- A former nurse named Niels Högel was convicted of killing 85 patients by lethal doses of medication.
- He is not the only medical professional who has fallen into this pattern.
- These killers are known as “angels of death.”
- Visit INSIDER’s homepage for more stories.
This month, former nurse Niels Högel was convicted of killing 85 patients between 1999 and 2005 by administering lethal doses of heart medication. Though Högel’s story is shocking, it actually falls into a pattern known by professionals.
Known as an “angel of death” or medical killer, this type of serial killer purposefully ends the life of a person under their care. They’re often employed as healthcare professionals or caregivers and may be active for years without being caught.
“Angel of death serial killers are extremely lethal and typically have a high body count,” Carol Lieberman, MD, a forensic psychiatrist and expert witness, told INSIDER.
INSIDER consulted with psychologists and criminal experts to shed some light on what drives some people to kill in this way.
Experts recognise different types of angel of death killers, including the ‘angel of mercy’
The one thing that unites all angels of death is their desire to kill people whom they are meant to be helping. Beyond this basic urge, they may have different motivations for their crimes. One variation of the medical killer type is the “angel of mercy.”
“The ‘angel of mercy’ killer may perceive their acts as merciful to the victim, such as an elderly or chronically ill victim,” forensic psychologist and former FBI consultant Dr. Darrel Turner told INSIDER.
Along with deriving pleasure from killing, the angel of mercy sees their actions as actually benefiting their victim. They might target long-term hospital patients who they deem unlikely to recover, people experiencing high levels of pain, or any victim whom they feel would be better off dead. Occasionally, an angel of mercy may kill to spare the victim’s family the pain of watching a loved one die slowly.
“Some angels of mercy may also be acting out trauma from their childhood, such as a parent who lingered for months before they died,” said Dr. Lieberman. “They tell themselves they are trying to prevent the patients’ families from going through the same despair.”
One famous example of a self-proclaimed mercy killer is serial killer Donald Harvey, who worked as an orderly in Cincinnati-area hospitals in the 1970s and ’80s. Harvey eventually pleaded guilty to murdering 37 people over the course of more than a decade, though he claimed to have been responsible for the deaths of nearly 90 individuals. During his confession, Harvey claimed that he murdered his victims to ease their suffering.
Some angels of death fall into the ‘malignant hero’ category
For some angels of death, murdering those in their care isn’t about mercy at all. Malignant heroes are killers who intentionally bring their victims to the brink of death in order to rescue them at the last moment.
“An angel of death may have a ‘saviour complex,’ and find a perverse pleasure in being viewed by others as a hero trying to save the very person they are actually murdering,” said Dr. Turner.
Malignant heroes choose to harm their victims just to resuscitate them, thereby impressing their coworkers or even earning a promotion, explained Dr. Lieberman. Since the malignant hero is often the only one who knows exactly what is causing the patient’s medical distress, they’re usually perfectly positioned to administer the life-saving treatment or “miracle” cure.
Suspicions may be aroused amongst family or hospital staff if a patient’s condition always seems to worsen during a certain caregiver’s shift, or if the killer is the only person able to bring the patient back from the edge of death.
In 2001, American serial killer and former nurse Kristen Gilbert was convicted of killing four of her patients. Investigators discovered that Gilbert would inject her victims with epinephrine, sending them into cardiac arrest. She would then respond to the emergency call and attempt to resuscitate them herself. Other nurses eventually noticed a correlation between Gilbert’s presence and an increased number of cardiac emergencies.
Prosecutors theorised that along with playing the hero, Gilbert was trying to attract the attention of hospital police officer James Perrault.
The sadistic angel of death loves having power over their victims
Some medical killers revel in the feeling of power that killing or saving their victims allows them to experience. Known as sadistic killers, they take true pleasure in the act of murder and use their position to reinforce dominance over others.
“This type of killing is more about the god-like power the predator has over their victims, the ability to control the life and death of another person,” explained Dr. Turner.
Jane Toppan is perhaps one of the most infamous sadistic medical killers. Nicknamed “Jolly Jane” for her apparently warm and friendly demeanour, Toppan worked as a nurse in Boston during the late 1800s. She used morphine and atropine to experiment on patients before killing them with overdoses. Toppan later said she derived sexual satisfaction from climbing into bed with her dying victims and enjoyed watching the life fade from their eyes.
When confronted by authorities after her arrest in 1901, Toppan reportedly stated that it was her ambition “to have killed more people – helpless people – than any other man or woman who ever lived.”
Unlike many serial killers, many angels of death aren’t considered to be antisocial. This can make them hard to spot.
Many serial killers display behaviour consistent with what psychologists would call antisocial personality disorder, or a pathological disregard for other people’s feelings that sometimes leads to violent or reckless behaviour. But unlike most serial killers, medical killers don’t always fit this mould.
“Generally, serial killers are diagnosed with antisocial personality disorder,” psychologist Dr. Michele Leno told INSIDER. “Angels of death, however, do not always possess antisocial intent. They may believe that their actions eliminate misery and serve the greater good.”
Though narcissistic or self-centered thinking may drive their behaviour, Dr. Leno explained that angels of death are not easily identified or diagnosed because they don’t always conform to the typical antisocial psychiatric category.
“Medical killers may be rigid, controlling, and intense, but others may perceive them as simply high strung or serious about their jobs,” said Dr. Leno.
Angels of death may be unique, but they still conform to some established patterns
“An angel of death killing is rather unique in that it speaks to a more complex psychopathy at work in the mind of the predator,” said Dr. Turner.
Even so, experts often see some of the same patterns among these killers as they do with traditional serial killers. Dr. Turner explained that the most obvious similarity between angels of death and traditional serial killers is that they both usually fall into one of two types: disorganized and organised killers.
“The organised, methodical killer has a higher degree of intelligence and therefore a higher threshold for risk. The disorganized killer is a sloppier and more impulsive killer who does it because it’s easy,” said Dr. Turner.
Dr. Turner explained that murdering people with whom you are regularly in close contact, such as patients or dependents, greatly increases the risk of getting caught. It often takes an organised killer to deal with this level of risk and avoid detection.
However, some angels of death are classed as disorganized killers who simply take advantage of the ease of access and ample opportunity that a hospital setting provides to harm their victims.
“It is far easier to kill someone who is under your care at a hospital, simply by changing their medication or increasing the dosage, than it is to find a random victim, lure them into a car, and bludgeon them to death,” said Dr. Turner.
Business Insider Emails & Alerts
Site highlights each day to your inbox.