COVERT VIDEO SURVEILLANCE IN MUNCHAUSEN-SYNDROME BY PROXY - ETHICAL COMPROMISE OR ESSENTIAL TECHNIQUE

It has been suggested that the use of covert video surveillance in sus pected cases of Munchausen syndrome by proxy should be curtailed as it represents a breach of trust between health care workers, parents and children. We present a case of asphyxia induced by a mother, which wa s discovered by videotaping without consent. Two previous sudden infan t deaths in the family over the preceding two years, with unexplained apnoeic episodes in the third child, were considered sufficiently susp icious to justify covert surveillance. Incontrovertible evidence of pa rentally induced asphyxia was obtained within 24 hours of full-time co vert surveillance. Despite initial denial, the mother eventually plead ed guilty to manslaughter of the first infant and to causing grievous bodily harm to the third infant. We believe that alternative technique s, such as parent-child separation, or of videotaping only after infor med consent has been obtained, could have compromised the investigatio n and produced unacceptable delays which would have placed the survivi ng infant at risk of serious morbidity or of death.