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A Critical Analysis of Joseph Fins’ Mosaic Decisionmaking: A Response to “Mosaic Decisionmaking and Reemergent Agency after Severe Brain Injury” (CQ 27 (1))

Published online by Cambridge University Press:  17 September 2019

ANDREW PETERSON
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Abstract:

In this paper, the author argues that Joseph Fins’ mosaic decisionmaking model for brain-injured patients is untenable. He supports this claim by identifying three problems with mosaic decisionmaking. First, that it is unclear whether a mosaic is a conceptually adequate metaphor for a decisionmaking process that is intended to promote patient autonomy. Second, that the proposed legal framework for mosaic decisionmaking is inappropriate. Third, that it is unclear how we ought to select patients for participation in mosaic decisionmaking.

Keywords

brain injurybrain-injured patientsmosaic decisionmakingpatient autonomy
Type
Departments and Columns
Information
Cambridge Quarterly of Healthcare Ethics , Volume 28 , Special Issue 4: Clinical Neuroethics , October 2019 , pp. 725 - 736
Copyright
Copyright © Cambridge University Press 2019 

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Footnotes

Acknowledgments: This article responds to a presentation by Joseph Fins at the annual 2016 Neuroethics Network conference at the ICM Brain and Spine Institute, Paris, France. Fins’ presentation was subsequently published in 2018 in Cambridge Quarterly of Healthcare Ethics. I thank Charles Weijer, Cory E. Goldstein, an anonymous reviewer, and the audience of the 2018 Neuroethics Network conference for helpful comments and discussion. I thank Tomi Kushner and Yves Agid for inviting me to present my response to Fins’ work. This research is supported by the Greenwall Faculty Scholars program.

CQ welcomes readers’ comments on papers published in the journal, please send submissions to T. Kushner at [email protected].

References

Notes

1. Maas, AI, Menon, DK, Adelson, PD, Andelic, N, Bell, MJ, Belli, A, et al. Traumatic brain injury: Integrated approaches to improve prevention, clinical care, and research. The Lancet Neurology 2017;16(12):987–1048.CrossRefGoogle ScholarPubMed

2. Coronado, VG, McGuire, LC, Sarmiento, K, Bell, J, Lionbarger, MR, Jones, CD, et al. Trends in traumatic brain injury in the US and the public health response: 1995–2009. Journal of Safety Research 2012;43(4):299–307.CrossRefGoogle Scholar

3. Finkelstein, E, Corso, P, Miller, T. The Incidence and Economic Burden of Injuries in the United States . Oxford: Oxford University Press; 2006.CrossRefGoogle Scholar

4. Zaloshnja, E, Miller, T, Langlois, JA, Selassie, AW. Prevalence of long-term disability from traumatic brain injury in the civilian population of the United States, 2005. The Journal of Head Trauma Rehabilitation 2008;23(6):394–400.CrossRefGoogle ScholarPubMed

5. Dikmen, SS, Corrigan, JD, Levin, HS, Machamer, J, Stiers, W, Weisskopf, MG. Cognitive outcome following traumatic brain injury. The Journal of Head Trauma Rehabilitation 2009;24(6):430–8.CrossRefGoogle ScholarPubMed

6. Fins, JJ, Illes, J, Bernat, JL, Hirsch, J, Laureys, S, Murphy, E. Neuroimaging and disorders of consciousness: Envisioning an ethical research agenda. American Journal of Bioethics 2008;8(9):3–12.CrossRefGoogle ScholarPubMed

7. Weijer, C, Peterson, A, Webster, F, Graham, M, Cruse, D, Fernández-Espejo, D, et al. Ethics of neuroimaging after serious brain injury. BMC Medical Ethics 2014;41(15):1–13.Google Scholar

8. Graham, M, Weijer, C, Peterson, A, Naci, L, Cruse, D, Fernández-Espejo, D, et al. Acknowledging awareness: Informing families of individual research results for patients in the vegetative state. Journal of Medical Ethics 2015;41(7):534–8.CrossRefGoogle ScholarPubMed

9. Graham, M, Weijer, C, Cruse, D, Fernandez-Espejo, D, Gofton, T, Gonzalez-Lara, LE, et al. An ethics of welfare for patients diagnosed as vegetative with covert awareness. American Journal of Bioethics-Neuroscience 2015;6(2):31–41.Google Scholar

10. Peterson, A, Cruse, D, Naci, L, Weijer, C, Owen, AM. Risk, diagnostic error, and the clinical science of consciousness. Neuroimage: Clinical 2015;7:588–97.CrossRefGoogle Scholar

11. Peterson, A, Bayne, T. Post-comatose disorders of consciousness. In: Gennaro, RJ, ed. Routledge Handbook of Consciousness. New York: Routledge; 2018, at 351–65.CrossRefGoogle Scholar

12. Bendtsen, K. Communicating with the minimally conscious: Ethical implications in end-of-life care. American Journal of Bioethics-Neuroscience 2013;4(1):46–51.Google Scholar

13. Peterson, A, Naci, L, Weijer, C, Cruse, D, Fernández-Espejo, D, Graham, M, et al. Assessing decision-making capacity in the behaviorally nonresponsive patient with residual covert awareness. American Journal of Bioethics-Neuroscience 2013;4(4):3–14.Google Scholar

14. Glannon, W. Brain-computer interfaces in end-of-life decision-making. Brain-Computer Interfaces 2016;3(3):133–9.CrossRefGoogle Scholar

15. Peterson, A. Should neuroscience inform judgements of decision-making capacity? Neuroethics 2018:1–9, published first online 9 May 2018, doi.org/10.1007/s12152-018-9369-4.Google Scholar

16. Cairncross, M, Peterson, A, Lazosky, A, Gofton, T, Weijer, C. Assessing decision-making capacity in patients with communication impairments: A case study. Cambridge Quarterly of Healthcare Ethics 2016;25(4):691–9.CrossRefGoogle Scholar

17. Wright, MS, Kraft, C, Ulrich, MR, Fins, JJ. Disorders of consciousness, agency, and health care decision making: Lessons from a developmental model. American Journal of Bioethics-Neuroscience 2018;9(1):56–64.Google Scholar

18. Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics, 5th ed. Oxford: Oxford University Press; 2001.Google Scholar

19. Fins, JJ. Mosaic Decisionmaking and reemergent agency after severe brain injury. Cambridge Quarterly of Healthcare Ethics 2018;27(1):163–74.CrossRefGoogle ScholarPubMed

20. Miller, P. Justifying Fiduciary Duties. McGill Law Journal 2013;58(4):969–1023.CrossRefGoogle Scholar

21. Buchanan, AE, Brock, DW. Deciding for Others: The Ethics of Surrogate Decision Making . Cambridge: Cambridge University Press; 1989.Google Scholar

22. Appelbaum, PS, Grisso, T. MacArthur Competence Assessment Tool for Treatment (MacCAT-T) . Sarasota, FL: Professional Resource Press/Professional Resource Exchange; 1998.Google Scholar

23. Faden, RR, Beauchamp, TL. A History and Theory of Informed Consent. Oxford: Oxford University Press; 1986.Google Scholar

24. See note 19, Fins 2018, at 165.

25. See note 19, Fins 2018, at 168.

26. See note 19, Fins 2018, at 168.

27. See note 19, Fins 2018, at 170.

28. See note 19, Fins 2018, at 170.

29. See note 19, Fins 2018, at 169.

30. Sundram, CJ. Informed consent for major medical treatment of mentally disabled people. New England Journal of Medicine 1988;318(21):1368–73.CrossRefGoogle ScholarPubMed

31. New York Mental Hygiene Law, Art. 80.

32. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Making health care decisions: A report on the ethical and legal implications of informed consent in the patient-practitioner relationship. 1982. Vol. 1; available at: https://repository.library.georgetown.edu/handle/10822/559354 (last accessed 7 Aug 2018).Google Scholar

33. Sundram, CJ, Stavis, PF. Obtaining informed consent for treatment of mentally incompetent patients: A decade under New York’s innovative approach. International Journal of Law and Psychiatry 1999;22(2):107–23.CrossRefGoogle ScholarPubMed

34. See note 30, Sundram 1988, at 1372.

35. See note 30, Sundram 1988, at 1370.

36. See note 30, Sundram 1988, at 1369.

37. See note 30, Sundram 1988. For example, Sundram notes the 1988 Brookdale Center study.

38. See note 33, Sundram, Stavis 1999, at 121.

39. Miller, TE, Coleman, CH, Cugliari, AM. Treatment decisions for patients without surrogates: Rethinking policies for a vulnerable population. Journal of the American Geriatrics Society 1997;45(3):369–74.CrossRefGoogle ScholarPubMed

40. Herr, SS and Hopkins, BL. Health care decision making for persons with disabilities: An alternative to guardianship. JAMA 1994;271:1018–22.CrossRefGoogle ScholarPubMed

41. Dingfelder, SF. The scientist at the easel. APA Monitor 2010;41(2):34.Google Scholar

42. Goodale, MA, Milner, AD. Separate visual pathways for perception and action. Trends in Neurosciences 1992;15(1):20–5.CrossRefGoogle ScholarPubMed

43. See note 19, Fins 2018.

44. See note 39, Miller et al. 1997.

45. See note 40, Herr, Hopkins 1994.

46. See note 30, Sundram 1988.

47. See Owen Lab, Brain and Mind Institute, University of Western Ontario, Canada; available at http://www.owenlab.uwo.ca (last accessed Aug 26, 2018).

48. Fins, JJ. Rights Come to Mind: Brain Injury, Ethics, and The Struggle for Consciousness. Cambridge: Cambridge University Press; 2015.CrossRefGoogle Scholar

49. See note 19, Fins 2018.

50. See note 31, New York Mental Hygiene Law, Art. 80.05 (h).

51. See note 19, Fins 2018, at 172, emphasis added.

52. See note 30, Sundram 1988, at 1370.

53. See note 19, Fins 2018, at 170. Here, Fins alludes to a sliding-scale account of decisionmaking capacity developed by, among others, James Drane. See Drane JF. Competency to give an informed consent. A model for making clinical assessments. JAMA 1984;252(7):925–7. Readers should note that this sliding-scale account has been challenged in the literature. Critics argue that it leads to a risk asymmetry, wherein a decision to accept a clinician’s recommendation could be deemed less risky (and thus requires less capacity) than a decision to refuse therapy. I will not pursue this line of criticism, but it is worth observing that Fins does not address this problem. Future critiques of mosaic decisionmaking might turn on this vulnerability.

54. See note 19, Fins 2018, at 171.

55. Feinberg, TE. Neuropathologies of the self: A general theory. Neuropsychoanalysis 2010; 12(2):133–58.CrossRefGoogle Scholar

56. Feinberg, TE, Venneri, A, Simone, AM, Fan, Y, Northoff, G. The neuroanatomy of asomatognosia and somatoparaphrenia. Journal of Neurology, Neurosurgery & Psychiatry 2010; 81(3):276–81.CrossRefGoogle ScholarPubMed

57. Wasserman, JA, Navin, MC. Capacity for preferences: Respecting patients with compromised decision-making. Hastings Center Report 2018;48(3):31–9.CrossRefGoogle ScholarPubMed