Medical ethicist says doctors often write off minimally conscious patients

Medical policies limit hospitals’ ability to understand patients with traumatic brain injuries.

Experts gathered Wednesday for a three-day conference to discuss the mental states of individuals with severe neurological damage as part of the Nancy Weaver Emerson Lectureship series. The Finding Consciousness conference kicked off Wednesday night in the Nasher Museum of Art with a keynote speech from Dr. Joseph Fins, president of the American Society for Bioethics and Humanities. The lectures will focus on recent advances in neuroscience that have shed light on states of consciousness in victims of serious brain injuries, as well as their ethical and legal implications.

In his speech, Fins noted the failings of current medical procedures in diagnosing and treating patients in a minimally conscious state between coma and vegetation. Drawing on prior research, he argued that the potential for cognitive recovery in minimally conscious patients is being overlooked by a medical system that is missing the signs of awareness.

“People are being written off, despite growing scientific evidence to the contrary,” Fins said.

Fins referenced several studies that indicated general dissatisfaction on the part of patients’ families with the attentiveness of care offered for disabling brain injuries, as well as a “staggering” 41 percent of patients who are misdiagnosed as vegetables. Fins said many patients who appear to have entered a vegetative state are actually experiencing minimal consciousness, a partial preservation of conscious awareness.

“[Minimal consciousness] is a flickering light,” Fins said. “Some patients at first glance appear to be vegetative, but start to break the rules and periodically show evidence of awareness.”

Fins went on to reference numerous cases of individuals being in supposed vegetative states for years before suddenly waking up. After such prolonged periods of neural latency, he said that some processes seen only when the brain is first forming are resurrected, allowing the brain to “re-wire” itself years after a serious injury.

Dr. Jeffrey Baker, director of the History of Medicine program at the School of Medicine, explained that neurologists’ understanding of different kinds of consciousness are still developing.

Fins also touched briefly on the final field covered by the workshop: ethics. Fins argued that brain injury patients do not have high visibility and are often swept under the rug. Treating a minimally conscious person as if they were a vegetable, however, is a violation of their fundamental rights, he said.

“These people aren’t even perceived as meriting the protection of the Americans with Disabilities Act. This is a denial of their equal protection—it’s a basic civil right,” Fins said.

At the end of his speech, Fins described the treatment of brain-injured patients as a civil rights issue, like the treatment of minorities before civil rights, women before suffrage and homosexuals today.

“When I first started talking about this in a civil rights context, people looked at me like I was crazy, but if you think about these previous kinds of issues, is it any crazier than giving women the right to vote was?” he asked.

The Finding Consciousness workshops will meet for the next two days at various locations around campus, covering new technology, policy and theories regarding cognition and awareness. The conference was sponsored by the Trent Center for Bioethics, Humanities and the History of Medicine and funded Bioethics at the National Institutes of Health, among others.