Ethical Issue Paper for Munchausen by Proxy

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The curious case of Munchausen By Proxy
Safa Elkhidir
Metropolitan State University

Introduction
Munchausen Syndrome dates back to 1843, when British physician Hector Gavin differentiated between people who faked an illness to achieve some sort of compensation and those who pretended to be ill for no other reason but to assume the sick role (Berry, 2008). The name Munchausen came from German cavalry captain who known for telling exaggerated stories about his life, travels and adventures (Berry, 2008). The first case of Munchausen syndrome diagnosed in 1951 by the British physician Richard Asher. He noted “the most remarkable feature of the syndrome is the apparent senselessness of it becoming a patient is the purpose of the syndrome" (Criddle, 2010, p. 46). Overview of the Disorder

Munchausen By Proxy is a rare but devastating illness. This is a condition where a caregiver induces or fabricates illness in a child, and presents for medical treatment (Beard, 2007). The DSM-IV -TR calls Munchausen By Proxy, a Factitious Disorder, in which the following criteria apply: 1. Intentional production or feigning of physical signs or symptoms. 2. The motivation for the behavior to assume the sick role. 3. External incentives for the behavior (such as economic gain, avoiding legal liability, or improving physical well-being, and in Malingering) are absent (American Psychiatric Association, 2000). This disorder is not about the child, but about the parent attempting to fulfill their needs and insecurities. The most common perpetrators are women who usually have medical knowledge such as nurses, or other health care professionals (Berry, 2008). These mothers are highly strategic in that they gain a trusting relationship with multiple healthcare providers. They are extremely active and interested in the care of their child, and often act as the liaison among healthcare teams (Kannai, 2009). The mother's extensive knowledge and vocabulary about medical problems often gains them the respect of health care team which gives them the attention and respect they crave. Although they have gained this knowledge from either education or internet research, the child presents with an undiagnosable case which has doctors puzzled, and motivated to find the cause of an untreatable illness. It usually starts when the mother brings the child to the doctor with a truly serious illness, and has a plan to maintain that illness, even when the child admitted into an acute setting.

The child will often present to the emergency department with bleeding (44%); seizure disorders (42%), central nervous system depression (19%), apnea (15%), diarrhea (11%), vomiting (10%), fever (10%), rash (9%) (Criddle, 2009). Mothers produce with ipecac, salt, insulin, laxatives, lorazepam, corrosives, diphenhydramine, amitriptyline, lamotrigine, and clonidine and the list go on (Criddle, 2009). Perpetrators these symptoms in their children in a variety of different ways. They can poison their children often mix their own blood into the child's urine and stool. They may suffocate their child to induce signs of apnea and seizures. They can also cause infection by depositing fecal matter, dirt, urine, or spit into wounds, orthopedic pin sites or intravenous catheters (Criddle, 2009).

However, according to Malatack, Consolini, Mann, and Raab (2006), there are two subtypes of Munchausen Syndrome By proxy. One type where the perpetrator directly causes the illness or injury or one in which the perpetrator simulates the disease or illness but does not directly cause injury to the child. There is no way to confirm whether or not the child had a fever the night before. An immense investigation can be stemmed from a child previously having severe symptoms of a fever or apnea, but no longer present with these symptoms. Often perpetrators will insist that something be done in order to "fix the problem" before they leave the hospital (Siegel, 2009). Perpetrators may start...
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