Columbia’s M.S. in Bioethics program recently hosted a thought-provoking conversation between program director Dr. Robert Klitzman and Dr. Joseph Fins, the E. William Davis Jr., M.D., Professor of Medical Ethics and Chief of the Division of Medical Ethics at Weill Cornell Medicine. The talk, From Coma to Consciousness: Are We Worried?, explored new frontiers in neuroscience, bioethics, and patient care for people who cannot speak for themselves.
Dr. Fins, a founding chair of the ethics committee at NewYork–Presbyterian/Weill Cornell Medical Center and a fellow of the National Academy of Medicine, brought decades of expertise to the discussion. “The title of this event is in response to an article by Daniela Lamas in The New York Times,” Fins explained. Lamas was astonished by the findings from his collaborative research with neuroscientist Nicholas Schiff. The article unpacked cognitive motor dissociation (CMD), the phenomenon where some patients who appear unresponsive in a vegetative or minimally conscious state can still respond intentionally when prompted under an fMRI scanner or EEG.
“Our paper, published in The New England Journal of Medicine, took 16 years to do,” Fins noted. “We basically found that in a large international sample, 25 percent of patients who we thought were unresponsive had cognitive motor dissociation.”
The findings created what Fins described as a “public health challenge,” one that is fraught with ethical implications. “Isn’t it more terrifying to have these patients there and not know they’re there than to recognize them and do something about it?” Fins asked.
Fins made clear that CMD is more than a novel medical term. It’s a path to personalized care for people with devastating brain injuries. “If you have CMD,” Fins explained, “it means you have intact neural networks and a better prognosis,” allowing new interventions like targeted drug therapy or electrical stimulation to support recovery.
According to Fins, the duty to identify patients with CMD is urgent. He stressed the need for regular bedside assessments like the coma recovery scale, EEGs, and advanced imaging. “Brain injuries are not static,” Fins emphasized. “People rewire.” He spoke about one of his patients, who, after years in a minimally conscious state, experienced measurable white matter recovery.
Fins’s work extends well beyond diagnosis. He shared his role in a groundbreaking trial, published last year in Nature Medicine, using deep brain stimulation (DBS) in people with moderate to severe brain injuries. The study showed that with carefully placed electrodes in the thalamus, neurologically “the center of our universe,” some patients experienced significant improvements in attention, processing speed, and even communication. “One subject read six novels,” Fins recalled. “That was transformative for her and her family.”
Drs. Klitzman and Fins also discussed how public policy, including standards of care in a pandemic, must catch up with neuroscience. “What we do in moments of crisis will be judged by history,” Fins said, referring to his work on ensuring that COVID-19 triage guidelines accounted for people with cognitive disabilities.
The event closed with audience questions on topics ranging from advanced directives and future EEG protocols to neurodivergence and language processing in patients with CMD. Fins’s reply was one of cautious humility. “We take a volitional response as a proxy for consciousness,” he said. “But we’re still learning, and we must listen carefully to what these patients may be telling us.”
Fins left the audience with an enduring thought: Advances in neuroscience must inspire a more humane and ethical health-care system—one that doesn’t look away from patients who can’t speak but who can still, in their own way, respond.
About the Program
Columbia University’s Master of Science in Bioethics grounds students in interdisciplinary approaches and models to address pressing bioethical challenges such as stem cell research and health-care reform. The program prepares students to act as responsible and responsive leaders in this new and ever-growing field. It also includes a concentration in global bioethics—the first of its kind in the U.S. Columbia’s Bioethics program offers a range of degrees and courses.
Learn more about the program—which is available full-time and part-time, online and on campus—here.
