Factitious disorder and liability

Some people deliberately fabricate illness or injury because they want to adopt the sick role. They have what was called ‘Munchausen’s Syndrome’ and is now called Factitious Disorder Imposed on Self (FDIS). People with FDIS not only harm themselves, they also cause harm to others, especially by diverting scarce health care resources away from those who need them. Should they be held criminally liable for the harm they do to others? The answer depends partly on whether criminalizing factitious behavior would deter people with FDIS, or whether it would have acceptable administrative costs and effects on the relationship with health care providers. My focus, however, will be on whether factitious behavior is blameworthy. I show that FDIS cannot be excused as a form of insanity, ignorance, addiction, or compulsion. At the least, it would be reasonable to hold people responsible for factitious behaviour harmful to others.