@article{6987fa1c65b642aa802eb73ddbdde948,
title = "Mosaic Decisionmaking and Reemergent Agency after Severe Brain Injury",
abstract = "In this article, I will discuss the challenge posed by the reemergent agency of individuals with severe brain injury whose ability to communicate has been partially restored by neuroprosthetics, drugs, and rehabilitation. Instead of categorically distinguishing patients as either competent or incompetent, these technologies necessitate a more nuanced approach to intermediate states of decisionmaking capacity. This indeterminacy is addressed through a mosaic approach to decisionmaking, which seeks to achieve a proportionate and prudent balance between unbridled self-determination and conventional surrogate representation.",
keywords = "agency, brain injury, competence, decisionmaking capacity, minimally conscious state, neuroethics, surrogate decisionmaking",
author = "Fins, {Joseph J.}",
note = "Funding Information: FINS JOSEPH J. Joseph J. Fins, M.D., is the E. William Davis, Jr., M.D. Professor of Medical Ethics, Chief of the Division of Medical Ethics, and a Professor of Medicine at Weill Cornell Medical College where he codirects the Consortium for the Advanced Study of Brain Injury (CASBI), at both Weill Cornell and Rockefeller University, New York, New York. An earlier version of this article was presented to the Neuroethics Network on June 29, 2016 at Le Instiut du Cerveau et de la Moelle, CHU Piti{\'e}-Salp{\^e}tri{\`e}re, Paris . This article is funded by a grant to the Consortium for the Advanced Study of Brain Injury (CASBI), at Weill Cornell Medical College by the Jerold B. Katz Foundation and partial support from the Qatar National Research Fund, award NPRP-7-380-5-051 on disability, law and ethics. The statements made herein are solely my own and not those of any funder or institutional affiliation. The author thanks Nancy Worthen and Elinor Quigley for the permission to tell their stories in print; Amy B. Ehrlich, Samantha Knowlton, and Nicholas D. Schiff for their comments; and Zoe M. Adams for her editorial support. 18 09 2017 01 2018 27 1 163 174 Copyright {\textcopyright} Cambridge University Press 2017 2017 Cambridge University Press Neuroethics Now welcomes articles addressing the ethical application of neuroscience in research and patient care, as well as its impact on society. Publisher Copyright: {\textcopyright} Cambridge University Press 2017. Copyright: Copyright 2017 Elsevier B.V., All rights reserved.",
year = "2018",
month = jan,
day = "1",
doi = "10.1017/S0963180117000329",
language = "English (US)",
volume = "27",
pages = "163--174",
journal = "Cambridge Quarterly of Healthcare Ethics",
issn = "0963-1801",
publisher = "Cambridge University Press",
number = "1",
}