A Model Consent Form

A Model Consent Form for Children and Psychiatric Drugs

Dr. John Breeding 

I understand that my child has been assigned a DSM-IV diagnostic label, based on my doctor’s (and perhaps others) subjective observation of my child’s behavior. I am aware that there is no medical evidence that my child has a medical problem, and no scientific evidence that proves the existence of the illness, which my child is said to have.

I am aware that I will never be able to remove this diagnostic label or any other from my child’s medical record, and that this record may interfere with possible educational and vocational directions of my child.

I have been informed that the drug or drugs my doctor is prescribing for my child cannot cure whatever “illness” or “chemical imbalance” this doctor may believe my child to have, but can only affect “symptoms.” I understand that psychiatric drugs have not been demonstrated to have long-term positive effects on any measure of learning, behavior or social development in children.

I understand that the review and approval process of psychoactive drugs by the FDA is both controversial and complicated, and that, therefore, all psychiatric drugs must be considered experimental. I have been informed of all the known effects of any recommended drug, and I have a copy of the current information listed on these drugs in the Physicians Desk Reference.     I also am aware of the up-to-date accumulation of FDA adverse reaction reports of any prescribed drug; I understand that it is necessary to multiply the number of reported reactions by up to 100 to estimate the actual incidence of these reactions. I understand that these drugs are addictive and create dependency, and that drug withdrawal can pose serious problems.

I understand that taking psychiatric drugs may cause severe pain and discomfort to my child, worsen my child¹s condition, or even cause my child permanent damage or death. I also understand that no body of research clearly shows that the problems indicated by my child’s diagnosis require or respond more favorably to drug treatment than to one or more forms of non-drug treatment.

I understand that this brief statement is only the “tip of the iceberg” regarding psychiatric diagnosis and drug treatment of my child, and that it is my responsibility to take the necessary time and trouble to fully research the relevant necessary information in order to make an informed decision on behalf of my child.

I understand that since psychiatric diagnosis and drug treatment of children is considered customary and usual medical practice, doctors are generally not held liable for harm resulting from such treatment. Therefore, I understand that the effects of such treatment are, practically speaking, my complete responsibility as a parent.

Signature of Parent or Guardian: ______________________________________

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