The Silence of the Lambs

A chilling trial in Berlin revives memories of Germany’s most notorious medical murders and raises troubling questions about end-of-life care oversight.

Germany is once again confronting the spectre of a caregiver turned killer. A 40-year-old palliative care doctor, known only as ‘Johannes M’ under Germany’s strict privacy laws, stands accused of murdering 15 patients over a span of nearly three years. The grave charges include 15 counts of premeditated murder with “base motives.”

The shock lies not just in the number of deaths, but in the chilling method and motive: prosecutors say Johannes M injected a cocktail of anaesthetics and muscle relaxants into unsuspecting patients, asphyxiating them silently in their homes. He then allegedly set some of those homes on fire to cover his tracks. Germany, known for its rigorous medical regulations and somber postwar soul-searching, is no stranger to the horror of medical professionals who violate their oath to heal.

The name Niels Högel still casts a long shadow. He was a nurse convicted in 2019 of killing 85 patients with lethal injections between 2000 and 2005, thus making him the most prolific serial killer in modern German history. Högel’s case prompted deep institutional introspection. Yet little seems to have changed structurally in the intervening years.

The prosecutor, Philipp Meyhöfer, told the Berlin state court that Johannes M conducted house visits “with the intention of killing his patients without their knowledge or consent,” motivated by a need to assert control over life and death. Two victims were killed on the same day. Five are believed to have died in fires he set, a macabre twist that finally alerted a suspicious colleague.

His motive remains shrouded in mystery. He has declined to speak in court or submit to psychiatric evaluation. The prosecution seeks not just a life sentence but also a finding of “particularly serious guilt.” That would make it possible to keep him imprisoned indefinitely and ban him from ever practising medicine again. Meanwhile, investigators are combing through at least 70 other suspicious deaths, including that of his mother-in-law in Poland.

The parallels to Högel are not merely sensationalist. Both men operated in the quiet spaces of the healthcare system, trusted with life’s most fragile moments. Both were allegedly driven by some obscure psychological need to manipulate death, unchecked by oversight or professional accountability.

Palliative care is, by its nature, intimate, subjective and emotionally complex. It exists in a legal and moral grey zone where doctors are trusted to make difficult decisions on behalf of dying patients. That very trust makes it ripe for abuse. Germany’s strict medical privacy rules and decentralised home-care model, designed to preserve patient dignity, may inadvertently shield malfeasance. When institutions rely more on honour systems than on rigorous data-sharing and monitoring, malevolent actors can flourish in the cracks.

The legal framework in Germany has lagged behind medical ethics debates. Euthanasia remains a contentious issue. Assisted suicide was decriminalised in 2020 following a constitutional court ruling, but no cohesive law has yet been enacted to regulate it. That vacuum may create opportunities for confusion or exploitation. In this case, however, no suggestion has been made that the patients wanted to die. On the contrary, the prosecution asserts that none were expected to pass away imminently.

The trial, expected to stretch until 2026, will likely prompt new scrutiny of how palliative care is delivered and monitored. Yet whether it leads to real reform is far from certain. After the Högel case, calls were made for better death certification, mandatory post-mortem reviews and a centralised registry for unusual medical incidents. Few of those safeguards have been implemented. Cost, bureaucracy, and a reluctance to question doctors too aggressively remain obstacles.

Ultimately, the horror lies not just in the alleged actions of one man, but in the structures that failed to detect him. In a system built on trust, even one rogue doctor can wreak untold havoc before the alarm bells ring. The German state must reckon not only with Johannes M, but with the ghosts it allowed to slip past.