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Ethics and

Brain Injury

Brain injury is an international health problem that places a significant burden on patients, their families, and health care systems. Globally, it is estimated that 50-60 million traumatic brain injury cases occur annually. In the U.S., it is estimated that 3.5 million traumatic brain injuries occur per year with an annual cost burden of at least $76.5 billion. Improvements in neurocritical care have increased survival rates following severe brain injury, but outcome remains variable. Following a period of coma, some patients make a good recovery, while others progress into a vegetative state, minimally conscious state, or die. Diagnosis is difficult and errors occur often. Advancements in functional magnetic resonance imaging  and electroencephalography  can provide a solution. These technologies can improve the accuracy of diagnosis and could revolutionize our understanding of severe brain injury and the nature of human consciousness. Yet the use of these technologies also raises complex ethical and policy issues. This project seeks to investigate ethical and policy issues in the use of functional neuroimaging and electroencephalography to assess brain-injured patients. This project builds upon a Canadian Institutes for Health Research-funded project entitled, The Ethics of Neuroimaging after Serious Brain Injury. 

PARTNERS

Sean Aas (Georgetown University; Kennedy Institute of Ethics)

Tim Bayne (Monash University; Canadian Institute for Advanced Research)

Jennifer Blumenthal-Barby (Baylor College of Medicine; Center for Medical Ethics and Health Policy)

Damian Cruse (University of Birmingham)

Davinia Fernández-Espejo (University of Birmingham)

Chad Heilig (U.S. Centers for Disease Control)

Jason Karlawish (University of Pennsylvania; Penn Memory Center)

Kristin Kostick (Baylor College of Medicine; Center for Medical Ethics and Health Policy)

Emily Largent (University of Pennsylvania; Department of Medical Ethics and Health Policy)

Lorina Naci (Trinity College Dublin)

Adrian Owen (Western University; Canadian Institute for Advanced Research)

Andrew Peterson (George Mason University; Institute for Philosophy and Public Policy)

David Wasserman (National Institutes of Health Bioethics Unit)

Charles Weijer (Western University; Rotman Institute of Philosophy)

 

FUNDING

Greenwall Faculty Scholars Program, Greenwall Foundation (2018-2021; Peterson, PI)

Canadian Institutes for Health Research (2014-2018; Weijer, PI)

Vanier Canada Graduate Scholars Program, Canada Tri-Council Agency (2013-2015; Peterson, PI)

 

SELECTED PUBLICATIONS

Peterson A, Owen AM. (Forthcoming) Confronting the gray zone after severe brain injury. Emerging Topics in The Life Sciences.

Peterson A, Tagliazzuchi E, Weijer C. (2019) The ethics of psychedelic research in disorders of consciousness. Neuroscience of Consciousness. Published online October 9, 2019. doi.org/10.1093/nc/niz013

Peterson A, Owen AM, Karlawish J. (2019) Alive inside. Bioethics. Published online October 2, 2019. doi.org/10.1111/bioe.12678

 

Peterson A. (2019) A critical analysis of Joseph Fins' mosaic decision making. Cambridge Quarterly of Healthcare Ethics; 28(4): 725-736. [With accompanying response from Fins]

 

Peterson A, Aas S, Wasserman D. (2018) What justifies the prioritization of healthcare resources for patients with severe brain injury? (Abstract). AJOB-Neuroscience; 10(1): W1.

Peterson A (2018) Should neuroscience inform judgments of decision-making capacity? Neuroethics; 12(2):133-151.

 

Peterson A, Bayne T. (2018) Global disorders of consciousness. In Gennaro R.J. (ed.) Routledge Handbook of Consciousness; Routledge: New York. [15-pages] 

Kluck M, Peterson A. (2018) Ethical considerations for fMRI research involving human fetuses in utero. (Abstract). AJOB-Neuroscience; 9(1): W5-W6.

Downes P, Peterson A. (2018) Ethical issues in pharmacological research in disorders of consciousness: A case study of Amantadine. (Abstract). AJOB-Neuroscience; 9(1): W6.

Peterson A, Bayne T. (2017) A taxonomy for disorders of consciousness that takes consciousness seriously. AJOB-Neuroscience. 8(3): 153-55

 

Peterson A, Bayne T. (2017) A taxonomy for disorders of consciousness that takes consciousness seriously. AJOB-Neuroscience. 8(3): 153-55

 

Cairncross M, Peterson A, Lazosky A, Gofton T, Weijer C. (2016) Assessing decision-making capacity in patients with communication impairments. Cambridge Quarterly of Healthcare Ethics; 25: 691-699.

 

Peterson A. (2016) Consilience, clinical validation, and global disorders of consciousness. Neuroscience of Consciousness. 1(1). DOI: doi:10.1093/nc/niw011 [9-pages]

 

Weijer C, Bruni T, Gofton T, Young B, Norton L, Peterson A, Owen AM. (2016) Ethical considerations in functional magnetic resonance imaging research in acutely comatose patients. Brain; 139(pt1): 292-299.

 

Graham M, Weijer C, Cruse D, Fernández-Espejo D, Gofton T, Gonzalez-Lara L, Lazosky A, Naci L, Norton L, Peterson A, Speechley K, Young B, Owen AM. (2015) An ethics of welfare for patients diagnosed as vegetative with covert awareness. AJOB-Neuroscience; 6(2): 31-41

 

Peterson A, Cruse D, Naci L, Weijer C, Owen AM. (2015) Risk, diagnostic error, and the clinical science of consciousness. NeuroImage:Clinical; 7: 588-597.

 

Graham M, Weijer C, Peterson A, Naci L, Cruse D, Fernández-Espejo D, Owen AM. (2015) Acknowledging awareness: informing families of individual research results for patients in vegetative states. Journal of Medical Ethics; 41(7): 534-8.

 

Peterson A, Norton L, Naci L, Owen AM, Weijer C. (2014) Toward a science of brain death. American Journal of Bioethics; 14(8): 29-31.

 

Weijer C, Peterson A, Webster F, Graham M, Cruse D, Fernández-Espejo D, Gofton T, Gonzalez-Lara L, Lazosky A, Naci L, Owen AM. (2014) Ethics of neuroimaging after serious brain injury. BMC Medical Ethics; 15(41). doi: 10.1186/1472-6939-15-41. [13 pages]

 

Peterson A, Naci L, Weijer C, Cruse D, Fernández-Espejo D, Graham M, Owen AM. (2013) Assessing decision-making capacity in the behaviorally non-responsive patient with residual covert awareness. AJOB-Neuroscience; 4(4): 3-14.

 

Peterson A, Naci L, Weijer C, Owen AM. (2013) A principled argument, but not a practical one. AJOB-Neuroscience; 4(1): 52-53.

 

SELECTED PRESENTATIONS

Peterson A, Kostick K, Blumenthal-Barby J. Seeing minds in disorders of consciousness patients. (Oral presentation). American Society for Bioethics and Humanities. Pittsburgh, USA. October, 2019.

Peterson A. Alive Inside: The search for consciousness following severe brain injury. (Invited oral presentation). Neurosurgery Grand Rounds, Baylor College of Medicine. Houston, USA. September, 2019.

Peterson A. Are the really conscious? Responding to criticism of the mental imagery task. (Invited oral presentation). Center for Medical Ethics and Health Policy, Baylor College of Medicine. Houston, USA. September, 2019.

Peterson A, Heilig C. Are the levels of consciousness? An instrumentalist's reply. (Poster presentation). Association for the Scientific Study of Consciousness 23rd annual meeting. London, Canada. June, 2019. 

Peterson A. Erring on the side of consciousness. (Invited symposium presentation; Chair: Fins). Neuroethics Network Meeting, ICM Brain and Spine Institute. Paris, France. June, 2019.

Peterson A, Kostick K, Blumenthal-Barby J. Seeing minds in disorders of consciousness patients. (Invited oral presentation). Disorders of consciousness workshop. Trinity College Dublin, IR. April, 2019. 

Peterson A. Alive inside: The ethics of neuroimaging after severe brain injury. (Invited oral presentation). Penn Program in Precision Medicine for the Brain. University of Pennsylvania. Philadelphia, USA. March, 2019. 

Peterson A. Should neuroscience inform judgments of decision-making capacity? (Invited oral presentation). National Institutes of Health 1stYear Bioethics Fellows Seminar. Bethesda, USA. December, 2018. 

​Peterson A, Aas S, Wasserman D.What justifies the prioritization of healthcare resources for patients with severe brain injury?(Poster presentation). International Neuroethics Society. San Diego, USA. November, 2018. 

Peterson A. A critical analysis of mosaic decision making. (Invited symposium presentation; Chairs: Fins and Naccache). Neuroethics Network Meeting, ICM Brain and Spine Institute. Paris, France. June, 2018.

 

Peterson A. Ethics, machine learning, and disorders of consciousness. (Invited oral presentation). Janelia Research Campus, Howard Hughs Medical Institute. Ashburn, USA. March, 2018.

DeFranco J, Peterson A. An analysis of disparities in methods for determining brain death across U.S. medical centers. (Poster presentation). International Neuroethics Society. Washington DC, USA. November, 2017.

Downes P, Peterson A. Ethical issues in pharmacological research in disorders of consciousness. (Poster presentation). International Neuroethics Society. Washington DC, USA. November, 2017. AJOB-Neuroscience top abstract award.

Kluck M, Peterson A. Ethical considerations for fMRI research involving human fetuses in utero. (Poster presentation). International Neuroethics Society. Washington DC, USA. November, 2017. AJOB-Neuroscience top abstract award.

Kirkpatrick J, Barrett E, Peterson A. Coming Home: Dialogues on the moral, psychological, and spiritual impacts of war. (Poster presentation). International Neuroethics Society. Washington DC, USA. November, 2017.

Neely C, Peterson A. A bayesian framework for disorders of consciousness research. (Poster presentation). Society for Neuroscience. Washington DC, USA. November, 2017.

Peterson A. Finding consciousness following catastrophic brain injury. (Invited oral presentation). Center for Neural Informatics, Neural Structures, and Neural Plasticity. Krasnow Institute for Advanced Study. Washington DC, USA. November, 2016

Stephensen M, Peterson A, Weijer C. Are organ donors really dead, or just dead enough? A critique of the dead donor rule. (Oral presentation). Canadian Brioethics Society. Toronto, Canada. May, 2016.

Peterson A. Unlocking their voices: The ethics of neuroimaging consciousness. (Invited oral presentation). Institute for Philosophy and Public Policy, George Mason University. Washington DC, USA. March, 2016

 

Peterson A, Naci L, Goering S, Silvers A, Weijer C. Reading the minds of severely brain injured persons. (Invited symposium). American Philosophical Association, Pacific Division. Sponsored by the Society for Philosophy and Disability. San Francisco, USA. March, 2016.

 

Peterson A, Weijer C, Owen AM. Clinical validation studies and the science of consciousness. (Poster presentation). Association for the Scientific Study of Consciousness 19th Annual Meeting. Paris, France. July, 2015.

 

Peterson A, Cruse D, Fernandez-Espejo D, Bruni T, Weijer C, Owen AM. A framework for comparing neuroimaging techniques used to assess disorders of consciousness. (Poster presentation). International Neuroethics Society. Washington DC, USA. November, 2014.

 

Weijer C, Bruni T, Gofton T, Norton L, Peterson A, Young GB, Owen AM. Ethical issues in fMRI research in patients with severe brain injuries in the intensive care unit. (Poster presentation). International Neuroethics Society. Washington DC, November, 2014.

 

Graham M, Weijer C, Cruse D, Fernández-Espejo D, Gonzalez-Lara L, Peterson A, Speechley K, Owen AM. Evaluating subjective well-being in patients diagnosed as vegetative with covert awareness. (Poster presentation). International Neuroethics Society. Washington DC, USA. November, 2014.

 

Weijer C, Graham M, Peterson A, Naci L, Cruse D, Fernandez-Espejo D, Gonzalez-Lara L, Owen AM. Acknowledging awareness: Informing families of individual research results for patients in the vegetative state. (Oral presentation). Canadian Bioethics Society. Vancouver, Canada. May, 2014.

        

Graham M, Weijer C, Peterson A, Naci L, Fernández-Espejo D, Cruse D, Lazosky A, Gonzalez-Lara L, Owen AM. Communication with patients diagnosed with disorders of consciousness, and the moral significance of sentience. (Oral presentation). Canadian Bioethics Society. Vancouver, Canada. May, 2014.

        

Peterson A, Naci L, Weijer C, Benmordecai D, Cruse D, Fernandez-Espejo D, Gofton T, Gonzalez-Lara L, Lazosky A, Speechley K, Young B, Owen AM. Is is possible to assess decision making capacity in the disorders of consciousness patient? (Oral presentation). Canadian Bioethics Society. Vancouver, Canada. May, 2014.

        

Weijer C, Peterson A, Naci L, Graham M, Cruse D, Fernández-Espejo D, Lazosky A, Owen AM. Why discussion of end-of-life decisions through brain computer interfaces starts the ethical debate off on the wrong foot. (Oral presentation). Brain Matters 4. Vancouver, Canada. March, 2014.

 

Graham M , Weijer C,  Peterson A, Naci L, Fernández-Espejo D, Cruse D, Lazosky A, Gonzalez-Lara L, Owen AM. Communication with patients diagnosed with disorders of consciousness, and the moral significance of sentience. (Oral presentation). Brain Matters 4. Vancouver, Canada. March, 2014.

 

Peterson A, Naci L, Weijer C, Bor D, Young B, Owen AM. Ethical implications of detecting awareness in the disorders of consciousness patient. (Plenary symposium). Association for the Scientific Study of Consciousness. San Diego, USA. July, 2013.

Peterson A, Cruse D, Naci L, Fernández-Espejo D, Graham M, Lazosky A, Weijer C, Owen AM. Ethical challenges in deriving the clinical utility of EEG for diagnosis of the vegetative state. (Poster presentation). International Neuroethics Society. San Diego, USA. November, 2013.

 

Graham M, Weijer C, Peterson A, Naci L, Fernández-Espejo D, Cruse D, Lazosky A, Gonzalez-Lara L, Owen AM. Communication with patients diagnosed with disorders of consciousness, and the moral significance of sentience. (Poster presentation). International Neuroethics Society. San Diego, USA. November, 2013.

 

Weijer C, Peterson A, Naci L, Graham M, Cruse D, Fernández-Espejo D, Lazosky A, Owen AM. Why discussion of end-of-life decisions through brain computer interfaces starts the ethical debate off on the wrong foot. (Oral and poster presentation). International Neuroethics Society. San Diego, USA. November, 2013. INS Travel Award.

  

Peterson A. Assessing decision-making capacity in disorders of consciousness. (Oral presentation). Association for the Scientific Study of Consciousness 17th Annual Meeting. San Diego, USA. July, 2013.

  

Peterson A, Weijer C, Naci L, Cruse D, Fernández-Espejo D, Shriver A, Graham M, Owen AM. Are you in pain? Attending to the sentience of the disorder of consciousness patient. (Poster presentation). The Canadian Association of Neuroscience. Toronto, Canada. May, 2013.

  

Peterson A, Naci L, Weijer C, Cruse D, Fernández-Espejo D, Graham M, Owen AM. Ethical implications of detecting awareness in VS. (Oral presentation). Brain Matters 3. Cleveland, USA. October, 2012. Early Scholar Award.

 

Graham M, Peterson A, Naci L, Weijer C, Cruse D, Fernández-Espejo D, Owen AM. Ethical implications of disclosing research results to patients’ families in disorder of consciousness research. (Oral presentation). Brain Matters 3. Cleveland, USA. October, 2012.

 

Peterson A. Ethical implications of detecting covert awareness in disorders of consciousness. (Oral presentation) The Hastings Centre visiting scholar lecture series. New York, USA. June, 2012.