermined because we've seen these "Big Guest Star suffers from illness" tales before. James Woods, Ray Liotta, Bob Newhart, James Cromwell, Sally Field, and Alan Alda are just a few of the Big Actors who have come through the ER with their various maladies. It's an incredibly predictable ratings stunt for ER every year. (And that's not including the other bits of stunt casting involving ER docs and nurses.) And then there are the romantic entanglements: in just half of this season, Dr. Kovacs has gone from being deeply involved with Nurse Sam (incidentally, the most irritating character on this show since Dr. Finch) to having a baby with Abby Lockhart, with whom he was already romantically involved several seasons back.
Has ER jumped the shark? For me, it most definitely has. (In fact, I think there have been two shark-jumping moments: the jaw-droppingly awful death of Dr. Romano, and the equally horrible resolution to the Reese Benton custody fight.) But does this mean that a show should go off the air while it's still fresh? Probably. I'm hard pressed to think of a single show that's lasted that long that hasn't become boring. ER? Yup. The X-Files? We just discussed that the other day on this blog. Happy Days? MASH? Yup. Even I have to admit that my beloved Friends stuck around a year or two too long, and Seinfeld couldn't have lived another minute, as far as I can see. Frasier suffered in its last couple of seasons, even though its last handful of episodes were wonderfully done. I suppose some would mention Law and Order as an exception, but I've never found L&O particularly compelling, and anyway, that show's relentless formula is a major reason it has stuck round this long. I'm actually glad that The West Wing is departing (and, in fact, I think that Aaron Sorkin's freshness itself started to slip in years three and four), and if Scrubs dies this year, I'll be fine with the brilliance we've had.
Thing is, though, ER doesn't have to be so ditch-dull. There are plenty of stories that can be told in hospitals. Grey's Anatomy is, frankly, a lot more fresh now than ER. And there will be hospital shows even after ER goes away. So why is ER dead in the water, at least for me? As I noted above: it's not just recycling story ideas, but it's recycling a tiny number of story ideas. It's relying on the same tricks, year in and year out. The soap opera stuff too often feels like flailing. And in an ensemble drama, so much depends on the characters -- of which there are few compelling examples now.