A recent BBC documentary profiles the extraordinary work of Western’s Dr. Adrian M. Owen on detecting unrecognized awareness in individuals diagnosed as being in a vegetative state (VS). Owen and his research team have developed a way for patients who are behaviorally non-responsive, and so incapable of revealing overt signs of awareness, to show that they are aware and potentially able to communicate with family and physicians. By placing these patients in an fMRI scanner, and asking them to imagine playing tennis or walking from room to room in their house, Owen has been able to detect and reliably track activation in distinct areas of the brain, and use this as a proxy for the patient’s inability to behaviorally respond to commands (Monti et al 2010, Boly et al 2007, Owen et al 2006). In this way, participants who were previously believed to be completely non-responsive have shown that they can, in fact, respond to instructions by modulating their brain activity. In the most robust study to date, 4 of 23 patients (17%) previously diagnosed as being in VS were identified who could willfully modulate their brain activity.

Moreover, by using a slight modification of the above protocol, Owen’s team has been able to meaningfully communicate with at least one reported patient who has been diagnosed as vegetative for approximately 5 years. This patient successfully responded to questions regarding the name of his father, whether he had any siblings, and the last country he visited prior to his injury. This was done by coding the imagined activities of playing tennis and moving from room to room in one’s house with the respective answers ‘yes’ and ‘no’ (Monti et al, 2010). The BBC documentary is especially exciting since it debuts the unpublished use of this technique in a Canadian patient by asking whether or not he is in pain.

In January 2012, members from the Rotman Institute of Philosophy and Owen’s lab came together to form a collaborative group with the aim of tackling pressing ethical questions in this research and developing an ethical framework for integrating brain-computer interfaces (BCIs) into medical practice (Naci et al 2012). Comprised of philosophers canadian pharmacy cialis