His profession was healing, and many of his patients admired him for his industry and the kindliness that seemed to be reflected in his benign and slightly sad eyes. But behind that caring exterior, Dr. Harold Frederick Shipman was a killer, perhaps the worst in British history. A judge in Preston, 50 km north of Manchester, last week gave him 15 life sentences for the murders, by lethal injection, of 15 women in his care. Prosecutors say they have strong evidence of another 23 killings, and police say he may have slain more than 150 of his patients over several decades.
He got away with murder precisely because he was a doctor and his victims were mostly elderly and single. In Hyde, the plain suburb of Manchester where he worked, Shipman was renowned for his energy and concern and became so popular that even in a solo practice he had 3,100 patients, 9% of the town's population. He frequently made house calls to check on the sick, to take blood samples or inject antibiotics. But some of them got a different injection: diamorphine, otherwise known as heroin, which doctors normally use to relieve pain. It first put them to sleep and then killed them, usually in about five minutes. Some he killed in his own office, emerging to see other patients while the diamorphine did its work. He covered his tracks by entering bogus ailments on the death certificate, falsifying records to concoct a plausible history of prior illness, discouraging relatives from requesting autopsies and by encouraging cremation.
He killed, apparently, for the thrill of domination he got from causing and observing death. Richard Badcock, a forensic psychiatrist who interviewed him before the trial, says Shipman has a powerful, constant need for control which has taken many forms. Arrogant to other doctors, a domineering husband, greedy for adulation from his patients, he would be "virtually in a state of collapse" when he felt his sense of control threatened--and was never more powerful than when snuffing out the life of someone who trusted him. He was hooked on the painkiller pethidine in the 1970s, which he self-injected to relieve depression, a drug habit he kicked only to become addicted to killing. The death in 1963 of his own doting but demanding mother from cancer, which was eased by morphine, may have been one trigger for his murderous journey.
Whatever the motive, he killed so often that there were some close calls. He poisoned an 81-year-old patient named Maria West in 1995 without realizing that a friend was waiting quietly in the kitchen. He momentarily lost his composure when he came in to wash his hands and encountered her, but gathered himself and announced West's death. In 1997 a neighbor of Jean Lilley walked over to check on the 58-year-old who was suffering from a cold, and saw Shipman driving away. Inside, the neighbor found Lilley on her couch, freshly dead, her lips turning blue. Typically for Shipman's victims, Lilley was sitting up and fully clothed. Also that year Shipman visited Kathleen Wagstaff, 81, without a request from her. A friend overheard her say, "Fancy seeing you here," as Shipman arrived; 45 minutes later she was dead.
People became suspicious. John Shaw, a Hyde taxi driver, noticed as early as 1994 that many of his regular customers were dying and that Shipman was their doctor. He began to keep a list. It had reached 23 in 1998 when he went to the police with his fears. An undertaker wondered why Shipman's practice provided so many corpses. Two nearby doctors worried about the large number of cremation certificates he asked them to countersign. But a cursory review of his death certificates found nothing obviously amiss.
In the end it was greed that halted Shipman's death machine. He forged the will of Kathleen Grundy, an energetic 81-year-old former Hyde mayor, leaving her entire estate of $615,000 to him in recognition of "all the care he has given to me and the people of Hyde." But Grundy's daughter Angela Woodruff is a lawyer. The new, crudely typed will with an unfamiliar signature showed up after her mother's unexpected death and once she determined that the ostensible witnesses didn't recall signing it, Woodruff went to the police. Investigators obtained an exhumation order, and tests on Grundy's body showed fatal levels of diamorphine. Shipman heatedly denied all charges. But he collapsed and then stopped answering questions when the police confronted him with logs from his own computer showing that he had altered his victims' medical records.
One result of the verdict is deep soul-searching in Britain's medical profession. Shipman had stockpiled enough diamorphine to murder 1,000 people by picking up prescriptions for patients himself and snitching leftovers from the bedsides of those he murdered. Victims seldom had autopsies because none is required if a physician has seen the patient within two weeks of death. The doctors he asked to authorize cremations did not always examine the bodies or review their case histories. Nor does any agency monitor death rates in medical practices. A government inquiry, set up after the verdict, will recommend how to tighten the supervision of doctors.
Shipman has never confessed to any of the murders. Nor, says psychiatrist Badcock, is he ever likely to, because that would require confronting a terrible shame. So even in jail he will continue to prey on the people of Hyde: keeping hundreds of families in the dark about whether their loved ones died naturally or were random victims of his evil obsession.