The Passing of Henry Gustav Molaison

"He left a legacy in science that cannot be erased." - New York Times, December 5, 2008.

Known to the world as H.M., Molaison spent the better part of 50 years under the scrutiny of scientists. Thankfully, it was beyond his ability to remember the indignity of such an existence. Molaison suffered from a type of anterograde amnesia as the result of an experimental brain surgery in 1953, and was unable to create new long-term episodic memories.

Molaison's unique impairment fueled the development of the field of cognitive neuroscience. Unlike other patients with traumatic brain injury, Molaison's brain damage had been surgically induced in an attempt to alleviate seizures. The unexpected memory impairment he also suffered as a result of the surgery provided some of the first clues as to the neuroscience of memory, the different types of memory, and memory encoding and retrieval processes.

His impairment left him unable to hold a job, and following the surgery (at age 27) he did not or could not live alone. As Molaison was cut off from the one cognitive function that enables us to learn, reflect, grow and make judgments, it is hard to know exactly how he felt about his life as the object of intense research. Was it a life he would have chosen for himself had he the capacity to remember even a year of such an existence?

Caught in a perpetual 'now', Molaison was at the mercy of the intentions of others. What informed consent he was able to give for his participation in the ongoing series of studies was limited to his feelings and perceptions at the moment. While his participation is these studies undoubtedly made a profound contribution to the field of cognitive neuroscience, reading his obituary in the New York Times left me pondering what principles guided the decisions about his participation. Can any of us say we would have chosen his life if we retained the ability to remember each day as a test subject? Is the argument then that he did not suffer because he was unable to remember the endless series of tasks in which his role may have been more akin to that of a lab rat than an equal collaborative partner?

Molaison's obituary alternatively refers to him as 'Mr. Molaison' and 'H.M.', in roughly equal measure. 'H.M.' was his identity in the community of science. Myself a student of memory, I did not know his given name until today. Was his status as a person somehow diminished by the reduction of his attributes to a set of data that bore the label 'H.M.'? Was this level of impersonalization necessary for the scientific enterprise to operate in an unbiased manner, or did it create and fuel an atmosphere that permitted Molaison to be unnecessarily objectified?

We live in an era that is increasingly concerned with issues of cognitive liberty (and rightfully so), and we must make sure that cognitive differences become neither an excuse to dehumanize, nor exploit any individual. Sovereignty of self should not be limited by how a person thinks. When we choose what another should experience, or how they should spend their time, we are shaping the future state of their brain and mind. This is nowhere more apparent than in the experience of parenting, but it applies as well to those who bears the responsibility of care for a person who is cognitively impaired. The impact of a single event may be greatly reduced in a person with certain cognitive impairments, or it may be greatly exaggerated. Therefore there is no catch-all answer as to the best way to ensure that such a person's sovereignty is held in responsible trust by its guardians. As a society, we are beginning to make inroads in recognizing these issues, and they require our ongoing willingness to tackle questions about individual identity and autonomy, such as those faced by Molaison, and the larger questions about how we treat those whose internal experience we can only begin to understand.