Tania Gergel
King's College London
The primary aims are to consider whether a range of paternalistic medical interventions can be justified in the treatment of factitious disorder (FD) and to show that the particularities of FD and its management make it an ideal phenomenon to highlight the difficulties of balancing respect for self‐determination, responsibility and duty of care in psychiatry. FD is usually classified as a mental disorder involving deliberate and hidden feigning or inducement of illness, in order to achieve patient status. Both the nature of the disorder and the approach to treatment are controversial and under‐researched. It is argued that FD should be classified as a mental disorder; may well expose the patient to extreme risk; can warrant paternalistic interventions, in order to fulfil duty of care. Moreover, treatment of FD is inherently paternalistic and therefore raises interesting questions about justifications and type of paternalistic interventions in psychiatry both for FD and in general. A brief account of key questions concerning psychiatry and paternalism is followed by some case histories of FD, the clinical dilemmas posed and the question of how this disorder might warrant paternalistic interventions. In order to answer this question, two things are considered: the legitimacy and character of FD as a mental disorder; possible frameworks for and types of paternalistic interventions. To conclude, it is argued that there are no compelling reasons for rejecting the use of paternalistic interventions for FD, but that further investigation of FD and type and frameworks for psychiatric paternalism, in relation to FD and other mental disorders, are urgently needed.
Keywords paternalism, self-harm, self-deception, illness, factitious disorder, Munchausen's  philosophy of psychiatry
Categories (categorize this paper)
DOI 10.1111/jep.12388
Edit this record
Mark as duplicate
Export citation
Find it on Scholar
Request removal from index
Revision history

Download options

PhilArchive copy

 PhilArchive page | Other versions
External links

Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
Through your library

References found in this work BETA

A Normatively Neutral Definition of Paternalism.Emma C. Bullock - 2015 - Philosophical Quarterly 65 (258):1-21.

Add more references

Citations of this work BETA

Theory, Experience and Practice.Michael Loughlin, Jonathan Fuller, Robyn Bluhm, Stephen Buetow & Kirstin Borgerson - 2016 - Journal of Evaluation in Clinical Practice 22 (4):459-465.

Add more citations

Similar books and articles

Factitious Illness: An Exploration in Ethics.Neal Jay Meropol, Charles V. Ford & Richard M. Zaner - 1985 - Perspectives in Biology and Medicine 28 (2):269-281.
The Origins of Factitious Disorder.Richard A. A. Kanaan & Simon C. Wessely - 2010 - History of the Human Sciences 23 (2):68-85.
Mental Disorder, Moral Agency, and the Self.Jeanette Kennett - 2007 - In Bonnie Steinbock (ed.), The Oxford Handbook of Bioethics. Oxford University Press. pp. 90-113.
Personality Disorder and Competence to Refuse Treatment.E. Winburn & R. Mullen - 2008 - Journal of Medical Ethics 34 (10):715-716.
Reflections on Self-Deception.William von Hippel & Robert Trivers - 2011 - Behavioral and Brain Sciences 34 (1):41-56.
The Metaphor of Mental Illness.Neil Pickering - 2005 - Oxford University Press.


Added to PP index

Total views
61 ( #176,632 of 2,454,402 )

Recent downloads (6 months)
25 ( #29,342 of 2,454,402 )

How can I increase my downloads?


My notes