Identification of persons with Munchausen's syndrome: ethical problems

Many of the most difficult management dilemmas created by patients with Munchausen's syndrome lie at the interface of law and medicine. Does a legal physician-patient relationship survive the imposturing of these patients? Are physicians relieved of their ethical and legal obligations in general, and their promise of confidentiality in particular, when they discover the elaborate counterfeit that these patients have constructed? Should physicians disclose confidential information to others--indeed do they have an obligation to do so--in an effort to break the endless cycle of hospital admissions that these patients invariably seek? This paper presents three possible approaches to these problems, and suggests useful criteria for managing Munchausen's patients, gleaned from the law of privacy, providing physicians with a firm basis upon which to strike an appropriate balance of all competing considerations. Specific guidelines and criteria can be formulated for disclosing the identities of Munchausen's patients without unduly encroaching upon their legal rights as patients.