Intended for healthcare professionals


Opportunity may be more important than profession in serial homicide

BMJ 2001; 322 doi: (Published 21 April 2001) Cite this as: BMJ 2001;322:993
  1. Cameron Stark (Cameron.Stark{at}, consultant in public health medicine,
  2. Brodie Paterson, lecturer,
  3. Brian Kidd, consultant psychiatrist
  1. Highland Health Board, Assunt House, Inverness IV2 3HG
  2. Department of Nursing, Stirling University, Stirling FK9 4LA
  3. Forth Valley Primary Care NHS Trust, Royal Scottish National Hospital, Larbert FK7 8AH

    EDITOR—Kinnell suggests that the incidence of serial homicide among doctors may indicate a pathological interest in the power of life and death.1 He notes that other professions may have fewer murderers. Our analysis of serial killers in nursing suggests an alternative interpretation.2

    At least in relation to the murder of patients, nursing provides further examples of healthcare staff who have murdered patients in their care. In a review of 34 serial murderers in the United States, six were nurses.3 We identified 13 convictions of nurses for the serial murder of patients up to 1997.2 In Hickey's series, nurses had often killed for several years before they were identified.3 Higher risk is associated with the delivery of intravenous fluids, with being in a bed out of sight of a nursing station, and with evenings or nights.2

    When this information is combined with Kinnell's observations on Shipman and Nesset, it begins to seem plausible that all walks of life have people with the potential to murder. The key difference may be opportunity. The features associated with risk noted above suggest that access and a low chance of observation are important. The difference between nurses and doctors may be that doctors also control the means of disposal—in the case of Nesset and Shipman, they also provided the death certificate. The reason for the difference in the number of reported deaths may simply relate to the doctors' greater opportunity to remain undiscovered.

    The difference between professions may be less striking than it first seems. We should not focus on one occupation. It is more important to develop safe systems. We have argued for the importance of appropriate critical incident review, which allows the identification of serial murder as well as other far commoner problems.4 Shipman's case should not promote paranoia but should lead us to consider how best to identify problems. The techniques for further analysis of unexpected deaths are readily available, but we should not confine our attention to any one possible cause or profession.


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