Misguided shield for abusive parents
RECENTLY, a child in Seattle made repeated trips to the hospital for vomiting. His doctor found traces of a toxic chemical in the child's urine. The doctor alerted Child Protective Services, and police visited the child's home. They found the chemical in the family's medicine cabinet. Child Protective Services then accused the mother of repeatedly poisoning her child. This was allegedly Munchausen by Proxy - a syndrome whereby parents hurt their children to gain notoriety.
Child Protective Services removed the child from his home. But then the case swerved in a surprising direction. A local newspaper called the doctor overzealous. Because of confidentiality laws, the doctor couldn't defend himself in print, even to reveal his evidence. The family became a cause célèbre: That's the power of news media. Under public pressure, the child was returned to his mother and the risk that she might injure him yet again.
In New York, lawmakers are sponsoring a bill to make it harder for experts to act against guardians who are suspected of Munchausen by Proxy. The bill, if it passes, is likely to be repeated in other states. On the surface, the bill seems right. Who doesn't want to protect families from government pen pushers and grasping doctors? But this underestimates the complexity of the problem. Its passage would likely lead to more children being kept in danger.
Munchausen by Proxy was identified 30 years ago by the controversial British pediatrician Roy Meadow. (He was knighted for this discovery in 1998). Meadow's reputation guttered after he helped with the prosecution of Sally Clark - a woman convicted of murdering two of her sons; Meadow had cited faulty statistics about the "recurrence risk" for Sudden Infant Death Syndrome. Sally Clark was exonerated; though Meadow was found not guilty of "serious professional misconduct," two additional cases on which he'd helped the prosecution were overturned and hundreds have been put under official review.
After that scandal, doctors making a Munchausen by Proxy diagnosis often have been made to look zealous, even antifamily. While the parents can spoon-feed delectable lies to the press, the doctor - unable to make his case - is left to seem the guilty one.
Doctors aren't keen to have their own reputations and legal fates mingled with those of people who can defame them. The medical community has recently learned - after brushing the stove a few times, coming away with a number of high-profile burns - that the risks in making a Munchausen by Proxy diagnosis may outweigh the rewards.
Certainly, Americans believe in our authority to raise our children as we see fit: About a month ago, a Texas court ruled that authorities couldn't remove children from a polygamist compound, despite claims of child sexual abuse. And no one should take lightly the idea of the government plucking any child who's trapped in an imperfect family and dropping him into the howling foster care system.
However, doctors normally don't report Munchausen by Proxy; they report child abuse.
If a mother harms her child - or only lies about the severity of a real illness to bring about unnecessary treatment - it's the child's health that the doctor reports, and not Munchausen in the parent. All the same, it's appropriate for the protective systems also to be concerned about the caretaker's motives: Such factors can often predict how effective rehabilitation might be.
Munchausen by Proxy is a real syndrome. Last year, physicians diagnosed at least 1,200 cases in the United States. But doctors say the number of victims who go undiagnosed probably remains exponentially higher than that. Illness falsification also involves all gradations and severity of child injury.
Meanwhile, activists pushing for the kind of laws that shield parents from Munchausen accusations point to stats: Many accused parents do eventually win their children back. But that doesn't disprove the diagnosis. Activists can speak while the doctors cannot. And shouldn't the law be slanted toward the protection of the child?
Stories of Munchausen by Proxy often involve unbelievable details - fathers injecting sons with feces; mothers strangling babies. And so, naturally, juries and even judges often find it hard to fathom that parents would do the unfathomable. I'm sure the lawmakers behind the Albany bill are motivated by the most innocent of reasons: helping reunite broken families. But I'm reminded of Graham Greene's line about innocence - that it's like a dumb leper who has lost his bell, wandering the world, meaning no harm.
Darin Strauss is author of "More Than It Hurts You," the story of a mother accused of Munchausen by Proxy.
