2025
Chapter 13 Emerging ethical issues in patients with disorders of consciousness: A clinical guide
Bernat J, Fins J. Chapter 13 Emerging ethical issues in patients with disorders of consciousness: A clinical guide. Handbook Of Clinical Neurology 2025, 207: 217-236. PMID: 39986723, DOI: 10.1016/b978-0-443-13408-1.00001-4.Peer-Reviewed Original ResearchConceptsEthical issuesGoal-concordant careSurrogate decision-makersLife-sustaining therapyServices of patientsDisorders of consciousnessCognitive-motor dissociationPalliative careCare sitesDOC patientsMinimally conscious stateDecision-makingClinical guidePractice landscapeClinical practiceConceptual analysisCareHuman rightsConsciousnessConscious stateConsciousness disorderPatientsAccurate prognosisVegetative stateIrreducible uncertainty
2022
Syndromes in Search of a Name: Disorders of Consciousness, Neuroethics, and Nosological Humility
Fins J. Syndromes in Search of a Name: Disorders of Consciousness, Neuroethics, and Nosological Humility. 2022, 163-175. DOI: 10.1007/978-3-031-04935-4_18.Peer-Reviewed Original ResearchDisorders of consciousnessBrain injuryCognitive motor dissociationStruggle for ConsciousnessRecognition of consciousnessVegetative stateDiagnostic categorizationLimits of knowledgePermanent vegetative stateNosologyPersistent vegetative stateMotor dissociationCovert consciousnessNormative importanceBrainDisordersChronic vegetative stateConsciousnessSocial integrationHumilityEvolving storyNeuroimagingNeuroscienceMindfulnessRights
2020
Concerns of surrogate decision makers for patients with acute brain injury: A US population survey.
Hwang DY, Knies AK, Mampre D, Kolenikov S, Schalk M, Hammer H, White DB, Holloway RG, Sheth KN, Fraenkel L. Concerns of surrogate decision makers for patients with acute brain injury: A US population survey. Neurology 2020, 94: e2054-e2068. PMID: 32341190, PMCID: PMC7282883, DOI: 10.1212/wnl.0000000000009406.Peer-Reviewed Original ResearchConceptsSevere acute brain injurySevere functional disabilityAcute brain injurySurrogate decision makersBrain injuryLatent class analysisPatient's wishesVegetative stateLong-term careFunctional disabilityPoor prognosisUS population surveySD groupPrognostic accuracyHypothetical patientsPatientsUS populationAdditional groupOlder adultsFuture interventionsCompletion ratesInjuryFamily consensusPopulation surveyUnique concerns
2019
Disorders of Consciousness, Past, Present, and Future
Fins J. Disorders of Consciousness, Past, Present, and Future. Cambridge Quarterly Of Healthcare Ethics 2019, 28: 603-615. PMID: 31405394, DOI: 10.1017/s0963180119000719.Peer-Reviewed Original ResearchConceptsDisorders of consciousnessLegal obligationsPersistent vegetative stateConsciousness literatureNational Institute on DisabilityCognitive motor dissociationMinimally conscious stateCounter-narrativesAmerican Academy of NeurologyVegetative stateMotor dissociationCovert consciousnessObligationsConscious stateDisordersIndependent livingStateWhen No One Notices: Disorders of Consciousness and the Chronic Vegetative State
Fins J. When No One Notices: Disorders of Consciousness and the Chronic Vegetative State. The Hastings Center Report 2019, 49: 14-17. PMID: 31429953, DOI: 10.1002/hast.1030.Peer-Reviewed Original ResearchConceptsNational Institute on DisabilityMulti-Society Task Force ReportDisorders of consciousnessAmerican Academy of NeurologyComprehensive evidence-based reviewEvidence-based reviewRehabilitation researchRehabilitation medicineVegetative stateChronic vegetative stateHealthcare facilitiesTask Force ReportPractice guidelinesIndependent livingPersistent vegetative stateAmerican CollegeAmerican AcademyMisdiagnosis of patientsLevel of consciousnessPermanent vegetative stateForce ReportDiagnostic categoriesPatientsAmericanGuidelines
2018
Ethical, Palliative, and Policy Considerations in Disorders of Consciousness
Fins J, Bernat J. Ethical, Palliative, and Policy Considerations in Disorders of Consciousness. Archives Of Physical Medicine And Rehabilitation 2018, 99: 1927-1931. PMID: 30098790, DOI: 10.1016/j.apmr.2018.07.003.Peer-Reviewed Original ResearchConceptsLearning health care systemSystems of careHealth care systemAmerican Academy of Neurology guidelinesGroups of brain-injured patientsMedical decision-makingCognitive-motor dissociationNeuropalliative careAdvance directivesCare systemPractice scopeIncreasing frequency of reportsVegetative stateFrequency of reportingGuideline authorsNeurology guidelinesAmerican AcademyDisorders of consciousnessBrain-injured patientsCareCovert consciousnessGroup of patientsGuidelinesWakefulness syndromePrognostic refinementEthical, palliative, and policy considerations in disorders of consciousness
Fins J, Bernat J. Ethical, palliative, and policy considerations in disorders of consciousness. Neurology 2018, 91: 471-475. PMID: 30089621, DOI: 10.1212/wnl.0000000000005927.Peer-Reviewed Original ResearchConceptsLearning health care systemSystems of careHealth care systemAmerican Academy of Neurology guidelinesGroups of brain-injured patientsMedical decision-makingCognitive-motor dissociationNeuropalliative careAdvance directivesCare systemPractice scopeIncreasing frequency of reportsVegetative stateFrequency of reportingGuideline authorsNeurology guidelinesAmerican AcademyDisorders of consciousnessBrain-injured patientsCareCovert consciousnessGroup of patientsGuidelinesWakefulness syndromePrognostic refinement
2016
Brain death and disorders of consciousness
Schiff N, Fins J. Brain death and disorders of consciousness. Current Biology 2016, 26: r572-r576. PMID: 27404252, DOI: 10.1016/j.cub.2016.02.027.Peer-Reviewed Original ResearchConceptsDisorders of consciousnessBrain-dead patientsBrain deathVegetative stateCognitive motor dissociationScientific knowledgeCognitive functionMinimally conscious stateNon-medical specialistsSocietal contextBrain statesConsciousnessConscious stateMotor dissociationBrainDisordersDead patientsConceptual frameworkLack of sustainabilityHigher levelsFutilityParadoxDistinctionThe historical origins of the vegetative state: Received wisdom and the utility of the text
Adams Z, Fins J. The historical origins of the vegetative state: Received wisdom and the utility of the text. Journal Of The History Of The Neurosciences 2016, 26: 140-153. PMID: 27295518, DOI: 10.1080/0964704x.2016.1184074.Peer-Reviewed Original ResearchConceptsPersistent vegetative stateHistorical originsEarly-twentieth centuriesClassical scholarshipOriginal GreekAristotle’s treatisesAristotle’s definitionXavier BichatVegetative stateTheory of MindReception studiesMedical nosologyAristotleReceived wisdomPhrasesBichatAntiquityNineteenthGreekTreatisesCenturyEtymologyClassicsOriginScholarship
2013
Conscientious of the Conscious: Interactive Capacity as a Threshold Marker for Consciousness
Fischer D, Truog R. Conscientious of the Conscious: Interactive Capacity as a Threshold Marker for Consciousness. AJOB Neuroscience 2013, 4: 26-33. DOI: 10.1080/21507740.2013.819391.Peer-Reviewed Original ResearchMinimally conscious stateDiagnosing disorders of consciousnessBrain-injured patientsAbsence of consciousnessDisorders of consciousnessStates of consciousnessDiagnostic distinctionDiagnosed disordersManagement of patientsConscious stateThreshold markersEthical importanceEthical managementVegetative stateEthical challengesElectroencephalographic assessmentNeuroimagingConsciousness
2012
Generalized periodic discharges in the critically ill
Foreman B, Claassen J, Abou Khaled K, Jirsch J, Alschuler DM, Wittman J, Emerson RG, Hirsch LJ. Generalized periodic discharges in the critically ill. Neurology 2012, 79: 1951-1960. PMID: 23035068, PMCID: PMC3484988, DOI: 10.1212/wnl.0b013e3182735cd7.Peer-Reviewed Original ResearchConceptsNonconvulsive status epilepticusStatus epilepticusLevel of consciousnessPeriodic dischargesNonconvulsive seizuresCardiac arrestWorse outcomesAcute systemic illnessAcute brain injuryCardiac arrest patientsContinuous EEG monitoringHospital staySystemic illnessConvulsive seizuresArrest patientsMean ageUnivariate analysisBrain injuryMultivariate predictorsEpilepticusEEG monitoringPatientsSeizuresSevere disabilityVegetative state
2010
A network approach to assessing cognition in disorders of consciousness(e–Pub ahead of print)(CME)
Rodriguez Moreno D, Schiff N, Giacino J, Kalmar K, Hirsch J. A network approach to assessing cognition in disorders of consciousness(e–Pub ahead of print)(CME). Neurology 2010, 75: 1871-1878. PMID: 20980667, PMCID: PMC2995384, DOI: 10.1212/wnl.0b013e3181feb259.Peer-Reviewed Original ResearchMeSH KeywordsAdultAwarenessBrainCognitionConsciousness DisordersFemaleGlasgow Coma ScaleHumansMagnetic Resonance ImagingMaleMiddle AgedNerve NetNeuropsychological TestsPattern Recognition, VisualPersistent Vegetative StatePoint-of-Care SystemsQuadriplegiaSensitivity and SpecificityVerbal BehaviorYoung AdultConceptsDisorders of consciousnessVegetative stateComa Recovery ScaleHigh-level cognitionObject-naming taskPicture-naming taskLanguage-related regionsElicit brain activationEMCS patientsVS patientsHealthy subjectsDiagnostic criteriaPatientsVolitional processesRecovery ScaleBrain activationLanguage networkFMRI studyMotor responseOvert behaviorConscious stateNeural systemsBehavioral assessmentCognitionPartial preservation
2009
Behavioral assessment in patients with disorders of consciousness: gold standard or fool's gold?
Giacino JT, Schnakers C, Rodriguez-Moreno D, Kalmar K, Schiff N, Hirsch J. Behavioral assessment in patients with disorders of consciousness: gold standard or fool's gold? Progress In Brain Research 2009, 177: 33-48. PMID: 19818893, DOI: 10.1016/s0079-6123(09)17704-x.Peer-Reviewed Original ResearchConceptsDisorders of consciousnessMedication side effectsSevere brain injuryAssessment of patientsBehavioral assessmentCurrent diagnostic criteriaFunctional neuroimaging findingsBrain injuryInvoluntary movementsNeuroimaging findingsMotor impairmentDiagnostic criteriaSide effectsBehavioral assessment techniquesNeurophysiologic markersVegetative stateConscious stateGold standardBehavioral assessment methodsFunctional neuroimagingPatientsDisordersIndirect evidenceBehavioral markersMarkers
2008
Schiff et al. reply
Schiff N, Giacino J, Kalmar K, D.Victor J, Baker K, Gerber M, Fritz B, Eisenberg B, Biondi T, O’Connor J, Kobylarz E, Farris S, Machado A, McCagg C, Plum F, Fins J, Rezai A. Schiff et al. reply. Nature 2008, 452: e1-e2. DOI: 10.1038/nature06575.Peer-Reviewed Original Research
2007
Late recovery from the minimally conscious state
Fins J, Schiff N, Foley K. Late recovery from the minimally conscious state. Neurology 2007, 68: 304-307. PMID: 17242341, DOI: 10.1212/01.wnl.0000252376.43779.96.Peer-Reviewed Original ResearchConceptsMinimally conscious stateDisorders of consciousnessDiagnosis of persistent vegetative stateLate recoveryInvestigation of patientsPersistent vegetative stateConscious statePrognostic markerTraumatic injuryPublic confusionMeeting participantsResearch initiativesDiagnostic testsAxonal regrowthPublished studiesParticipantsPatientsMechanisms of recoveryVegetative stateMeetingInitial focus
2006
Functional Neuroimaging Applications for Assessment and Rehabilitation Planning in Patients With Disorders of Consciousness
Giacino JT, Hirsch J, Schiff N, Laureys S. Functional Neuroimaging Applications for Assessment and Rehabilitation Planning in Patients With Disorders of Consciousness. Archives Of Physical Medicine And Rehabilitation 2006, 87: 67-76. PMID: 17140882, DOI: 10.1016/j.apmr.2006.07.272.Peer-Reviewed Original ResearchConceptsDisorders of consciousnessHigher-order association corticesStudy of patientsRestoration of functionPrimary cortical areasFunctional magnetic resonanceFunctional neuroimaging techniquesFunctional neuroimaging protocolsPotential clinical applicationsPathophysiologic mechanismsPattern of activationPatient characterizationPositron emission tomography activation studyDifferential diagnosisPrognostic assessmentDisconnection syndromeCortical areasAssociation cortexLarge-scale cortical networksPatientsNeuroimaging protocolVegetative stateNeuroimaging techniquesConscious stateCortical networksAffirming the right to care, preserving the right to die: Disorders of consciousness and neuroethics after Schiavo
Fins J. Affirming the right to care, preserving the right to die: Disorders of consciousness and neuroethics after Schiavo. Palliative & Supportive Care 2006, 4: 169-178. PMID: 16903588, DOI: 10.1017/s1478951506060238.Peer-Reviewed Original ResearchConceptsSchiavo caseRight to lifePermanent vegetative stateEnd-of-life careVegetative stateEthical CurrentsEnd-of-lifeDisorders of consciousnessEthical implicationsSchiavoRhetorical statementsConsciousnessConscious stateIdeological positionsMinimally conscious stateNational discourseRightsDiscourseBrain injuryNeuroscienceProviding careNeuroethicsCareFutilityLife
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