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

222 University of California, Davis [Vol. 50:205
not have symptoms that warrant a doctor visit, even though the parent
accurately relays the child’s symptoms. 70 Moving further along the
spectrum, a parent could misstate a child’s symptoms or condition to a
doctor unintentionally, making an error that a considerable number of
parents would make (say, overestimating the amount a child has spit
up, or inaccurately remembering when a particular symptom began).
Or, moving along the spectrum of parental conduct, a parent could
intentionally overstate a child’s symptoms to the doctor, as parents
often do, 71 in an effort to get the child treatment that the parent truly
believes that the child needs. (The parent may say, for example, that
the child could not get to sleep until 5 a.m. every morning as a result
of a medication side effect that induced insomnia, when the child had
gotten to sleep at 3 a.m. one morning.) Or a parent could significantly
overstate a child’s condition because the parent is simply wrong, or
has been misled by the child. Or, moving still further along the
spectrum, a parent could have what might be called “hypochondriasis
by proxy,” 72 and imagine symptoms that a child does not have. And all
the way at the other end of the spectrum is the behavior associated
with MSBP — the intentional lie or inducement of symptoms by the
parent to get medical care that the parent knows that the child doesn’t
need for the parent’s own secondary gain. All of this becomes potential
grounds for intervention under the MCA definition.
The vagueness of the term “instigate” was not Dr. Roesler and Dr.
Jenny’s only innovation to expand doctors’ supervisory authority over
parents by means of MCA charges. Through including behavior by the
parent that led to both harmful and potentially harmful medical care,
and then defining the term “potentially harmful” to include exposure
of a child to any potential degree of risk whatsoever, 73 the MCA
70 See ROESLER & JENNY, supra note 12, at 143 T.1. Dr. Meggan Goodpasture of
Wake Forest Baptist Hospital publicly noted controversy within the subfield of child
abuse pediatrics on the issue of whether the term “instigates” covers overly-anxious
parents who accurately recount their child’s symptoms, and stated that she personally
would not diagnose MCA in such a case. See Meggan Goodpasture, Ass’t Professor of
Pediatrics, Wake Forest School of Medicine, Medical Child Abuse: A Review of
Caregiver Fabricated Illness and Its Impact on Children, Families and the Medical
Team at the Wake Forest Baptist Medical Center 2015-2016 Conference Series (June
14, 2016).
71 See C. J. Morley, Practical Concerns About the Diagnosis of Munchausen Syndrome
by Proxy, 72 ARCHIVES DISEASE CHILDHOOD 528, 528 (1995) (“Many mothers are just
over anxious and trying to get the doctor to listen, or exaggeration may be part of her
normal language.”).
72 The term is Eric Mart’s. See MART, supra note 37, at 26.
73 Isaac & Roesler, supra note 63, at 291 (“Any medical procedure, for example, a
blood draw, or a trial of medication that is potentially harmful, could be considered