Truth or Lie? The Ethics of Malingering in Prison Healthcare
- codeofcures
- Sep 27
- 4 min read
How can healthcare professionals balance skepticism within their patients’ healthcare?
By Crystal Kong and Chloe Cherng, High School Students
Published September 25, 2025
Behind bars, an inmate's healthcare can be challenging to understand because healthcare workers are tasked with distinguishing truth from deception. This dilemma involves the ability to correctly identify if a patient’s reported illness/pain is genuine or feigned. Known as malingering, this practice involves exaggerating or fabricating symptoms for personal gain. Yet the ethical stakes are high: dismissing real illness as malingering can cause serious harm, while accepting false symptoms drains limited resources and undermines trust in prison healthcare.
Why does Malingering Exist?
The prison environment is a fertile ground for malingering due to multiple motives. Some prisoners seek to fake or exaggerate their symptoms to avoid incarceration, get transferred to less restrictive settings, escape duties, obtain medications, and attain a better living situation in the prison cell.
The three types of malingering are: pure malingering, partial malingering, and false imputation. Pure malingering is defined as the total fabrication of symptoms. Partial malingering involves exaggerating real symptoms, while false imputation involves attributing real symptoms to incorrect or unrelated causes (Kumar 2024).
An example of pure malingering would be faking psychosis or cognitive disorders. These disorders are popularly feigned conditions because their features appear more visual and obvious to show that they need to seek medical attention. With the help of the media, many TV shows often showcase symptoms of psychosis, giving inmates a familiar background in how to display symptoms. In addition, clinicians can observe behavior and assess the patients’ self-reports, but hallucinations and delusions are subjective experiences. This makes malingering harder to identify. If diagnosed with psychosis, they may be found incompetent to stand trial or get lighter sentencing, transferred to psychiatric units with better living conditions, and obtain sedatives as medication. These powerful incentives help explain why psychosis is one of the most frequently malingered conditions in correctional settings, placing clinicians in the difficult position of separating genuine illness from strategic deception.
Ethical Dilemmas for Healthcare Providers
Within the healthcare field, all providers must uphold ethical principles of autonomy, beneficence, non-maleficence, and justice. However, within a prison, lines can become blurred.
Incarceration limits physical freedom, but prisoners have the ethical right to make their own medical decisions. Thus, prisoners maintain the right to consent or refuse treatment; however, malingering complicates respect for autonomy. Physicians may suspect malingering from a prisoner, but this risks ignoring true symptoms, undermining trust and autonomy.
As physicians, they must act in the best interest of patients, even if they may be participating in malingering. Providing care must be done without rewarding deception. In all, providing care to an individual feigning symptoms may be beneficial, but overall, beneficence is complicated. For one, treating the symptoms can waste resources that could be used to care for others, or it may reinforce harmful behavior. Additionally, failure to provide treatment may lead to missing a true illness that is disguised by exaggeration.
While providing care, nonmaleficence may be undermined because harm can occur both ways: malingering is misdiagnosed as a real illness, or true illness is labeled as malingering. Oversurveillance of patients may lead to the erosion of the trust that exists within the patient-provider relationship. In all, physicians must be careful to avoid overtreatment and undertreatment in order to protect the vulnerable incarcerated population.
All patients, whether incarcerated or not, are subject to equitable healthcare. Physicians must provide unbiased care, not suspecting that prisoners are likely to malinger. However, malingering can deplete already limited prison healthcare resources. Thus, physicians must balance fairness between providing care to patients while also carefully distributing scarce resources.
Due to the risk of malingering, physicians must account for these principles when providing care in order to avoid legal consequences.
Recommended Ethical Practices
Overcoming malingering practices requires a careful balance of clinical work and ethical considerations. The most effective approach begins with a comprehensive psychiatric evaluation, supported by collateral information such as staff observations, prior medical records, and behavioral history to cross-check the validity of reported symptoms. In addition, physicians should look for atypical features. This includes identifying symptoms that sound too “textbook” or popularized by the media, inconsistent reports, and symptoms that don’t match the claimed condition. When made available, psychometric or validity testing can provide objective measures of cognitive function, strengthening the accuracy of assessments. Labeling someone a malingerer too hastily can worsen stigma and deny necessary care. By combining structured evaluation with respect for patient dignity, providers can better protect both the integrity of the system and the health of incarcerated individuals.
Conclusion
The concept of malingering blurs the line between providing equitable quality care for all, whether incarcerated or non-incarcerated, due to societal stigmas that exist. The role of physicians is extremely important within a prison due to the vulnerabilities that exist for the incarcerated population. This is because of their lack of physical autonomy, history of subjection to abuse, restricted privacy, risk of bias, and dependence on the state. Ultimately, with the right ethical practices, incarcerated individuals can receive quality care without being profiled based on stigma.
Works Cited
Comer, Amber R. “Care of Patients Who Are Incarcerated.” AMA Journal of Ethics, vol. 27, no. 4, Apr. 2025, pp. 277–282, journalofethics.ama-assn.org/article/care-patients-who-are-incarcerated/2025-04, https://doi.org/10.1001/amajethics.2025.277..
Kumar, Vikram. “Malingering in the Forensic and Correctional Settings.” Psychiatric Times, 21 Nov. 2024, www.psychiatrictimes.com/view/malingering-in-the-forensic-and-correctional-settings.
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