Joseph Fins: “Euthanasia is an act of desperation, it assumes that the system has failed”

Joseph J. Fins is, in addition to chief of the Division of Medical Ethics at New York Presbyterian Hospital and Weill Cornell Medical College of New York, an eminence in the field of bioethics and disorders of consciousness after severe brain injury . Fins, who is the president of the International Association of Neuroethics, co-authored the landmark “Nature” article describing the first use of deep brain stimulation in the minimally conscious state. During his intervention at the XV Seminar on Biomedicine, Ethics and Human Rights, held at the Faculty of Medicine of the Complutense University of Madrid, he attended ABC Salud. Is euthanasia a failure of our society? As far as I know, there have been very few people in Spain who have opted for this option. I think it is very easy to think that euthanasia is a remedy for our own humanity and mortality. In my opinion, what should be done is to invest more money so that palliative treatment is accessible to all. In Spain, and also in the US, more money must be spent on how we are going to die. We have a level of ambivalence about life. You always want more and more treatments, but what is most important is prevention, not getting to that point. Now, having reached this situation, I think it is a failure not to satisfy the needs of people in the process of dying. Standard Related News No “I am technology”, the story of the first ‘cyborg man’ The British Neil Harbisson implanted an antenna in his head with which he claims to perceive a ‘new reality’ in his brain, which can be accessed via NFT I am very respectful of Spanish culture and its decision on euthanasia, but as an expert doctor in Ethics I have some reservations. I accept the interest that the euthanasia debate arouses, but as a doctor specializing in palliative care I believe that this is an act of desperation and, therefore, reaching this point means that the care system has failed, if only because it did not prevent pain and suffering. In some cases there are alternatives, and there are other remedies that can discourage you from making this fateful decision, and that does not necessarily mean being in favor of abusing technical resources to artificially maintain life. I have had patients who have requested assisted suicide. I personally am not in favor of assisted suicide or euthanasia, but I answered them: I cannot do that, but I can promise you that I will be with you when you are dying and promise that you will not suffer. And I assure you that they do not ask for assisted suicide anymore. I think it is more the fear of the process, of suffering or pain that scares us and leads us to request euthanasia. In Spain there is the right to euthanasia, but you cannot force any doctor to carry it out if they do not want to. And it is very important to respect the autonomy of doctors, because you should not force them…. There is then a clash of interests between fulfilling the patient’s right to euthanasia and the doctor’s right to conscientious objection. Which right should prevail? In those cases, there are other doctors who can do it. In Spain, some stages have been established to determine whether or not a person can opt for this decision. What happens is that what will happen is that there will be doctors who do not want to participate in the process and others who do not have any problem of conscience when participating and who will probably always be in favor of it. Should there be committees that involve both parties so that the final decision is as objective as possible and that religious or political ideas are not decisive? Unlike the US, in Spain a very rigorous process has been established. I like to clarify that euthanasia is not the same as assisted suicide. The first needs the doctor’s hand. I say that if a person has to intervene, it is possible that it is no longer an act of the patient’s will. For this reason, all laws in the US refer to assisted suicide due to the risk of unintentional suicide. I like to clarify that euthanasia is not the same as assisted suicide. The first needs the doctor’s hand Euthanasia is a personal decision, but it is important to know the consequences of this decision and assess its impact on other people close to the patient. Therefore, the best option is to act proportionally and constantly evaluating that the risks/benefits are balanced. You are an expert in the diagnosis and development of treatments for people with disorders of consciousness. We currently enjoy extraordinary knowledge and technological resources that, for example, allow us to know what people who are in a state of minimal consciousness think or think, which offers enormous benefits… but can also lead to abuses, so it is essential to reach to a balance between negative and positive rights. While technology has determined that there is brain activity in people who are in a coma, however, do we know what kind of brain activity it is? can we talk about conscience? How long can palliative care be extended? I have written a book answering this question ( Rights come to mind ). We have to distinguish two parts; On the one hand, if the patient can receive deep brain stimulation for minimal awareness, which is part of a study regulated by the hospital’s ethics committee. Of these people, the fear is if they can suffer and how to help them. Secondly, if with the deep brain stimulation treatment we can reverse the effect. There is a saying in the world of disability rights and it is ‘nothing about us without us’. That is, we do not have to imagine what they are thinking, but rather know that they are thinking. Our contribution has been to give them the possibility of giving voice to their thoughts, a way of expressing themselves. The other side of the coin is how long are we going to wait. We don’t have the answer, but I think that the effort now in neuroscience is to be able to better diagnose and discriminate between people who are going to survive and those who are not. But having more information does not force us to do anything, although we can talk to the family, explain what we know and what we don’t know, and then make decisions. A person who is in a true vegetative state cannot feel pain, but if he has pain, it must be treated. The big problem is not treating pain when a patient may be experiencing it. Pain treatment can be very long term, but if there is no awareness, is it possible to know if that person is suffering or not? We find ourselves with the problem that if we do not know if he may be suffering, it is not possible to ask him because he cannot communicate. But we have to make decisions. Making decisions is part of bioethics. In this situation it is very decisive to know if there is a previous decision adopted by the patient to know how to act. In my opinion, the more information we have, the better. Don’t you think that more information is needed for people in life to make decisions about the end of life? I remember the case of a person with a state of minimal consciousness who was the subject of the day in the New York Times who was able to communicate her decision. When they asked my opinion, I answered that what was happening at the moment was a bad communication between the patient and the doctors and it is difficult to make a decision in that state. Because to make a correct decision you must have full knowledge of the question. A person with a minimal conscience is not able to express himself or understand well enough to make an irrevocable decision. There is a saying in the world of the rights of people with disabilities and it is ‘nothing of us without us’ That is why it is important that, when a person is fully aware, they express their prior wills and wishes -I do not want to live like this- or appoint a representative to give them a voice. The regulation of neurorights is one of the most current and controversial problems in Bioethics. What should we worry about? New neurotechnologies will soon be able to scrutinize the brain and make private thoughts public. I am especially concerned, especially when efforts to exploit decision-making privacy are catalyzed by profit motives or by a police state that might try to use emerging neurotechnology as a means of social control. But as a new regulatory or statutory scheme is considered and outlined, it is important to also anticipate the unintended consequences that could arise if neurotechnologies are implemented prematurely or hastily before their implications are fully understood. For this reason, I am committed to following a prudential ethic. What should be regulated in the field of neurorights? Any neurorights regime would need to satisfy several criteria: it would be required to balance positive and negative rights in promoting human capabilities; he would have to be forward-looking and well versed in the science he seeks to regulate, lest he fall prey to science fiction fantasies that have no basis in reality; it would need to be specific and avoid generalizations that would lead to conceptual confusion and litigation that could retard scientific progress and, finally, it would need to harmonize novel neurorights with long-established norms in international disability and human rights law. Failure to meet these criteria will lead to inadequate regulation of neurorights.