Ethical issues in child and adolescent psychopharmacology

Today's child and adolescent practitioner is faced with a series of clinical dilemmas that encompass ethical considerations. These clinical dilemmas warrant thoughtful and judicious decision-making starting with the initial contact with the patient and family. Ethical decision-making requires knowledge of the law in the particular jurisdiction in which the clinician is practicing, as well an appreciation of the many unknowns encompassed in the practice of prescribing psychopharmacologic agents for youth. The importance of weighing the effects of chronic psychopathology on the development of the child against the effects, often unknown, of short- and long-term psychopharmacologic treatment cannot be emphasized enough. The alliance with both parent and child or adolescent is essential in this process, and the viability of this alliance will determine compliance and, ultimately, outcome. Informed consent and assent involves all parties and must take into account developmental capacities and concerns. Well-kept records serve to document this process and are far more important from clinical, legal, and ethical perspectives than a 'consent' form.