Medical Ethics
Neuroethics Research
Over the past several years, Dr. Joseph Fins has pursued research focused on the neuroethical issues of disorders of consciousness. He is especially interested in the “minimally conscious” brain state, which is neurologically distinct from the vegetative state. Unlike vegetative patients, those in a minimally conscious state show intermittent intention, attention, and memory, and they have the potential to fully or partially recover.
In collaboration with Nicholas D. Schiff, M.D., Associate Professor of Neurology and Neuroscience and Associate Professor of Public Health, Dr. Fins is working to understand the neuroscience of how people recover consciousness in order to elucidate clinical and ethical aspects of this impairment. In addition to discovering how best to treat minimally conscious patients, a major goal of their research is to have the knowledge to serve as advocates for brain injured patients, who have historically been neglected.
The past few years have seen exciting major developments:
- In July 2006 senior author Dr. Schiff, lead author Dr. Henning Voss, Assistant Professor of Physics in Radiology, and Dr. Fins led breakthrough research on Terry Wallis, a 42-year-old patient who emerged from a minimally conscious state after 19 years. Published in the July 2006 issue of Journal of Clinical Investigation, the study found that Wallis may have regained speech and movement because his brain rewired itself by growing tiny new nerve connections to replace the old ones sheared apart in a car crash.
- Dr. Fins received a Robert Wood Johnson Foundation Investigator Award in Health Policy Research for his proposal, “Minds Apart: Severe Brain Injury and Health Policy.” The grant began in July 2007 and will continue for three years. It funds interdisciplinary research into how best to serve the needs of patients with severe brain injury and their families through better clinical services and the promotion of clinical research. The work is designed to improve clinician-family communication about brain injury, inform educational standards for professionals, and articulate a justification for research in patients who are unable to provide consent. Read the press release. Dr. Fins’ efforts will result in a number of scholarly papers and a book to be published by Cambridge University Press.
- Drs. Fins and Schiff were sought for expert commentary on the discovery of mental activity in a severely brain injured woman, in a study led by brain researcher Adrian Owen at the Medical Research Council Cognition and Brain Sciences Unit in Cambridge, England, and published in the journal Science. The Science article described functional M.R.I. tests that showed active language processing areas in the woman, who was thought to be in a vegetative state. Dr. Fins said that the imaging techniques used in the study could help identify which patients are most likely to emerge [from a vegetative state to minimal consciousness, and possibly to full consciousness]—once the tests are studied in larger numbers of unconscious people.
- Dr. Fins, along with Nicholas Schiff, M.D., Associate Professor of Neurology and Neuroscience and Public Health, and Kathleen M. Foley, M.D., Professor of Neurology and Neuroscience and Clinical Pharmacology at Weill Cornell Medical College, recently published a commentary in Neurology urging a nationwide epidemiological study of severely brain-injured patients. The paper reports on an Institutes of Medicine exploratory meeting on disorders of consciousness. The meeting committee was chaired by Dr. Foley, with Drs. Fins and Schiff serving as members. Read the press release.
- Dr. Fins testified on July 18, 2007, before the U.S. House of Representatives Committee on Veteran's Affairs hearing on traumatic brain injury (TBI). Dr. Fins called attention to the compelling needs of minimally conscious patients, both among the military and civilian populations. Read his testimony, which includes specific recommendations for improving care.
- Dr. Schiff was the lead author of a groundbreaking study on the success of deep brain stimulation (DBS) in improving the condition of a severely brain injured man who had been in a minimally conscious state for six years. Dr. Fins, a co-author of the article, formulated the ethical framework that guided the design and execution of the study, which represented a collaboration among researchers from the Cleveland Clinic, the JFK Johnson Rehabilitation Center for Head Injuries, and Weill Cornell Medical College. The report was titled “Behavioural improvements with thalamic stimulation after severe traumatic brain injury” and appeared in the August 2, 2007, issue of Nature. Read the press release. The study’s findings were covered extensively in the media.
