Symposium 4: Detecting covert awareness

Monday July 15 16:30-18:30

Ethical implications of detecting covert awareness in disorders of consciousness

Chairs: Adrian M. Owen (Cognitive Neuroscience and Imaging, Western University, Ontario, CA),
Andrew Peterson (Rotman Institute of Philosophy, Western University, Ontario, CA)

Recent findings in cognitive neuroscience (Monti et al .2010, Owen et al.2006) suggest that functional mag- netic resonance imaging (fMRI) may be a viable means for detecting covert awareness in the vegetative state (VS). This research opens a promising new avenue for developing brain-computer interfaces (Naci et al. 2012) that compliment the current diagnostic criteria of disorders of consciousness (DOC), thereby increasing the effectiveness of diagnostic screening in this patient group. Given the high rate of misdiagno- sis in this population (Andrews et al. 1996, Childs et al. 1993), actively seeking out patients, who retain conscious awareness despite a clinical diagnosis of VS, is of the highest importance. Moreover, this tech- nique may also permit patients, who are consciously aware and have high levels of preserved cognition, to meaningfully engage in the decision making process related to their own medical care. To date, one patient, previously diagnosed as vegetative for approximately five years, was able to successfully answer a series of autobiographical ‘yes’ or ‘no’ questions correctly overrepeated fMRI scanning sessions (Montietal.2010).

A natural step forward in this research program, therefore, is to apply similar neuroimaging methods to address medical questions relevant to individual DOC patients (Peterson et al. in preparation). Though these scientific findings appear highly promising in principle, incorporating any neuroimaging--based method into clinical setting will require satisfaction of established ethical and legal norms of medical practice. In particular, these concerns include: determining how information acquired from such techniques will be disclosed to patients’ families, what the cost of running such tests will be, whether any individual DOC patient is capable of making medically relevant decisions with these techniques, and what type of ques- tions we ought to be asking this patient population. We propose a symposium that brings together three different perspectives on this problem: neuroscience, neurology, and clinical ethics.

The first perspective, offered by Drs. Lorina Naci PhD and Daniel Bor PhD, both neuroscientists working with these neuroimaging paradigms, will shed light on practical obstacles and ways forward focusing neuroimaging to assess residual cognition in DOC patients.

The second perspective, offered by Dr. Bryan Young MD, a clinical neurologist working directly with this patient group, will highlight the difficulties as well as the potential that neuroim- aging holds for DOC patients in the medical setting.

Finally, Dr. Charles Weijer MD, PhD and Andrew Peterson MA, both medical ethicists and philosophers of science, will offer views on the overarching ethical standards relevant to this research. Dr. Adrian M. Owen, a neuroscientist working in this field, will chair the session.

We hope that this interdisciplinary approach will facilitate a novel and productive conversation about the merits of this research and future directions for using it in the clinical setting.

Using fMRI to assess conscious awareness in patients with disorders of consciousness– practical considerations
Lorina Naci (Experimental Psychology, Western University, Ontario, CA)

Using multiple neuroimaging techniques to assess the quality of conscious awareness in DOC patients
Daniel Bor (Cognitive Neuroscience, Sackler Centre for Consciousness Science, University of Sussex, Brighton, U.K.)

Obstacles at the interface between advances in cognitive neuroscience and clinical practice
Bryan Young (Neurology and Critical Care Medicine, Western University, Ontario, CA)
Conceptual foundations for assessing decision-making capacity in disorders of consciousness
Andrew Peterson (Rotman Institute of Philosophy, Western University, Ontario, CA)

Navigating the transition between research and treatment when integrating novel neuroimaging techniques in medical practice
Charles Weijer (Bioethics, Rotman Institute of Philosophy, Western University, Ontario, CA)