University of Newcastle, Australia (Summer 2014)
|Archangel Michael reaching to
save souls in purgatory, 17th century, Jacopo Vignali
Medical murder or clinicide is defined by the psychiatrist Robert Kaplan as the “unnatural death of multiple patients in the course of treatment by a doctor.”1 Medical murder must be distinguished from euthanasia in that patients do not request the termination of their life. It must also be differentiated from death resulting from medical error or from iatrogenic causes, as these lack both the intent to kill and malice aforethought.2Kaplan divides clinicide into three categories; medical serial killers, treatment killers and political mass murderers. Medical serial killers derive a pathological and sadistic pleasure from the act of taking life.
One such example would be the case of British general practitioner Harold Shipman in 2000. An esteemed member of the community, Shipman was found guilty of fifteen counts of murder, though a government inquiry found it probable that Shipman was responsible for over 250 deaths. The killings took place over the span of Shipman’s thirty year career, and there was a pattern to the deaths, most of his victims being elderly women in otherwise good health. The victims were given lethal injections of the diamorphine; and Shipman signed their death certificates and altered medical records so that it would appear the victims had been in declining health.3 Though financial gain was not the primary motive, Shipman stood to gain financially from each murder.
Another medical serial killer is the American physician Michael Swango, who was found guilty of causing four deaths over a sixteen year period beginning in 1981, though a more reasonable estimate is sixty deaths. Practicing in America, Zimbabwe, and Zambia, he used identical means of selecting and killing otherwise healthy patients. He preferred those in intensive care units and injected them with poison, unnecessary medicine, or overdoses of regular medications. His diaries, which later formed part of his prosecution, detailed the pleasure he derived from the murders he committed “the sweet smell of indoor homicide…the only way I have of reminding myself that I’m still alive.”4
Within the category of medical serial killers, there are two paradigms that are of interest to note. The first is that of the Angel of Death – where physicians genuinely believe they are being compassionate and merciful in their murders.5 The second paradigm is that of a professional Munchausen by Proxy, whereby the doctor deliberately endangers the patient’s life, but hopes to be seen as making a genuine effort to revive the patient.5
Kaplan’s second category of clinicide is that of treatment killers. Such killers knowingly cause the death of their patients by subjecting them to a particular medical treatment. An instance of this type would be the Australian psychiatrist Harry Bailey, who was thought to be responsible for the deaths of seventy-five patients under his care at the Chelmsford Private Hospital between 1962 and 1979.6 Bailey was highly qualified and well travelled, and carried out experimental procedures such as Deep Sleep Therapy and Electroconvulsive Therapy on his mentally ill patients. There was little or no scientific basis for the effectiveness of his treatment, which was often performed without consent. Furthermore, patients were treated extremely inhumanely, sedated for up to fourteen days at a time with potent barbiturates. Men and women lay naked in common wards, fed through a nasogastric tube, lying in their own excrement and urine, and at high risk of pneumonia, infections, dehydration, vomiting, and respiratory problems.6
Jayant Patel is another medical treatment killer. Patel completed basic medical training in India before pursuing an interest in surgery in America. Failing to acquire specialist surgical qualifications, he relocated to the Australian town of Bundaberg, where between 2003-2005 he cause thirty to eighty-seven deaths. He neglected to follow basic hygiene, operated ineptly, and accumulating a track record of “unnecessary amputations, infections, internal bleeding and mutilation of healthy organs.”7
The last of Kaplan’s three categories are political mass murderers. They are perhaps the most overtly recognizable, as their killings are often sanctioned by the state in times of social and political upheaval. One of the most infamous examples is Josef Mengele, a Nazi physician at the Auschwitz concentration camp between 1943 and 1945. Mengele preyed on the extreme vulnerability of the Jewish prison inmates, using his position of power to sentence thousands to death by gassing or lethal injection, and to conduct perverted and barbaric experiments in the name of eugenics. Mengele was fascinated by identical twins, dwarfs, and people with two different eye colors. The true atrocities of Mengele’s experiments remain unknown, as few records exist today. His experiments on twins were said to include amputating limbs, sewing twins together to create conjoined twins, injecting one with an infectious disease and transfusing the blood of one into another. His experiments on individuals with two different eye colors consisted of injecting chemicals into the eyes of subjects, or at times killing individuals so that their eyes could be examined.8
Another less widely known example of political mass murders would be those murders brought about by Unit 731, a division of the Imperial Japanese Army. During the Second Sino-Japanese War from 1937-1945, doctors in Unit 731 were responsible for the deaths of an estimated 12,000 Chinese and Russian victims in Manchuria who underwent procedures such as vivisections, amputations, and mutilative surgery, often without anaesthetic. Victims were also deliberately infected with plague, cholera, syphilis, and used as live weapon targets. After the Japanese surrender to America in 1945, the physicians of Unit 731 were granted immunity in exchange for exclusively supplying the American Army with the results of their experiments. Some physicians were prosecuted and sentenced by the Soviet Union in 1949.
Nobody knows exactly how often medical murder occurs, or why. The practitioners of medical murder are experts, and there is not always conclusive evidence or reliable records of their actions. Often clinicide goes either wholly unnoticed or unnoticed for extended periods of time. Nor is the motive behind medical murder always easily discernible, though it has been postulated that the practice of medicine attracts individuals with highly narcissistic characteristics who develop a God-like complex. These individuals become infatuated by exercising complete power over life and death. Other physicians may kill out of sheer incompetence, or from the misguided belief that what they are doing is for the greater good of the patient. Political mass murderers justify their actions in the name of advancing scientific knowledge of the time, and because they ascribe to the notion that some races of people are inherently superior to others.
Medical murders often go unnoticed at the time because of a complex interplay of factors. Within the category of medical serial killers, physicians are expert in selecting vulnerable victims, whose deaths would likely go unnoticed, for example elderly and intensive care unit patients. These physicians have easy access to stores of lethal drugs, and are in charge of compiling medical records. They are easily able to falsify medical records, and in the event that suspicion is raised about their practices, they can hide behind the defense of euthanasia or medical error. There is also often within the professions a high degree of protectionism or “looking the other way” in regards to colleagues’ misconduct. Also, bureaucracy and red tape prevent inquiries from being appropriately timed, and there is often insufficient discipline. In the case of political mass murderers, these are the most opportunistic of killers, taking advantage of the social and political upheaval of the time.
- Kaplan, R. 2007. “The clinicide phenomenon: an exploration of medical murder”. Australasian Psychiatry 15 (4): 299-304. doi 10.1080/10398560701383236
- Law.com. 2014. Law.com. http://dictionary.law.com/Default.aspx?selected=1303
- Bovson, M. 2013. “Doctor Death Harold Frederick Shipman killed 250 patients- possibly more –earning himself the distinction of Britain’s most prolific serial killer.” Daily News, August 10. http://www.nydailynews.com/news/justice-story/dr-death-britain-prolific-serial-killer-article-1.1423566
- Geringer, Joseph. 2014. Michael Swango – Doctor of Death. http://www.crimelibrary.com/serial_killers/weird/swango/pleasure_8.html
- Crime Library. 2014. Crime Library. http://www.crimelibrary.com/
- Garton, S. 2007. “Bailey, Harry Richard (1922-1985).” Australian Dictionary of Biography 17 (4). http://adb.anu.edu.au/biography/bailey-harry-richard-12162
- Thomas, Hedley. 2007. Sick to Death. 1st ed. Allen and Unwin.
- Trueman, Chris. 2013. Josef Mengele. http://www.historylearningsite.co.uk/josef_mengele.htm
is a third year medical student at the University of Newcastle, Australia. Prior to starting Medicine she studied a Bachelor of Economics. She has a strong interest in current affairs and journalism, and finds medical journalism the perfect way to bridge her profession with personal pursuits. She has written articles for medical student publications; and regularly submits essays in local and national writing competitions.
Highlighted in Frontispiece Summer 2016 – Volume 8, Special Issue