Bad Medicine Parents the State and the Charge of “Medical Child Abuse”

214 University of California, Davis [Vol. 50:205
positive results. The result, this Part shows, is that any given MCA
diagnosis is more likely to be a false positive result rather than a true
case of child abuse.
Finally, Part V turns to how the child protection and legal systems
should properly treat claims of child abuse involving medical care. It
argues that the only cases appropriate for state intervention on
grounds of child abuse involve those in which parents intentionally
induce or fabricate symptoms to get children unnecessary medical
care. These cases should be handled according to existing child abuse
law, rather than according to the MCA standards conceptualized by
doctors. Further, expert “diagnoses” of MCA should play no role in
these cases. Implementing this approach would restore parents’
constitutional rights to make their children’s health-care decisions,
safeguard the welfare of sick children who are better served in their
parents’ care rather than the state’s, and still protect children from the
rare, blameworthy parent committing genuine child abuse through
medical care.
I. THE GENESIS OF MEDICAL CHILD ABUSE CLAIMS
A. The Rise and Fall of the Munchausen’s Syndrome by Proxy Diagnosis
The precursor to the MCA movement dates back to 1977, when
British pediatrician Roy Meadow published case studies of two
mothers who had each repeatedly sought medical care for a child, but
turned out to be deliberately manufacturing their child’s medical
symptoms. 33 In one, the mother of a six-year-old treated for recurrent
urinary tract infections for several years was found to be adding her
own bloody urine to the child’s urine specimens. In the other case, the
mother had given her child repeated large doses of salt, from which he
later died. Both mothers, Meadow noted, “were very pleasant people to
deal with, cooperative, and appreciative of good medical care . . . .” 34
Noting that the behavior resembled Munchausen Syndrome, the
psychological syndrome in which healthy patients feign illness to
obtain medical care (named for Baron von Munchausen, a fictional
eighteenth-century raconteur), Meadow suggested that the
phenomenon might be called “Munchausen [S]yndrome [B]y [P]roxy”
33 See Roy Meadow, Munchausen Syndrome by Proxy: The Hinterland of Child Abuse,
310 LANCET 343, 343-45 (1977) [hereinafter Hinterland].
34 Id. at 344.