Friday 22 September 2017

When medicine and the need to play God collide

Serial killer: Harold Shipman
Serial killer: Harold Shipman

People who are sick are vulnerable and need the absolute assurance that their wellbeing will be the primary concern of those charged with healing them or caring for them, especially if their illnesses are protracted or terminal. How firmly based is that special duty of care and is the public trust in doctors and nurses misplaced?

In recent years, several well-known names have come to public attention for betraying this special trust. Beverly Allitt, now in her 40s, was a paediatric nurse in Lincolnshire who murdered four young children under her care and attempted to kill more. She is now detained at Rampton Secure Hospital in Nottinghamshire. Her motives have never been made clear.

British GP Harold Shipman murdered up to 250 people, most of whom were elderly. Shipman was 58 when he was found hanging in his cell at Wakefield Prison in 2004. His motives were never discussed by him and he insisted on his innocence even after conviction, as did his wife.

Now a German male nurse, known as 'Neils H', convicted of murdering patients at two clinics in Germany by injecting them with lethal substances, admits he killed more. He also participated in the resuscitation exercise with vigour so as to impress the medical staff with his skills, according to his statements. Some 100 remains have been exhumed and traces of the substance he used on the other victims have been identified in 84 of the remains.

To be seen to be making heroic rescue attempts is not the motivating factor here. In the work of Drs Elizabeth Yardly and David Wilson, respected criminologists whose profiling of the perpetrators of 'healthcare serial killers', approval seeking does not figure. Their work examined 16 such offenders in Britain and the US. They found that over 50pc had a history of mental health problems and features of personality disorder. Difficult personal relationships and frequent hospital moves also feature.

Dr Eindra Khin Khin from the University of Virginia in the US believes that globally the number of such murders has increased from the 1970s, when 10 cases were recorded to 40 from 2001 to 2006. She identifies thrill-seeking as one of the personality traits of this group, which they then wish to repeat. They are callous and indifferent to the suffering of the families left behind. Thus, they become remorselessly addicted to murder.

For others, it is power. Other gain financially by stealing the victims' money or possessions, such as jewellery. Some kill out of a misguided sense that they are doing good by removing those who are unworthy of life or, initially in some instances, those who are suffering.

While the majority of healthcare serial killers act alone, there have been a few recorded cases of group involvement, such as a case in Vienna in which four nurses killed 49 patients between 1983 and 1991. They were caught when a doctor overheard them laughing about their latest victim. The investigation into their actions suggested they may have taken the lives of more than 200 people.

The numbers of death perpetrated by healthcare professionals are often high because they are undetected for so long. The killer has the access and the means to kill. Their victims are invariably seriously ill and the death may seem explicable.

In some instances, these have come to light when deaths unexpectedly peaked in certain wards or during a particular nurse's shift. But that alone is not enough evidence and there is at least one miscarriage of justice case being considered by the Criminal Cases Review Commission in Britain at present, in the finding against Colin Norris. A BBC Panorama programme in 2014 suggested that the victims to whom he allegedly gave high doses of insulin and who did not need it may have died from natural causes due to a rare condition called insulin auto immune syndrome (IAS).

It remains to be seen if assisted suicide laws will attract and even encourage an even greater number of potential healthcare serial killers. It is certainly the case that they will have access and means and they may now have a seeming justification for "playing God".

For now, thankfully, healthcare killers are rare and we can take comfort from the commitment and care shown by the overwhelming majority of health service professionals. For now, at any rate, our trust is not misplaced.

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