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The case of a Nazi sympathizer who entered a famed Swedish medical school in 2007, seven years after being convicted of a hate murder, throws a rarely discussed question into sharp focus: Should a murderer ever be allowed to practice medicine?

A killer turned healer might seem to be a shining example of prison rehabilitation. And in many societies, including the United States, criminals who pursue an education during or after their prison sentence are often admired for their determination to turn their lives around.

Yet it is hard to think of a case in which a murderer should become a medical doctor. Integrity and trust are the core of the patient-doctor relationship. How many patients would feel comfortable being put to sleep by an anesthesiologist who once murdered?

The Swedish case is extraordinary, of course. But it poses questions that resonate far beyond the prestigious Karolinska Institute, where the murderer, Karl Helge Hampus Svensson, 31, began medical school last year. (Late last month, he was expelled on a technical issue - apparently falsifying his high school transcript.)

Alliances like the European Union have made it easier for doctors licensed in one country to practice in another. This increases the pressure on medical schools to be ever more vigilant in asking applicants about past criminal activity.

Potential terrorists, for example, might find a medical license useful. In the Middle East, doctors have been leaders of terrorist groups, and just last July, British officials implicated four doctors and three other medical workers in botched terrorist attacks in London and Glasgow.

Svensson (he had legally changed his surname from Hellekant while in prison) was convicted in the 1999 hate murder of a trade union worker and was paroled after serving 61/2years of an 11-year sentence. The Karolinska learned of his identity through two anonymous tips last fall. Although many Swedish news organizations reported the story at the time, most adhered to local journalistic custom and did not name him.

In scores of interviews, Swedes tended to express the view that a convicted criminal who wanted to go to medical school deserved the opportunity. But their opinions changed when they were informed that the Karolinska student was the publicized 1999 murderer.

What makes murder a special problem for medicine is the lengthy, costly and complex education system.

Consider the application process, which can vary among medical schools. The Karolinska does not require letters of recommendation, as is usually standard in the United States. About one-third of the Karolinska students are admitted on the basis of grades without an interview. The other two-thirds are judged on grades and an interview with senior faculty members. Applicants choose whether they want to be interviewed, and Svensson was one of them.

Two faculty members, one a psychiatrist, interviewed Svensson separately. But neither asked for an explanation of the 61/2-year period in his life, when he took courses through a prison-based intranet system. He did not volunteer his prison record. Karolinska faculty interviewers are not required to keep notes of those encounters.

No one knows how many Swedish doctors have criminal records, in part because of Swedish laws and culture that emphasize personal integrity.

In the United States, the chances of a convicted criminal's being admitted to medical school were reduced in 2002, when the standard application form from the Association of American Medical Colleges began requiring answers to questions about military discharge history, arrests and felony convictions. Each school determines which offenses, if any, would disqualify an individual for admission.

The association also recommends that all medical schools conduct criminal background checks for all matriculating students. But it is not clear how many do. From 2002 to 2006, on average, 26 of 36,000 applicants a year said yes to a felony.

Dr. Harriet Wallberg-Henriksson, the Karolinska's president, has asked the institute's ethics committee to address a number of questions concerning long-range policy on the issue of admitting criminals to the medical school.

Among the questions: Must educators and administrators inform patients about a convicted criminal student's past? If so, when and how? What about a convicted murderer who was later involved in treating a patient who died under medical care? Even if he was innocent in that death, the suspicions would be hard to erase.

Speaking of the general problems in admitting a murderer to medical school, Dr. Wallberg-Henriksson said: "In the final analysis, it comes down to trust, because when you are a patient you are putting your life in someone else's hands."

She said that because Svensson's expulsion was based on a technicality, his case did not resolve the broad issue of who is fit to be a doctor and whether a murderer forfeits the right to become one.


The ethics case that began at that Nobel place

The Karolinska Institute in Stockholm is famed for choosing the winners of the Nobel Prize in Medicine each year, and as one of the world's most prestigious medical schools, it rejects many students with the highest grades. Last summer, Karl Helge Hampus Svensson, 31, was among the 180 students admitted to the freshman class after receiving top grades in high school and courses he took online over the previous six years. But last fall, institute officials received two anonymous letters claiming that Svensson had been a Nazi sympathizer who was paroled from a maximum-security prison after being convicted in 2000 of murder, a killing the police called a hate crime. After confirming the information, the institute had to decide: Should Svensson be allowed to become a doctor? There was no legal way to expel Svensson, because "no national policy covers the situation," said Dr. Harriet Wallberg-Henriksson, the Karolinska's president. Late last month, the Karolinska Institute expelled Svensson - on a technical issue: He had apparently falsified the name on his high school academic transcripts.