Sunday, April 26, 2009

Craigslist Killer? What do we know about Physician Serial Murderers?

The so-called Craigslist Killer - hasn't even been convicted, at least not in a criminal court

The Craigslist Killer has been the recent subject of media attention. Since I seem to recall my law professors teaching me that an individual is presumed innocent until proven guilty at trial, I shall refrain from offering worthless speculation and adding to the hype. Instead, I'll try to do what I always do - provide you with some forensic knowledge about the issue in general, like I try to do with juries, and you can take this knowledge and form your own conclusions.

So - what do we really know about physicians who kill?

A physician swears by the hippocratic oath, and also swears to "first, do no harm," while putting his patients' best interests above all else. What could be more unnerving than a person who has taken this oath, looks the part, talks the talk of the helping profession, and appears to walk the walk as well? The truth is that killer doctors are nothing new, yet perhaps the aura of the profession has buffered these individuals from being examined too closely by the research - until relatively recently.

The study of medical serial killers may have gone overlooked due to an unwillingness to perceive sworn “healers” as potential murderers. However, research has revealed that medical killers may actually be the most prolific of all serial killers. Doctors who serially murder their patients are considered to belong to a larger group of “career-assisted killers.” The term “clinicide” has been used to describe “the unnatural death of multiple patients in the course of treatment by a doctor.”[i] Such murders may be difficult to detect, since they often occur in settings where death is expected to happen. Doctors accused of clinicide will be likely to put forth the defense that they were relieving suffering or providing euthanasia. Clinicidal doctors may have extreme narcissistic personalities, and may obtain pleasure by “determining” when a person will die.

One of the most deadly doctor serial killers may also hold the dubious distinction of being one of the most prolific serial murderers to date. Dr. Harold Shipman, a UK physician, was convicted of killing 15 patients with lethal injections of narcotics. In a post-trial investigation, it was concluded that Shipman was responsible for 218 known victims.[ii] Other estimates have suggested the number is closer to 450.[iii] Most of Shipman’s victims were not terminally ill, nor did they have an immediate life threatening illness. Shipman refused to speak to anyone, and no complete psychological assessment was ever performed on him.29 He committed suicide in prison in 2004.

Other healthcare professionals have been implicated in serial murder. In a study of 90 healthcare killers, 86% were nurses and 12% were doctors.[iv] Injection was the most common method used, followed by suffocation, poisoning and tampering with equipment Fifty-four of the 90 cases were ultimately convicted. A total of 2, 113 deaths could be attributed to these 54 convicted healthcare killers.

The motives? Most have speculated that it has much to do with the feelings engendered in the killer by the power of life over death - perhaps the very thing that drew them to the profession in the first place. Does the Craigslist killer appear to fit this profile? Unknown - because a legitimate forensic scientist will not draw such conclusions based only on what the media presents us with. We will just have to wait for the case and evidence to unfold.

[i] Kaplan R. The clinicide phenomenon: an exploration of medical murder. Australasian Psychiatry 2007 15(4): 299-304.
[ii] Esmail A. Physician as Serial Killer – The Shipman Case. N Eng Jour Med 2005 352(18): 1843-1844.
[iii] The Shipman Inquiry. First Report, Volume One Death Disguised. COI Communications, Manchester, 2002.
[iv] Yorker B., Kizer K., Lampe P., Forrest A., Lannan J., Russell D. Serial murder by healthcare professionals. J Forensic Sci 2006 51(6): 1362-71.

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