Letter: Parents accused

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Sir: Jeremy Laurance's article describing "psychiatric treatment" for parents with Munchhausen's syndrome by proxy (30 November) raises a serious question as to the ethics of consent for treatment and a further question over informed consent for its research elements.

Families are referred to centres like Dr David Jones's during family court hearings in cases of alleged Munchhausen's by proxy, where a finding has already been made on a balance of probabilities that abuse took place. The parents would have agreed to admission to the centre for assessment before a final decision on adopting out the children is made.

Continued denial of guilt is one of a number of diagnostic criteria for Munchhausen's syndrome by proxy. Confession is considered mandatory for rehabilitation.

In these circumstances there is a serious question as to the psychiatric treatment being voluntary, and there is a grave risk that admissions of guilt will be offered by parents in order to secure such treatment, even though experimental, to prevent their children being put up for adoption.

When the full published version of the article in Archives of Disease in Childhood is available it will be interesting to see how these issues were addressed.