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Constructive Disappointment and Disbelief: Building a Career in Neuroethics

Published online by Cambridge University Press:  10 September 2018

JOSEPH J. FINS
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Extract

Sometimes one’s greatest academic disappointments can have unexpected outcomes. This is especially true when one is trying to change career trajectories or do something that others did not take seriously. My path into neuroethics was an unexpected journey catalyzed in part by constructive disappointment and the disbelief of colleagues who thought that the work I was pursuing nearly two decades prior was a fool’s errand. After all, could anyone—in his or her right mind—ever conceive of waking up a person unconscious from brain injury and getting him to speak? 1

Type
The Road Less Traveled
Information
Cambridge Quarterly of Healthcare Ethics , Volume 27 , Special Issue 4: Clinical Neuroethics , October 2018 , pp. 544 - 553
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

This article is dedicated to Ralph L. Nachman, M.D., former E. Hugh Luckey Distinguished Professor of Medicine and Chair of the Department of Medicine at the New York Presbyterian Weill Cornell Medical Center, whose career advice got better with time. All trainees and faculty members would be fortunate to benefit from such wisdom and guidance. The author acknowledges the support of the Jerold B. Katz Foundation to the Consortium for the Advanced Study of Brain Injury and Weill Cornell Medical College.

In this series of essays, The Road Less Traveled, noted bioethicists share their stories and the personal experiences that prompted them to pursue the field. These memoirs are less professional chronologies and more descriptions of the seminal touchstone events and turning points that led—often unexpectedly—to their career path.

References

Notes

1. Schiff, ND, Giacino, JT, Kalmar, K, Victor, JD, Baker, K, Gerber, M, et al. Behavioral improvements with thalamic stimulation after severe traumatic brain injury. Nature 2007;448(7153):600–3.CrossRefGoogle ScholarPubMed

2. Fins, JJ. Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness. New York: Cambridge University Press; 2015.CrossRefGoogle Scholar

3. Fins, JJ. Lessons from the injured brain: A bioethicist in the vineyards of neuroscience. Cambridge Quarterly of Healthcare Ethics 2009;18(1):7–13.CrossRefGoogle ScholarPubMed

4. Fins, JJ. Death and dying in the 1990s: Intimations of reality and immortality. Generations: Journal of the American Society on Aging 1999;23(1):81–6.Google Scholar

5. Fins, JJ, Bacchetta, MD, Miller, FG. Clinical pragmatism: A method of moral problem solving. Kennedy Institute of Ethics Journal 1997;7(2):129–45.CrossRefGoogle ScholarPubMed

6. Miller, FG, Fins, JJ, Bacchetta, MD. Clinical pragmatism: John Dewey and clinical ethics. The Journal of Contemporary Health Law and Policy 1996;13(27):27–51.Google Scholar

7. Agrawal, SK, Fins, JJ. Ethics committees and case consultation in the hospital setting. In: Siegler, E, Mirafzali, S, Foust, JB, eds. A Guide to Hospitals and Inpatient Care. New York: Springer. 2003:256–67.Google Scholar

8. Fins, JJ. Ethics rounds: An introduction to the series. Journal of Pain and Symptom Management 1998;15(2):134–5.CrossRefGoogle Scholar

9. Didion, J. The Year of Magical Thinking. New York: Alfred A. Knopf; 2005.Google Scholar

10. Becker, E. The Denial of Death. New York: Simon & Schuster; 1973.Google Scholar

11. Callahan, D. Setting Limits. New York: HarperCollins; 1998.Google Scholar

12. Nuland, S. How We Die. New York: Alfred A. Knopf; 1994.Google ScholarPubMed

13. Fins, JJ. The face of finitude. A review of How We Die: Reflections on Life’s Final Chapter by Sherwin B. Nuland, New York: Alfred A. Knopf, 1994. The Hastings Center Report 1995;25(2):38.CrossRefGoogle Scholar

14. Lowes R. Sherwin Nuland, MD, clear-eyed witness to death, dies at 83. Messcape. March 7, 2014; available at https://www.medscape.com/viewarticle/821689 (last accessed 28 Jan 2018).

15. Fins, JJ. A Palliative Ethic of Care: Clinical Wisdom at Life’s End. Sudbury, MA: Jones and Bartlett; 2006.Google Scholar

16. See note 15, Fins 2006.

17. Fins, JJ, Miller, FG, Acres, CA, Bacchetta, MD, Huzzard, LL, and Rapkin, BD. End-of-Life Decision-Making in the Hospital: Current Practices and Future Prospects. Journal of Pain and Symptom Management 1999;17(1):6–15.CrossRefGoogle Scholar

18. Miller, FG, Fins, JJ. A proposal to restructure hospital care for dying patients. New England Journal of Medicine 1996;334:1740–2.CrossRefGoogle ScholarPubMed

19. Fins, JJ. A proposed ethical framework for interventional cognitive neuroscience: A consideration of deep brain stimulation in impaired consciousness. Neurological Research 2000;22:273–8.CrossRefGoogle ScholarPubMed

20. Giacino, JT, Ashwal, S, Childs, N, Cranford, R, Jennett, B, Katz, DI, et al. The minimally conscious state: Definition and diagnostic criteria. Neurology 2002;58(3):349–53.CrossRefGoogle ScholarPubMed

21. Fins, 2018 Fins, JJ. Family Portrait. Narrative Inquiry in Bioethics 2018;8(1):4–6.Google ScholarPubMed

22. Fins, JJ. A leg to stand on: Sir William Osler and Wilder Penfield’s “Neuroethics.” American Journal of Bioethics 2008;8(1):37–46.CrossRefGoogle Scholar

23. Fins, JJ. Towards a pragmatic neuroethics in theory and practice. In: Racine, E, Aspler, J, eds. The Debate about Neuroethics: Perspectives on the Field’s Development, Focus, and Future. Berlin: Springer; 2017:45–65.CrossRefGoogle Scholar

24. Schnakers, C, Vanhaudenhuyse, A, Giacino, J, Ventura, M, Boly, M, Majerus, S, et al. Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurology 2009;9:35.CrossRefGoogle ScholarPubMed

25. Laureys, S, Faymonville, ME, Peigneux, P, Damas, P, Lambermont, B, Del Fiore, G, et al. Cortical processing of noxious somatosensory stimuli in the persistent vegetative state. Neuroimage 2002;17(2):732–41.CrossRefGoogle ScholarPubMed

26. Fins, JJ. Neuroethics and disorders of consciousness: A pragmatic approach to neuro-palliative care. In: Laureys, S, Tononi, G, eds. The Neurology of Consciousness, Cognitive Neuroscience and Neuropathology. Amsterdam: Academic Press–Elsevier; 2008:234–44.Google Scholar

27. Fins, JJ, Pohl, BR. Neuro-palliative care and disorders of consciousness. In: Hanks, G, Cherny, NI, Christakis, NA, Fallon, M, Kassa, S, Portenoy, RK, eds. Oxford Textbook of Palliative Medicine, 5th Edition. Oxford: Oxford University Press; 2015:285–91.Google Scholar

28. Fins, JJ, Master, MG. Disorders of consciousness and neuro-palliative care: Towards an expanded scope of practice for the field. In: Youngner, SJ, Arnold, R, eds. Oxford Handbook of Ethics at the End of Life. New York: Oxford University Press; 2017:154–69.Google Scholar

29. Fins, JJ. Constructing an ethical stereotaxy for severe brain injury: Balancing risks, benefits and access. Nature Reviews Neuroscience 2003;4:323–7.CrossRefGoogle Scholar

30. Fins, JJ. Rethinking disorders of consciousness: New research and its implications. The Hastings Center Report 2005;35(2):22–4.CrossRefGoogle ScholarPubMed

31. Fins, JJ. Affirming the right to care, preserving the right to die: Disorders of consciousness and neuroethics after Schiavo. Supportive & Palliative Care 2006;4(2):169–78.CrossRefGoogle ScholarPubMed

32. Fins, JJ, Plum, F. Neurological diagnosis is more than a state of mind: Diagnostic clarity and impaired consciousness. Archives of Neurology 2004;61(9):1354–5.CrossRefGoogle ScholarPubMed

33. Fins, JJ, Schiff, ND. Differences that make a difference in disorders of consciousness. American Journal of Bioethics–Neuroethics 2017;8(3):131–4.Google Scholar

34. Kuhn, TS. The Structure of Scientific Revolutions, 2nd Edition. Chicago: University of Chicago Press; 1970.Google Scholar

35. See note 2, Fins 2015, at 221–2.

36. Schiff, ND, Fins, JJ. Brain death and disorders of consciousness. Current Biology 2016;26(13):R572–6.CrossRefGoogle ScholarPubMed

37. Corazzol, M, Lio, G, Lefevre, G, Deiana, G, Tell, L, André-Obadia, N, et al. Restoring consciousness with vagus nerve stimulation. Current Biology 2017;27(18):R994–6.CrossRefGoogle ScholarPubMed

38. Price, M. Experimental nerve-stimulation therapy partially revived man in long-term vegetative state—but experts urge caution. Science. September 25, 2017; available at http://www.sciencemag.org/news/2017/09/experimental-nerve-stimulation-therapy-partially-revives-man-long-term-vegetative-state (last accessed 28 Jan 2018).Google Scholar

39. Caplan, AL. Fins, Joseph J.’ Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness. The Dana Foundation. July 31, 2017; available at http://www.dana.org/Cerebrum/2017/Joseph_J__Fins_Rights_Come_to_Mind__Brain_Injury_Ethics_and_the_Struggle_for_Consciousness/ (last accessed 28 Jan 2018).Google Scholar

40. See note 2, Fins 2015.

41. Wright, MS, Fins, JJ. Rehabilitation, education, and the integration of individuals with severe brain injury into civil society: Towards an expanded rights agenda in response to new insights from translational neuroethics and neuroscience. Yale Journal of Health Policy, Law, and Ethics 2016;16(2):233–88.Google ScholarPubMed

42. Fins, JJ. Giving voice to consciousness: neuroethics, human rights and the indispensability of neuroscience. The Society for Neuroscience David Kopf Lecture on Neuroethics. Cambridge Quarterly of Healthcare Ethics 2016;25(4):583–99.CrossRefGoogle Scholar

43. Fins, JJ. The civil right we don’t think about. Sunday Review. The New York Times, SR-10.August 27, 2017; available at https://www.nytimes.com/2017/08/24/opinion/minimally-conscious-brain-civil-rights.html?_r=0 (last accessed 28 Jan 2018).Google Scholar

44. Fins, JJ, Wright, MS. Rights language and disorders of consciousness: A call for advocacy. Brain Injury 2018;32(5):670–4.CrossRefGoogle Scholar

45. Fins JJ. We can rewrite the script for some brain injury patients. The Houston Chronicle. January 15, 016, at B9

46. Giacino, JT, Fins, JJ, Laureys, S, Schiff, ND. Disorders of consciousness after acquired brain injury: The state of the science. Nature Reviews Neurology 2014;10:99–114.CrossRefGoogle ScholarPubMed

47. Purdum, TS. The newest Moynihan. The New York Times Magazine; August 7, 1994; available at https://www.nytimes.com/1994/08/07/magazine/the-newest-moynihan.html (last acessed 1 May 2018).Google Scholar

48. Fins, JJ, Leiman, JM, Pardes, H. Primum Non Nocere: Daniel Patrick Moynihan and the Defense of Academic Medicine. The Pharos of Alpha Omega Alpha – Honor Medical Society 2017;80(2):10–20.Google Scholar

49. Snow, CP. The Two Cultures and The Scientific Revolution. New York: Cambridge University Press; 1959.Google Scholar

50. Fins, JJ, de Melo Martin, I. C.P. Snow’s two cultures fifty years later: An enduring problem with an elusive solution. Technology in Society 2010;32(1):1–4.CrossRefGoogle Scholar

51. Fins, JJ. Being conscious of their burden: Severe Brain Injury and the Two Cultures Challenge. Proceedings from “Disorders of Consciousness.” 87th Annual Conference of the Association for Research in Nervous and Mental Disease. Annals of the New York Academy of Sciences 2009;1157:131–47.CrossRefGoogle Scholar

52. Fins, JJ. C.P. Snow at Wesleyan: Liberal learning and the origins of the “third culture.” Technology in Society 2010;32(1):10–7CrossRefGoogle Scholar

53. Fins, JJ. The humanities and the future of bioethics education. Cambridge Quarterly of Healthcare Ethics 2010;19(4):518–21.CrossRefGoogle ScholarPubMed

54. Fins, JJ, Pohl, B, Doukas, D. In praise of the humanities in academic medicine: Values, metrics and ethics in uncertain times. Cambridge Quarterly of Healthcare Ethics. 2013;22:355–64.CrossRefGoogle ScholarPubMed

55. Fins, JJ. My time in medicine. Perspectives in Biology and Medicine 2017;60(1):19–32.CrossRefGoogle Scholar