Intentionally harmful violations and patient safety: The example of Harold Shipman

Abstract

Harold Shipman was an English doctor who killed approximately 15 patients while working as a junior hospital doctor in the 1970s, and another 235 or so when working subsequently as a general practitioner.1 Is it possible to learn general lessons to improve patient safety from such extraordinary events? In this paper we argue that it is not possible fully to understand how Shipman came to be such a successful and prolific serial killer, nor to learn how the safety of healthcare systems can be improved, unless his diabolical activities are studied using approaches developed to investigate patient safety. The World Health Organization (WHO) defines a patient safety occurrence as ‘an event which resulted in, or could have resulted in, unintended harm to a patient by an act of commission or omission, not due to the underlying medical condition of the patient’.2 Whatever the complexity of his actual motives3 when Shipman administered massive doses of diamorphine he clearly intended harm. But on the WHO's definition Shipman's practice falls outside questions about patient safety. We argue on the contrary that Shipman's case precisely requires to be understood within a patient safety framework (in addition to relevant legal and criminal frameworks).