Dr. Joseph Fins: A Leader in Brain Research
By Joan Baum, Ph.D.
Dr. Joseph J. Fins, newly elected president of the American Society for Bioethics and Humanities (he assumes the position in 2011), is in the forefront of one of the most timely and controversial emerging medical fields. An internationally known, award-winning scholar, author, researcher, who is also on the board of many prestigious institutions, research centers and leading medical and philosophical journals, Dr. Fins notes that the American Society for Bioethics and Humanities, which was founded only a dozen years ago, represents a significant interdisciplinary and multidisciplinary trend in medical education.
For him, personally — as chief of the Division of Medical Ethics in the Department of Public Health and Medicine (incorporating medicine, public health and psychiatry) at Weill Cornell Medical College and director of medical ethics at New York-Presbyterian Hospital / Weill Cornell Medical Center — the new appointment offers a rich opportunity to broaden and deepen his exploration of ethical policy issues involved especially in brain injury and disorders of consciousness cases, his specialty. It also allows him to refine his work in palliative care. The goal remains: to “improve patient care, enrich medical education and inform health policy.”
The consolidation by the American Society for Bioethics and Humanities of the interests of three existing associations (the Society for Health and Human Values, the Society for Bioethics Consultation, and the American Association of Bioethics) suggests the 12-year-old organization has the potential to educate new professionals on a wider number of issues and concerns at the juncture of biology, medicine, technology and the humanities, among them abortion, organ donation, euthanasia, health care rationing and the allocation of scarce health care resources.
Dedicated to promoting an exchange of ideas and fostering professional policy development and “collegiality among people engaged in all of the endeavors related to clinical and academic bioethics and the health-related humanities,” the society’s activities include education, research, and discussion among professionals (“healthy dialogue”) and between them and the general public. In considering bioethics and humanities together, an area that has traditionally been associated with philosophy, Dr. Fins hopes that disciplines typically perceived as “dichotomous” will be perceived in new, creative ways that will enhance policy issues while avoiding “dumbing down” and “platitudes” in published research.
Interdisciplinary approaches are hardly new for Dr. Fins, who praises his own broad-based undergraduate liberal arts education at Wesleyan University with providing him with a strong appreciation of the benefits of cross-disciplinary pollination. The author of a forthcoming book on C.P. Snow, the father of the two cultures of science and humanities, Dr. Fins suggests that bioethics may be “a third culture,” a bridge that would ensure the continuation of democratic society by constituting a kind of policy platform for patients’ civil rights. To participate as intelligent citizens, he says, we must be literate in the sciences and the humanities, and bioethics could be the “vector” for “multiple” questions about how we live, how we die. Bioethics and humanities could “coalesce” a vast number of interests and talents to address proposed treatments for brain disease, like, for example, “deep brain stimulation” for Parkinson’s, an area of psychosurgery that many fear could create part-human, part-mechanical “cyborgs.”
Much of the excitement of the work Dr. Fins and his colleagues are doing centers on evaluating mental states. Take people who are thought to be in a coma. Behavioral evidence suggests that they are in a “minimally conscious state,” but neurological treatment might bring about a response — even speech (Dr. Fins has been quoted on such cases as recently as in a major piece in a February issue of The New York Times). What if such patients are living in nursing homes, “misdiagnosed,” having been declared to be in a “vegetative” state when they’re not? Such cases raise not only ethical issues, but are “game-changers” for states and the country, politically and economically. To those who say that deep brain stimulation is expensive, Dr. Fins replies yes, but it may well prove less expensive than nursing home costs, emotional costs to families, and the cost of technological interventions that don’t work.
Of course, others will and do disagree, just as they do about physician-assisted suicide, but Dr. Fins points out that patients sometimes don’t receive proper palliative care. He hopes that “pluralism,” a diversity of opinion, will win over flat-out ideological determination that denies other possibilities (as the final decision in the Terri Schiavo case proved, “rebuking,” finally, those who for seven years kept the issue going through a hierarchy of courts). Full, informed and courteous debate is, Dr. Fins believes, the most practical as well as the most desirable direction bioethics and the humanities can take. #
