Societal perception toward brain injuries must be challenged
Letter to the editor
I had the pleasure of speaking recently at the Rutgers Institute for Health, Health Care Policy and Aging Research about my current research into brain injury. In particular, how common views of brain injuries — including the terms we use to describe them — often inhibit a deeper understanding of their complexity, which in turn, undermines our ability to more accurately diagnose and more effectively treat brain injury. Coincidentally, the article covering my lecture published in The Daily Targum, which included misquotes that were attributed to me, provides an informative example of precisely the problem I was addressing in my talk. Though the inaccuracies and misquotes have since been corrected in the online version of the paper and a partial retraction was published in the print version, I would like to use this example as an opportunity to continue this vitally important discussion.
The first important error was in the title of the article, “Bioethics expert refutes beliefs about brain death.” In my lecture, I did not “refute beliefs about brain death” as the title contends. Rather, I discussed prevailing notions about prognosis and recovery in brain injury — arguing that our pervasive understandings, which tend to view brain injuries uniformly, need to be reexamined. I did not, however, refute the definition of “brain death,” which I believe remains valid.
Second, the original article included the following misquote attributed to me: “‘All catechisms he (Fins) learned about brain injury are no longer true,’ he said. ‘He grew up with (sic) believing a brain dead person has no cognitive function.’” Again, my view of clinical brain death has not changed. In my lecture, I highlighted my evolving understanding of disorders of consciousness, where those who are diagnosed minimally conscious are conscious, even though they may appear indistinguishable from a vegetative patient to the untrained eye.
Finally, the original article included an additional misquote attributed to me: “Brain dead is not synonymous with vegetable.” As a clinician, I would never use the term “vegetable.” In my talk, I used the term “vegetative,” in particular to emphasize important distinctions between persistent and permanent vegetative states. My point was to say that not all severe brain injuries result in impermanent vegetative states. My research finds that some patients will regain consciousness, albeit minimally so. While there is no prospect of recovery from the permanent vegetative state, recovery remains possible — for some — until the vegetative state becomes permanent.
In using the terms brain death and brain injury synonymously — in addition to the other telling errors in the piece — the original article in The Daily Targum illustrates precisely the prevailing social attitudes toward patients with severe brain injury that I believe we need to challenge. Patients are often presumed to have an unfavorable prognosis and treated as if they were dead, or nearly so. Some of these patients, however, harbor the prospect for additional recovery, over time and with emerging interventions, and it is essential that we develop a broader societal understanding of the distinctions within the degrees of brain injury.
Dr. Joseph J. Fins is The E. William Davis, Jr. M.D. Professor of Medical Ethics and Chief of the Division of Medical Ethics at Weill Cornell Medical College where he also serves as a tenured Professor of Medicine, Professor of Public Health and Professor of Medicine in Psychiatry.