Forty Years in the Making: From Nihilism Towards a Therapeutic Neuroethics for Disorders of Consciousness

In this retrospective essay celebrating the 40th anniversary of the Journal of Head Trauma and Rehabilitation, Dr. Joseph J. Fins traces the evolution of the neuroethics of disorders of consciousness through autobiographical reflections over the past four decades. His memoir highlights his origins as a medical student on the Cornell Neurology Service headed by Dr. Fred Plum, the co-originator of the Persistent Vegetative State with Dr. Bryan Jennett and culminates with his collaboration with Dr. Nicholas Schiff and the clinical and ethical importance of Cognitive Motor Dissociation in clinical care. During this period Fins describes the therapeutic nihilism that followed in the wake of landmark end-of-life cases like Quinlan, Cruzan and Schiavo and how scientific advance and an emerging nosology has begun to envision therapeutic possibility informed by an expanded nosology and neuroimaging. Fins asserts that the disability rights of people with disorders of consciousness need to be accommodated in tandem with access to technological advance in order to more fully integrate these individuals into the nexus of their families and communities. Fins argues that the developments of the past 40 years are a harbinger of further progress but cautions that this will not occur without sustained government support from the National Institutes of Health.