Dr. Michael Swango, also known as "the poison doctor," is believed to be one of the most prolific serial killers in American history.

Michael Swango's story is unique in the annals of serial murderers because he often found his victims in their hospital beds, where he came to them dressed in a white coat, disguised as one who would give them care. Though he had served nearly two years in prison for poisoning, Swango was licensed to practice medicine. Despite the trail of violence he left in his wake, no hospital was willing to participate in a thorough-going investigation of his activities. The number of Swango's alleged victims is astonishing, but equally surprising is the number of hospital administrators and doctors who entrusted the care of patients to a convicted felon, and who, thereby, allowed him to continue his killing spree.

Of course Swango, as an alleged serial killer, is an anomaly. But isn't it also true that some of those whose job it was to ensure the safety of patients demonstrated negligence?

The article below is excerpted from The New Yorker magazine (November 24, 1997) article by James B. Stewart. Stewart will publish a full treatment of the case in book form next year. We have selected a section of The New Yorker article that details matters of most concern to us, as medical ethicists. It relates primarily to events that took place prior to Dr. Swango's 1985 conviction, when he was a medical resident at Ohio State University Hospitals.

Following the excerpt from The New Yorker are three opinions, from PRC staff member Philip J. Boyle, who writes from the bioethics perspective; from Ralph Muller of the University of Chicago Hospitals and Health System, who writes as the chief executive of a major healthcare provider; and from Dr. Joan Lang, director of residency training at the University of Texas Medical Branch, who writes both as a psychiatrist and as one responsible for evaluating the backgrounds and performance of resident physicians.

Our three respondents will try to answer some of the nagging questions raised by this sensational case: What should have been done by medical professionals, both administrators and clinicians, to stop Michael Swango? What are the moral obligations in a case like this, and who bears them? Does the fear of litigation on the part of healthcare providers release them from responsibility as moral agents? Our respondents take on these questions, in the hope that the case of Michael Swango is the last of its kind.

We invite our readers to address these questions as well. We welcome your cases for inclusion in a book PRC staff is preparing on organizational ethics to be published by the American Hospital Association. And we welcome your letters on the Swango case and our respondents' opinions, as well as your views on how to provide quality health care within an ethical organization.