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PubMedDate not supplied

The physician as a health care proxy.

Many states prohibit patients from appointing their physicians as health care proxies, fearing paternalism and conflict of interest. But the potential for conflict is not unique to physicians, and patients may have compelling reasons to prefer that their doctor make decisions on their behalf. Managing potential conflicts serves patients better than denying them the right to choose who will make health care decisions for them when they are no longer competent.

Authoritarianism↗
PubMed2001

[Munchausen syndrome by proxy. Child abuse by falsification of symptoms].

Münchausen syndrome by proxy (MSbP) is a potentially lethal form of child abuse. Mortality rates around 10 percent have been reported. A knowledge of the characteristics of MSbP is needed in order to reveal the diagnosis and to handle the management correctly. Swedish experience is in accordance with international reports.

Adult↗
PubMed2001

[Munchausen syndrome by proxy, an unusual presentation].

We report a 12 year old girl that first consulted for fever with bilateral knee arthralgias. A neurological workout was started due to a progressive gait disturbance, but all results were incongruent with nerve or nerve root lesions, leading to the diagnosis of a functional paralysis. The patient worsened to the point of prostration. Due to the suspicion that the mother was inducing the symptoms, the patient was admitted to the hospital, where she improved notably. She was discharged walking. The improvement during hospital stay confirmed the diagnosis of a Münchausen by proxy syndrome, mimicking a disabling neurological condition.

Child↗
PubMedDate not supplied

Munchausen syndrome by proxy: a case report.

Munchausen syndrome by proxy (MSBP) is a serious form of child abuse, which is characterized by a child with symptoms and signs of an illness that have been fabricated by the mother. Here, we present a case of MSBP, who at four months of age was brought to our hospital by her mother because of rectal bleeding. The patient underwent many invasive procedures until the diagnosis of MSBP was finally considered. The mother reported no rectal bleeding for almost a year, during follow-up at the well-child outpatient department. At 19 months of age, another episode of rectal bleeding occurred, when a bloody diaper was presented to the attending physicians. The blood group and DNA analysis of the blood in the diaper confirmed the diagnosis. The case was reported to the social services and the patient was placed in the custody of her father's sister. The mother is still undergoing treatment in our psychiatry department.

Child Abuse↗
PubMed2002

Munchausen syndrome by proxy. The importance of behavioral characteristics in recognition and investigation.

Munchausen Syndrome by Proxy is a serious form of child abuse/maltreatment that often leads to death. Unfortunately, it is sometimes recognized only after a child dies. Police and EMS personnel are mandated reporters of child abuse; however, it is important to understand the differences in behaviors and characteristics found in Munchausen syndrome, as opposed to other forms of abuse.

Child↗
PubMed1992

The perversion of mothering: Munchausen syndrome by proxy.

Munchausen syndrome by proxy, in which a seemingly caring and concerned mother is simultaneously harming her child, can best be understood in terms of the mother's need for a relationship with a physician that is rooted in a profound sense of early abandonment. This understanding broadens the definition of perversions. The infant in this sadomasochistic interaction is dehumanized and is used as a fetishistic object to control the relationship. The author's literature review and case report provide the basis for his exploration of the historical, cultural, and psychological factors that both contribute to the development of the syndrome and conspire to deny its reality.

Adult↗
PubMed2004

Proxy identification: a time-dependent analysis.

OBJECTIVES: To describe the availability of next-of-kin (NOK) for proxy consent over the 24-hour time period following presentation of major trauma patients to a Level I trauma center. METHODS: The study was conducted by using a prospective, observational study design. Consecutive patients meeting predefined major trauma criteria during a three-month study period were enrolled and followed until NOK were contacted, or up to 24 hours. Survival analysis was used to determine the probability of NOK contact during the 24-hour follow-up period. RESULTS: Three hundred fifty (92%) of 382 subjects had NOK contacted during the follow-up period. The probabilities (95% confidence intervals [CIs]) of NOK contact at the time of arrival (t = 0) and 2, 4, 6, and 24 hours postpresentation were 0.25 (95% CI = 0.21 to 0.30), 0.68 (95% CI = 0.63 to 0.72), 0.77 (95% CI = 0.73 to 0.82), 0.80 (95% CI = 0.76 to 0.84), and 0.87 (95% CI = 0.84 to 0.90), respectively. The median time to contact was 40 minutes (95% CI = 27 to 54 min). CONCLUSIONS: One third of the trauma patients in this study did not have NOK available two hours following arrival in the emergency department. For time-critical research protocols, the time to NOK contact can significantly impact the ability to ensure prompt enrollment and treatment in clinical trials. Further studies are needed to assess the generalizability and consistency of these data.

Adult↗
PubMedDate not supplied

The New York State Health Care Proxy Law and the issue of artificial hydration and nutrition.

The New York State Health Care Proxy (HCP) Law allows a surrogate to make medical decisions for an individual when he or she loses the capacity to make them. In the area of artificial hydration and nutrition, however, this law dictates that if the agent is not aware of the patient's wishes regarding hydration and nutrition, the agent cannot decide about this treatment.

Advance Care Planning↗
PubMedDate not supplied

Munchausen syndrome by proxy.

Munchausen syndrome by proxy may result in a child suffering significant morbidity and mortality either from a parent or carer or as a result of unnecessary hospital admissions, investigations and treatment. It should therefore be considered in the differential diagnosis of any child with signs or symptoms that remain unexplained after standard investigations or are unresponsive to treatment.

Child↗
PubMedDate not supplied

Munchausen syndrome by proxy: recognizing the victim.

Munchausen syndrome by proxy is a serious and potentially lethal form of child abuse in which a parent deliberately induces or reports physical symptoms in a child. The child not only suffers from parent's action, but he or she is subjected to an extensive battery of invasive medical and radiological testing that are unnecessary and painful. All health care professionals must work together to ensure that the syndrome is discovered in time and the child is protected. The child's psychological and physiological welfare are in danger.

Child, Preschool↗
PubMed2006

Persistent problems with the Munchausen syndrome by proxy label.

After nearly 30 years of clinical and legal experience, the definition of Munchausen syndrome by proxy remains controversial. As a result, mothers who present the problems of their children in ways perceived as unusual or problematic have become entangled in legal battles that should have been resolved clinically. Re-labeling the disorder as Pediatric Condition Falsification misdirects the focus onto mistakes and misunderstandings while avoiding the more crucial issue of intentions. Experts have enflamed the fears of harm by confusing warning signs with diagnostic signs and by citing retrospective studies instead of the more optimistic outcome studies. Accused mothers need the support of multidisciplinary teams but are often forced into contentious struggles with legal professionals and child protection services.

Diagnostic and Statistical Manual of Mental Disord↗
PubMedDate not supplied

Munchausen syndrome by proxy: a different kind of child abuse.

Munchausen syndrome by proxy (MSBP) continues to mystify health care professionals, law enforcement officials and the judicial system. Even though the first cases were described in 1977, it remains puzzling why a parent would want to induce fictitious symptoms and illnesses in a child. Many professionals do not consider MSBP as a diagnosis because the parent, usually the mother, is so convincing that she is a "good" mother, cares about and wants the best for her child. This article is offered to further educate physicians that MSBP exists, can present in the form of anything and should be considered as a diagnosis in cases that do not make medical sense. Case examples are provided, along with common and not so common presentations. MSBP is a form of severe child abuse that must be reported to Child Protection Service when a child is endangered. Physicians play a critical role in identifying these children and recommending the best course of action to the rest of the system.

Child Abuse↗
PubMed1995

[Description of two cases of Munchausen syndrome by proxy].

The Munchausen syndrome by proxy, or Polle syndrome can be considered as a form of child abuse in which parents falsify or even produce a real pathology in their children submitting them to frequent hospitalizations and pointless medical examinations. The authors discuss two cases and emphasize the importance of an early identification of these cases to avoid psychical impairments that inevitably stem from this "new" form of child abuse.

Child↗
PubMed1995

Munchausen syndrome by proxy: a profile for medical child abuse.

The term Munchausen Syndrome by Proxy describes a pattern of physical abuse in which a perpetrator produces or fabricates illness in a victim. Victims are almost always children. We alternatively call this behaviour medical child abuse. Our report describes five recent cases. Two presented with infantile apnoea, one with alleged hypoventilation, one with recurrent vomiting and one with recurrent infections. Three of the perpetrators were mothers, two were fathers. In three cases diagnoses were confirmed by covert video surveillance. Contrary to popular beliefs, this behaviour is not rare and is not a syndrome of any known psychopathology. It is simply another, very dangerous, form of child abuse. Reported victim mortalities range from 9% to 31%. To ensure child safety we suggest the medical, legal and law enforcement communities begin to view this entity more as a profile of criminal abusive behaviour and less as a medical syndrome.

Adult↗
PubMed1994

Munchausen syndrome by proxy: an exploratory study of pediatric nurses' knowledge and involvement.

The awareness and involvement of pediatric nurses in the type of child abuse known as Munchausen syndrome by proxy (MSBP) was explored in this study. A questionnaire assessing knowledge about and extent of involvement in the identification of MSBP cases and demographic information was completed by 320 registered nurses (RNS) employed at a children's hospital. Fewer than half of the subjects (47%) responded that they had heard of MSBP. Those who had heard of MSBP demonstrated only a moderate level of knowledge of the signs and signals of the syndrome. Thirty-four percent of those nurses who had heard of MSBP had been involved in the detection of cases. Findings suggest that it might be important for pediatric hospitals to include information about MSBP in their own required classes or in-house seminars.

Adult↗
PubMed1995

[Munchausen syndrome by proxy].

Munchausen Syndrome by Proxy (MSbP) in children is a form of child abuse in which a parent (usually the mother) or other care-taker feigns or fabricates disease symptoms in the child, often to the extent of causing serious physical harm, sometimes even resulting in death. Even if the child does not suffer actual physical harm, there is great danger that his or her social and mental development may be jeopardized. Health care personnel risk becoming party to the abuse through exposing the child to unnecessary medical procedures. A case of MSbP involving two siblings is presented in the article, together with a brief summary of current knowledge of the syndrome and measures for its management, emphasising the necessity of close cooperation between paediatrician, child psychiatrist and the social services.

Adult↗
PubMed1994

Covert video surveillance in Munchausen syndrome by proxy. Ethical compromise or essential technique?

It has been suggested that the use of covert video surveillance in suspected cases of Munchausen syndrome by proxy should be curtailed as it represents a breach of trust between health care workers, parents and children. We present a case of asphyxia induced by a mother, which was discovered by videotaping without consent. Two previous sudden infant deaths in the family over the preceding two years, with unexplained apnoeic episodes in the third child, were considered sufficiently suspicious to justify covert surveillance. Incontrovertible evidence of parentally induced asphyxia was obtained within 24 hours of full-time covert surveillance. Despite initial denial, the mother eventually pleaded guilty to manslaughter of the first infant and to causing grievous bodily harm to the third infant. We believe that alternative techniques, such as parent-child separation, or of videotaping only after informed consent has been obtained, could have compromised the investigation and produced unacceptable delays which would have placed the surviving infant at risk of serious morbidity or of death.

Apnea↗