Image Credit: John Hryniuk
Professor Adrian Owen demonstrates a burning enthusiasm for his research and empathy with his patients, which is nothing short of admirable. He has spent the last 15 years attempting to detect consciousness in vegetative patients via functional neuroimaging. While much of his work involves using MRI technology, since relocating to Canada in 2011, newer EEG technology has also become a factor. MRI technology senses brain activity via changes in blood flow, while EEG detects changes in activity by measuring voltage fluctuations across the scalp.
Owen discovered in 2006 that when humans imagine performing certain activities, such as playing tennis, the brain activity produces specific patterns on imaging technology. Extensive experimentation enabled Owen and his team to communicate with patients in vegetative states. They would accurately respond to any number of “yes” or “no” questions by imagining certain tasks: playing tennis for “yes”, navigating themselves through a house for “no”. Owen went on to publish a paper on this research in 2006, which would go on to revolutionise neuroscience. While many contenders of his work were unwilling to believe that it were possible for these previously-considered empty husks to house fully conscious human-beings, the fact that Owen had successfully communicated with these people forced many to reconsider the possibility. The implications of this research are extensive and MONOLITH catches up with Professor Owen to learn more about his work.
The prospect of communication with people in vegetative states is an exciting but ambitious prospect. How did you begin researching this area?
We began way back in 1997. Of course, back then we didn’t ever dream that we would end up communicating with people who appeared to be in a vegetative state, we were merely looking at some signs of cognitive function using the imaging technology that we had available to us at the time. But the results, even back then were tremendously encouraging and we pushed on to gradually improve our techniques until finally, in 2006, we managed to conclusively demonstrate that the patient who met all of the internationally agreed criteria for the vegetative state was in fact conscious and able to indicate that to us by simply modulating her brain activity. A few years later, in 2010 we actually first communicated with the patient using basically the same technology but with more than 10 years of experience under our belts. By then, we knew what we were looking for.
You spend a reasonable amount of time with your patients. Do you find that you build a personal attachment?
One has to try to remain objective because much of the assessment of these patients requires objectivity. That is not to say that we “depersonalise” them in any way – indeed, when we are testing them, we treat them exactly the same way we would treat any (healthy) participant in one of our studies. That is to say, we talk to them, we encourage them, and we tell them when they are doing well. And of course, sometimes it’s difficult not to build a personal attachment, especially when you hear about some of the difficult experiences these people have had.
How reliable are the responses you receive from patients during the MRI and EEG testing?
That depends on the patient. For some patients, it has been extremely reliable. We know this because we ask them questions that we could not possibly know the answers to (like whether they had ever visited the United States of America). We decode the answers and then we check with the family to find out what the real answer is. When a patient is consistently able to tell us information that we did not previously know, then we know that they are responding reliably. Of course, it does not work so perfectly every time and in fact, only one in five of the patients that we see turn out to be conscious, despite appearing to be vegetative to the outside world. We’ve generally found that among those who are able to respond, the responses tend to be quite reliable.
What do you believe are the strongest arguments that contend your work?
A general objection to our work is that there is little point in investigating these patients if we cannot do anything to alleviate their condition. Frankly, I think it’s a little ridiculous. That is to say, the idea that we should walk away from an awful situation because we can’t do anything about it is entirely unjustifiable in my opinion. Some of these patients are not what they appear to be at all. They appear to be in a vegetative state, yet they may well be entirely conscious of everything going on around them and that is extremely important information both for us and for them. It helps us to clarify the diagnosis and in some cases it has enabled us to communicate with patients for the first time since the injury. The more we know about these patients and the more that we can understand about how to diagnose them properly, the more likely it is that we will find solutions to some of their problems. Moreover, if we ignore them and pretend that they do not exist then science will not progress.
One researcher accused you of “assuming that consciousness is a binary phenomenon”. Can you define consciousness?
I am not seeking to define consciousness and I have never said that I was. The question that I address is whether this person in front of me is conscious in the sense that you and I are conscious or whether they are unconscious in the sense that somebody who is under the influence of a general anaesthetic is unconscious. In my research, a definition of consciousness wouldn’t be very helpful because at the end of the day, none of us know whether any of us are actually conscious.
Are there any large moral dilemmas brought to the surface by this kind of research?
Of course. When we find a patient who is conscious and is able to communicate we want to make all of our resources available to that patient for them to have every opportunity to communicate. Unfortunately, that is impossible, because our equipment is incredibly expensive and we need it to try to improve these methods to make them available to as many people as we can. But it is impossible not to feel like we have opened the door, but then failed to keep it open. In the long run we will find methods to do that and with luck we will be able to benefit some of the patients who have been kind enough to help us with our research. I think the moral dilemma that everybody thinks about when they consider this research is whether we should ask these patients whether they want to live or die. For me, we are not there yet. Until we know what we would do with the answer to a question like that, I do not think that we are ready to ask it. In most civilised societies, we do not have a clear framework that allows people to die when they want to. In addition, I think our techniques are far more usefully applied to less morally challenging questions like “are you in pain?”
What do you intend to achieve in the long run via this research?
I am a neuroscientist and I do what I do because I enjoy doing research on the brain. When this journey began I would never have believed in my wildest dreams that in a little more than 10 years we would be communicating with patients who were entirely incapable of any behavioural responses with their bodies. That is really just one way of me telling you that I have no idea where we will be 10 years from now. I know it will be exciting, I know we will be doing things that we would have never believed possible and I firmly believe we will be doing things that directly benefit people who have sustained the most difficult and troubling sort of brain injuries that we are ever likely to encounter.
