Joseph J Fins
Biographic Data
| ID | 329922 |
|---|---|
| NAME | Joseph J Fins |
| GIVEN NAMES | Joseph J |
| FAMILY NAME | Fins |
| SIGNATURE | FINS J J |
| AFFILIATIONS | Cornell University |
| ORCID | 0000-0002-7221-0053 |
| VERIFIED | Yes |
| TOTAL WORKS | 65 |
| TOTAL CITATIONS | 1 |
| AUTHOR COUNT | 65 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1990 |
| LATEST PUBLICATION YEAR | 2025 |
| H-INDEX | 1 |
Clinical Ethics and the Observant Jewish and Muslim Patient
Patients from religious minorities can face unique challenges reconciling their beliefs with the values that undergird Western Medical Ethics. This paper explores homologies between approaches of Orthodox Judaism and Islam to medical ethics, and how these religions’ moral codes differ from the prevailing ethos in medicine. Through analysis of religious and biomedical literature, this work examines how Jewish and Muslim religious observances affec…
Challenges and strategies in the psychiatric care of the ultra-Orthodox Jewish population
Despite the importance of accessible psychiatric care for the ultra-Orthodox Jewish community, prior research has characterized how stigma and suspicion of secular institutions limit mental healthcare utilization by this population. No study, however, has interviewed a cohort of psychiatrists to identify commonly encountered challenges or successfully employed strategies in the care of ultra-Orthodox Jewish psychiatric patients who have overcome …
Baseball and Bioethics Revisited
In this essay, the author reflects on a decade’s old essay on baseball and bioethics inspired by a conversation with the late David Thomasma. In a reprise of his earlier paper, Fins worries that modernity has come to baseball with the advent of the pitch clock and that this innovation brings age discrimination to a timeless pastime
Subject and Family Perspectives from the Central Thalamic Deep Brain Stimulation Trial for Traumatic Brain Injury
This is the second paper in a two-part series describing subject and family perspectives from the CENTURY-S (CENtral Thalamic Deep Brain Stimulation for the Treatment of Traumatic Brain InjURY-Safety) first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury (msTBI). To participate, subjects were independently assessed to formally establish decision-making capacity to provide v…
Toward a Social Bioethics Through Interpretivism
Recent global events demonstrate that analytical frameworks to aid professionals in healthcare ethics must consider the pervasive role of social structures in the emergence of bioethical issues. To address this, the authors propose a new sociologically informed approach to healthcare ethics that they term “social bioethics.” Their approach is animated by the interpretive social sciences to highlight how social structures operate vis-à-vis the eve…
Identity Theft, Deep Brain Stimulation, and the Primacy of Post‐trial Obligations
Patient narratives from two investigational deep brain stimulation trials for traumatic brain injury and obsessive‐compulsive disorder reveal that injury and illness rob individuals of personal identity and that neuromodulation can restore it. The early success of these interventions makes a compelling case for continued post‐trial access to these technologies. Given the centrality of personal identity to respect for persons, a failure to provide…
Bioethics, Ukraine, and the Peril of Silence
By considering the history of bioethics and international humanitarian law, Joseph J. Fins contends that bioethics as an academic and moral community should stand in solidarity with Ukraine as it defends freedom and civility
Minding Rights
The rise of neurotechnologies, especially in combination with artificial intelligence (AI)-based methods for brain data analytics, has given rise to concerns around the protection of mental privacy, mental integrity and cognitive liberty – often framed as “neurorights” in ethical, legal, and policy discussions. Several states are now looking at including neurorights into their constitutional legal frameworks, and international institutions and or…
Subject and Family Perspectives from the Central Thalamic Deep Brain Stimulation for Traumatic Brain Injury Study
This is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on in…
Should healthcare workers be prioritised during the Covid-19 pandemic? A view from Madrid and New York
While COVID-19 has generated a massive burden of illness worldwide, healthcare workers (HCWs) have been disproportionately exposed to SARS-CoV-2 coronavirus infection. During the so-called ‘first wave’, infection rates among this population group have ranged between 10% and 20%, raising as high as one in every four COVID-19 patients in Spain at the peak of the crisis. Now that many countries are already dealing with new waves of COVID-19 cases, a…
Before The Birth of Bioethics
In the 1960s, tucked away at Yale Divinity School, there was a remarkable confluence of bioethics scholars under the tutelage of James M. Gustafson. His students were Jim Childress, Albert R. Jonsen, Tom Beauchamp, LeRoy Walters, Jim Drane, and Stanley Hauerwas, among others. Jonsen later recalled, “That little group was really the beginning of scholarly bioethics.” Yet despite Gustafson’s influence on the founding generation of bioethics scholar…
Disorders of Consciousness, Disability Rights and Triage During the Covid-19 Pandemic
As a member of the New York State Task Force on Life and the Law and the author of Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness, the author draws upon his work as a clinical ethicist during the COVID-19 Spring surge in New York to analyze the impact of ventilator allocation guidelines proposed by the Task Force on people with disorders of consciousness. While a non-discriminatory methodology was intended by the Tas…
The Birth of Naloxone
Naloxone, which reverses the effects of opioids, was synthesized in 1960, though the hunt for opioid antagonists began a half-century earlier. The history of this quest reveals how cultural and medical attitudes toward opioids have been marked by a polarization of discourse that belies a keen ambivalence. From 1915 to 1960, researchers were stymied in seeking a “pure” antidote to opioids, discovering instead numerous opioid molecules of mixed or …
Brain Organoids and Consciousness
to science and illuminated the excitement of mid-century medicine informed by his work as an immunologist and concern for our ecosystem, both natural and manmade. In his most famous work, The Lives of a Cell, 1 Thomas likened the earth to a single cell. His essays are a perfect blend of Watson and Crick, Rachel Carson, and Montaigne, one of his favorite writers
Resuscitating Patient Rights during the Pandemic
The COVID-19 Pandemic a stress test for clinical medicine and medical ethics, with a confluence over questions of the proportionality of resuscitation. Drawing upon his experience as a clinical ethicist during the surge in New York City during the Spring of 2020, the author considers how attitudes regarding resuscitation have evolved since the inception of do-not-resuscitate (DNR) orders decades ago. Sharing a personal narrative about a DNR quand…
Congee for the Soul
Provision of adequate nutrition to elderly patients who develop dysphagia after a stroke can be quite challenging, often leading to the placement of a percutaneous entero‐gastrostomy (PEG) tube for nutritional support. This hypothetical case describes the additional challenge of cross‐cultural belief that leads a daughter to provide oral feeding to her mother, an act that the medical team believes is dangerous and the daughter sees as salubrious.…
History and Bioethics
Cultural historians and historians of medicine are a rarity in bioethics. Even those who write histories of bioethics are philosophers, sociologists, or theologians. Where have all the historians gone? If bioethics is to contribute to the urgent work of addressing social justice, structural racism, and health inequity, we bioethicists need to embrace history as a fully constituent part of our field. Historians can help us apprehend the ideas that…
Two Patients
In this essay, the author reflects on his development as a physician by recounting two patient narratives of patients he cared for as a third year medical student. In the process of telling these stories of sickness, the author also provides a window on medical practice in the 1980’s in an academic medicine center and how practices have changed. Decades before what has been dubbed “narrative medicine,” the author learned the power of words to sha…
Paternalism, Evangelism, and Power
Disability Rights as a Necessary Framework for Crisis Standards of Care and the Future of Health Care
In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule …
Pandemics, Protocols, and the Plague of Athens
When confronted by the novel ethical challenges posed by a pandemic, it is helpful to turn to history for guidance and direction. In this essay, the author revisits Thucydides's description of the Plague of Athens from The Peloponnesian War as he considers the New York State Task Force on Life and the Law's 2015 guidelines on ventilator allocation. Confronted by the exigencies of the Covid‐19 surge that struck New York, he questions the task forc…
When No One Notices
On January 5, 2019, the Associated Press reported that a woman thought to have been in the vegetative state for over a decade gave birth at a Hacienda HealthCare facility. Until she delivered, the staff at the Phoenix center had not noticed that their patient was pregnant. The patient was also misdiagnosed . Misdiagnosis of patients with disorders of consciousness in institutional settings is more the norm than the exception. Misdiagnosis is also…
North of Home
Undocumented and undomiciled, Gustavo Jiménez had been in the United States for several years. He knew his leg wasn’t right when it began to swell and redden. After the cellulitis spread to his bloodstream, he was found unconscious on the street and admitted to the intensive care unit. He improved quickly and was soon able to tell a social worker his name and that he had family in Quito. Then his health took a turn for the worse, and he developed…
Go in Peace
Beyond Good and Evil
Challenges and strategies in the psychiatric care of the ultra-Orthodox Jewish population
Despite the importance of accessible psychiatric care for the ultra-Orthodox Jewish community, prior research has characterized how stigma and suspicion of secular institutions limit mental healthcare utilization by this population. No study, however, has interviewed a cohort of psychiatrists to identify commonly encountered challenges or successfully employed strategies in the care of ultra-Orthodox Jewish psychiatric patients who have overcome …
How Many Hours
Case Studies
Sixty-one-year-old AT has recently been confined a wheelchair by progressive osteoarthritis in his right hip, which causes him considerable pain. Formerly an active individual--an avid walker and weekend sailor--AT is equally distressed by his lack of mobility and loss of independence. A hip replacement, for which his insurance company would pay, would relieve his pain, increase his mobility, and significantly improve the quality of his life. He …
The Hidden Costs of Market-Based Health Care Reform
The paradox is inescapable: the market reforms offered in the\n1980s to address the excesses of the health care system profoundly altered\nphysician thinking and led to the physician-businessman of the 1990s. This\ncausal argument is worth exploring for more than historic interest or\nverification. Indeed it is worth "discounting" if false, because market\nmeasures remain the predominant vehicle touted to reform America's health care\nsystem. Yet…
Palliation for the Dying
for the Dying Madam: In Palliation in the Age of Chronic Disease (HCR January-February 1992), Joseph J. Fins categorizes the patient's treatment as either palliative or therapeutic; however, there is a fine line between the two, and this case is too complex to reduce to simplistic terminology. Fins claims that a life expectancy of three years suggests that the surgery would be therapeutic, but at six months it is unclear. Is there a timetable
At the Center
Paho's Progress
Praxis Makes Perfect
Hospital formulary committees blend cost-effectiveness analysis, peer review, and continuing medical education to regulate hospital drug purchases and physicians' prescribing patterns in ways that may be instructive to the societal debate on health care reform
The rationing of health care
Bioethics with Portfolio
Encountering diversity
A secular chaplaincy
Case Study
AM, an eighty-year-old woman, is brought by ambulance to emergency room after an apparent suicide attempt. She was discovered by her neighbors, who have tried to look after her since her husband died three years ago. They became concerned when she did not answer her phone, and when they went to investigate, they found her unconscious on floor next to an empty bottle of sleeping pills. A suicide note was left on dining room table. Alarmed, neighbo…
The Face of Finitude
Book reviewed in this article: How We Die. By Sherwin B. Nuland. New York: Alfred A. Knopf
At the Center
Across the divide
From indifference to goodness
Case Study
In a Survivor's Voice
In a Survivor's Voice
Confronting Traumatic Brain Injury: Devastation, Hope and Healing. William J. Winslade. New Haven: Yale University Press, 1998. 220 pp. $27.50
A Decided Lack of Empathy
Case Study
Rethinking Disorders of Consciousness
Deep Brain Stimulation
Considerations of the cost of innovations like deep brain stimulation must take into account intangible and economic benefits of the treatment. Virtual Mentor is a monthly bioethics journal published by the American Medical Association
Brain Injury and the Culture of Neglect
Our essay will address both the right-to-die movement in America and the emerging culture of neglect in the treatment of a class of patients with disorders of consciousness with which the right-to-die movement is entwined. We trace the etiology of these two themes through changes in our scientific understanding of brain injury and recovery against a growing societal acculturation to dominion over one's self at life's end
It's Who You Know
Medicine (36 works) · Psychology (35 works) · Law (29 works) · Political science (29 works) · Sociology (25 works) · Philosophy (20 works) · Ethics in medical practice (16 works) · Psychiatry (14 works) · Computer Science (13 works) · Nursing (13 works)