Herbert West-Reanimator. A promethean figure of disgust or a modern day master of medicine?

What would happen if medical science could reanimate the dead?


Learning objectives

1. Introduce the fictional character of Herbert West

2. Participate in a thought experiment about resuscitation

3. Ph’nglui mglw’nafh Cthulhu R’lyeh wgah’nagl fhtagn


Herbert West-Reanimator is a short story written by H.P. Lovecraft between 1921-1922. Published serially over six episodes in 1985 it was adapted into a cult horror movie classic (+18) and spawned a number of sequels. However, I’ll be focusing on the written text which is in the public domain and available here.

The premise is that Herbert West dedicates his medical student and working life to perfect a solution able to reanimate the dead. Unable to convince the medical school to provide cadavers for experimentation, he seeks alternative means to continue his charnel obsession. He believes the sooner he can administer his experimental solution after death, the more more successful the reanimation process will be. I hope I’m not giving too much away when I say he tries multiple times with incrementally intriguing but gruesome effects.

What’s interesting when retrospectively reading about Herbert West is that now there is a type of reanimation process that exists, although we call it cardiopulmonary resuscitation (CPR).

A quick word on definitions. Resuscitation can be defined as the action or process of reviving someone from unconsciousness or apparent death. Reanimation is the restoration of life or consciousness. Resurrection is the revitalisation or revival of something and has a more religious connotations.

Although CPR success rates vary depending on the circumstances, in general the sooner it is attempted the more likely the individual is to survive and importantly, survive with less morbidity. There are plenty of examples where the media have reported on how defibrillation has brought particular individuals ‘back to life.


Questions

How comfortable do you feel about a resuscitation attempt 1 min after cardiac arrest?

How comfortable do you feel about a resuscitation attempt 1 hour after cardiac arrest?

How comfortable do you feel about a resuscitation attempt 1 day after cardiac arrest?


Let us embark upon a thought experiment. Imagine that Herbert was provided with all the support and resources he needed from the medical community. After much trial and error, he perfected the reanimation process. Indeed, the process was so well refined that it would be successful years after ‘death’.

This is the point where many clinicians switch off, stating that this just wouldn’t be possible (cellular breakdown etc). However, one way to view the core ethical issue is to assume that the technological limitations have been overcome and the process is indeed possible. In the story, Herbert West develops an embalming fluid to prevent decomposition of the body until he is ready to reanimate. Is this really so far removed from cryonics, where individuals hope that they will be resuscitated in the future with advances in medical science? Anyway, try to imagine that we really could resuscitate someone who has been apparently ‘dead’ for a long time.


Questions

How comfortable do you feel about a resuscitation attempt 1 month after ‘death’?

How comfortable do you feel about a resuscitation attempt 1 year after ‘death’?

How comfortable do you feel about a resuscitation attempt 100 years after ‘death’?


Let us take our thought experiment further. Let’s imagine medicine has advanced to the point that no embalming fluid or cryonics are required for reanimation. Indeed, the reanimation process is so advanced that conventionally buried bodies could be brought back to life to the same physical and mental state they were in just prior to ‘death’. Memories and neuronal connections are restored back to the time just prior to death and the revived individual would not realise that they had previously ‘died’.


Questions

How would you feel about successfully resuscitating someone who had been buried many years ago?

Would CPR as we know it today seem distasteful to the doctors of 100 years ago?

Do you believe in a ‘soul’ and if so, what does this mean?


One thing that Herbert West’s subjects didn’t give him was consent to try his reanimation process on them. But going back to current conventional CPR, consent is often assumed (although there are potential complexities for the legal status of those attempting CPR) (https://www.resus.org.uk/cpr/legal-status-of-those-attempting-cpr/). If someone was found lying unconscious in a public place, CPR would often be attempted by emergency responders as a default position. Going back to our thought experiment then, we also don’t know the consent status of the buried bodies lying in a grave.


Questions

If we had the the technology and opportunity, should the default position be to try and revive individuals no matter the time between apparent death and medical intervention?

Again, if the technology was available, do we as doctors have an obligation to revive individuals who have long been considered dead?

How would society react to this process and do you think relatives of the previously deceased would want to (or even feel pressurised) to revive their ancestors?


Back to today, improving resuscitation outcomes with currently available CPR would clearly be considered a medical triumph. A perfected resuscitation technique would eliminate the issue of urgency associated with current CPR attempts. However, in many people their feelings change when we extend the time period since apparent death and successful resuscitation. What is the threshold for acceptability? There would also be other factors to consider such as the mental trauma of returning back to life in a very different time period, alterations in what we mean by life and death, not to mention the societal and economic implications. Please add your thoughts in the comments section below.


Summary

To end this post, I’m going to quote a section of the story:

“West clashed disagreeably with Dr. Halsey near the end of our last undergraduate term in a wordy dispute that did less credit to him than to the kindly dean in point of courtesy. He felt that he was needlessly and irrationally retarded in a supremely great work; a work which he could of course conduct to suit himself in later years, but which he wished to begin while still possessed of the exceptional facilities of the university. That the tradition-bound elders should ignore his singular results on animals, and persist in their denial of the possibility of reanimation, was inexpressibly disgusting and almost incomprehensible to a youth of West’s logical temperament. Only greater maturity could help him understand the chronic mental limitations of the “professor-doctor” type—the product of generations of pathetic Puritanism; kindly, conscientious, and sometimes gentle and amiable, yet always narrow, intolerant, custom-ridden, and lacking in perspective.”


Further resources

We need to talk about resuscitation
http://www.bmj.com/content/356/bmj.j1216/rapid-responses

HTA statement on a family court case regarding cryo-preservation of a child
https://www.hta.gov.uk/news/hta-statement-family-court-case-regarding-cryo-preservation-child

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