When former nurse Niels Högel was convicted of murdering 85 patients at two German hospitals, he became what is thought to be the country's most prolific peacetime serial killer. His case raises a troubling question: why would healthcare professionals kill those in their care?
Offenders rarely speak about their motives, and when they do, experts urge caution. American nurse Charles Cullen, who admitted killing at least 29 patients, claimed he was ending suffering, yet some victims were in recovery. Canadian nurse Elizabeth Wettlaufer described deep anger towards her eight victims, whom she injected with fatal doses of insulin.
Motives may differ between doctors and nurses, according to forensic psychologist Katherine Ramsland. Doctors often kill from a desire for godlike power or experimental curiosity, while nurses may kill to gain attention, find power in a powerless world, or relieve frustration. Criminologist David Wilson noted Högel showed signs of Munchausen syndrome by proxy, killing to impress colleagues by reviving patients.
Ramsland outlined 22 red flags associated with healthcare serial killers, including predicting deaths, moving hospitals frequently, and preferring night shifts. A cluster of five or more would be cause for concern. Cullen displayed half of these traits. Experts say that many people recognised such flags but failed to act, partly due to poor communication between authorities and nurse shortages in the UK and US.
Whether these killers enter the field with murderous intent or evolve into it is unclear. Ramsland said a 'rare few' become 'angels of death' from the start, while others transform on the job, seeing opportunities to escalate harmful behaviour in a hospital setting.
