Introduction

Munchausen syndrome by proxy (MSBP) involves someone who is responsible for a patient (often the mother) lying about and possibly even producing his or her symptoms while persistently presenting the patient (most commonly a child) for medical assessment. Doctors are most interested in getting advice on morally permissible means of collecting evidence that MSBP is occurring, as a way to stop harm to the patient. However, there are also other issues of a conceptual nature raised by MSBP such as its relation to child abuse, the distinction between deceiving and harming, and between diagnosis and prevention of harm. In this chapter I will first discuss conceptual issues and then move on to the more clearly ethical concerns related to diagnosis and prevention of harm.

Conceptual issues

The use of the term “syndrome”

Suppose a small percentage of doctors deliberately gave their patients laxatives inappropriately and wrote notes in the patient's record, on which other physicians and nurses in a hospital rely, attesting to the patient's being diarrhetic. Would it be most appropriate to refer to the doctors' behavior as a “syndrome” and think that confirming its occurrence was most appropriately referred to as “diagnosing” the patient's problem? Surely this would be inappropriate language to use, because it medicalizes what is essentially criminal behavior. Similarly, finding out if A was poisoned by B is not best described as diagnosing the cause of A's ill health.