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Robert Klitzman and Joseph Fins Discuss Patients in Liminal States of Consciousness

On October 28th, Dr. Robert Klitzman spoke to Dr. Joseph Fins, author of Rights Come to Mind: Brain Injury, Ethics and The Struggle for Consciousness, to discuss the neuroethics of minimally conscious cases.

These are patients who appear to be unconscious but are actually able to think and understand their environment, and who often get misdiagnosed.

We don't exactly know what is going on inside of these people's minds, but we do know that brain scans show "that they are able to process information," explained Fins.

These situations can be improved: Fins and his colleagues have used deep-brain stimulation on a particular patient, allowing him to "form sentences, tell his mother he loved her, go shopping with her, and eat by mouth."

Discussing insurance policies and the ethics in these cases, Fins pointed out that "brains recover by biological mechanisms, not by reimbursement criteria," and argued that "this is a fundamental human rights issue," comparing it to major civil rights battles of the past. He said that the next generation will ask us, "How could you treat conscious people as if they were unconscious?"

In his closing remarks, Dr. Fins complimented Robert Klitzman on the "premier [Bioethics] program at Columbia" and urged young people to take neuroethics seriously, hoping that it could shift more towards the "service of the clinics and the needs of the patients."

Read more about the Bioethics graduate program.