Dr Mackenzie Graham | The Oxford Uehiro Centre for Practical Ethics

Research Fellow

Mackenzie Graham is a Research Fellow in Neuroethics, at the Oxford Uehiro Centre for Practical Ethics, and the Wellcome Centre for Ethics and Humanities. Mackenzie received a PhD in Philosophy from The University of Western Ontario, in London Canada, and was previously a Post-Doctoral Associate at the Brain and Mind Institute at Western. His research interests are in moral philosophy and neuroethics, particularly in the challenges of evaluating the well-being of individuals who are behaviourally non-responsive as a result of severe brain injury. His project investigates how can we assess well-being in patients whose means of communication are severely limited or non-existent, what actions can and should we take to promote their well-being, and questions pertaining to their moral status.

He has also written about clinical equipoise, disclosure of research results in functional neuroimaging research, and accidental awareness during general anaesthesia.

Journal Articles

Working for the Weekend Is Not Meaningful Work.

Graham, M, Weijer, C

2019
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Journal article
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Am J Bioeth

Financing, Personal, Humans, Patient Selection
Can they Feel? The Capacity for Pain and Pleasure in Patients with Cognitive Motor Dissociation

Graham, M

2019
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Journal article
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Neuroethics

© 2018, The Author(s). Unresponsive wakefulness syndrome is a disorder of consciousness wherein a patient is awake, but completely non-responsive at the bedside. However, research has shown that a minority of these patients remain aware, and can demonstrate their awareness via functional neuroimaging; these patients are referred to as having ‘cognitive motor dissociation’ (CMD). Unfortunately, we have little insight into the subjective experiences of these patients, making it difficult to determine how best to promote their well-being. In this paper, I argue that the capacity to experience pain or pleasure (sentience) is a key component of well-being for these patients. While patients with unresponsive wakefulness syndrome are believed to be incapable of experiencing pain or pleasure, I argue that there is evidence to support the notion that CMD patients likely can experience pain and pleasure. I analyze current neuroscientific research into the mechanisms of pain experience in patients with disorders of consciousness, and provide an explanation for why CMD patients likely can experience physical pain. I then do the same for physical pleasure. I conclude that providing these patients with pleasurable experiences, and avoiding subjecting them to pain, are viable means of promoting their well-being.
Informed consent for functional MRI research on comatose patients following severe brain injury: balancing the social benefits of research against patient autonomy.

Bruni, T, Graham, M, Norton, L, Gofton, T, Owen, AM, Weijer, C

2019
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Journal article
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J Med Ethics

Functional MRI shows promise as a candidate prognostication method in acutely comatose patients following severe brain injury. However, further research is needed before this technique becomes appropriate for clinical practice. Drawing on a clinical case, we investigate the process of obtaining informed consent for this kind of research and identify four ethical issues. After describing each issue, we propose potential solutions which would make a patient's participation in research compatible with her rights and interests. First, we defend the need for traditional proxy consent against two alternative approaches. Second, we examine the impact of the intensive care unit environment on the informed consent process. Third, we discuss the therapeutic misconception and its potential influence on informed consent. Finally, we deal with issues of timing in recruiting participants and related factors which may affect the risks of participation.

informed consent, neuroethics, neuroimaging
More Harm Than Good: Neurotechnological Thought Apprehension in Forensic Psychiatry.

Graham, M, Friesen, P

2019
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Journal article
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AJOB neuroscience
Using Neuroimaging to Detect Covert Awareness and Determine Prognosis of Comatose Patients: Informing Surrogate Decision Makers of Individual Patient Results.

Graham, M, Doherty, CP, Naci, L

2018
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Journal article
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Semin Neurol

Robust prognostic indicators of neurological recovery are urgently needed for acutely comatose patients. Functional neuroimaging is a highly sensitive tool for uncovering covert cognition and awareness in behaviorally nonresponsive patients with prolonged disorders of consciousness, and may be applicable to acutely comatose patients. Establishing a link between early detection of covert awareness in acutely comatose patients and eventual recovery of function could have significant implications for patient prognosis, treatment, and end-of-life decisions. Because functional neuroimaging of acutely comatose patients is currently limited to the research context, ethical guidelines for disseminating a patient's individual research results to clinical teams and surrogate decision makers are needed. We propose an ethical framework composed of four conditions that can guide ethical disclosure of individual results of neuroimaging research in the acute care context.

Brain Injuries, Coma, Consciousness, Consciousness Disorders, Decision Making, Humans, Neuroimaging

Journal Articles

Working for the Weekend Is Not Meaningful Work.

Can they Feel? The Capacity for Pain and Pleasure in Patients with Cognitive Motor Dissociation

Informed consent for functional MRI research on comatose patients following severe brain injury: balancing the social benefits of research against patient autonomy.

More Harm Than Good: Neurotechnological Thought Apprehension in Forensic Psychiatry.

Using Neuroimaging to Detect Covert Awareness and Determine Prognosis of Comatose Patients: Informing Surrogate Decision Makers of Individual Patient Results.

Books and Chapters