Attachment 4



          STATE OF WASHINGTON, DEPARTMENT OF INSTITUTIONS

                   Division of Adult Correction
                   Washington State Penitentiary
                                and
                     University of Washington
                      Walla Walla, Washington

	        CONSENT TO CONTROLLED IRRADIATION BY 
	          DESIGN AND WAIVER OF LIABILITY

I,   , an inmate of the Washington State Penitentiary, Walla
Walla, Washington, being over the age of twenty-one (21) years,
do hereby give my consent and authorize the Superintendent of the
Washington State Penitentiary at Walla Walla, Washington, to
direct and authorize a physician, licensed under the laws of the
State of Washington, to perform upon my person, specifically in
the area of and upon the testes, an act of controlled
irradiation.  Said irradiation is in the nature of scientific
investigation and research and it has been fully explained to me
that the consequences of said irradiation cannot be entirely
known.  To the extent that such consequences are known, they have
been explained to me.  I do hereby acknowledge the possibility of
hazardous consequences and assume all risks attendant thereto.

I further acknowledge, agree, and consent that the foregoing
irradiation procedure will be conducted and supervised in its
entirety by  C. Alvin Paulsen, M.D. as authorized by the
Superintendent of the Washington State Penitentiary, and/or such
persons, medical, technical and otherwise as deemed necessary or
advisable by him.

Further, I do hereby consent to the administration of such other
medical treatment prior and subsequent to the application of said
irradiation as may, in the discretion of the attending physician,
be reasonably necessary or advisable.

I do hereby waive, relinquish, and release any and all claims,
demands or causes of action which may arise against the State of
Washington, Washington State Penitentiary and/or University of
Washington occurring directly or indirectly as a result of said
irradiation, or as a direct or indirect result of the
administration of medical treatment prior or subsequent thereto,
which in the discretion of the attending physician may be
reasonably necessary or advisable.

I do hereby further state that I have read the foregoing consent
to controlled irradiation by design and waiver of liability and
understand the contents thereof, and that such consent to
irradiation and waiver of liability are given of my own free act
and deed and not under any undue influence, threat or coercion.

     Signed this    day of    ,    


WSP#
(Consenting inmate's signature)

                        CONSENT AND RELEASE

PATIENT:

     I, the undersigned, hereby volunteer and consent to
participate as a subject of scientific experimentation in a
project entitled The Study of Irradiation Effects on the Human
Testis; Including ILLEGIBLE, Chromosomal and Hormonal Aspects.

     I understand that this is a scientific experimentation and
its consequences cannot be entirely known but to the extent that
the nature and consequences of this scientific experimentation
are known, they have been explained to me and I acknowledge that
said experimentation may result in permanent sterility and/or
other injuries.

     With full knowledge of the aforementioned hazards, I have
consented to and volunteered for said experimentation, and hereby
assume all risks attendant thereto, and release the State of
Washington, the University of Washington, their agents,
employees, and assigns from any and all claims arising from said
experimentation, either directly or indirectly.

     I further hereby authorize Dr. C. Alvin Paulsen and/or such
assistants as may be selected by him to perform a vasectomy
operation on myself.  The aforesaid procedure has been explained
to me by Dr. C. Alvin Paulsen or his authorized
representative,and I completely understand the nature and
consequences of the procedure to be as follows:

     Under local anesthesia, a permanent interruption of the
spermatic cord will be performed.  This will then prevent the
sperm from entering the seminal fluid; and that permanent
sterility will result therefrom.

     I have carefully read and understand the foregoing.

     Dated this      day of   , 1966.

Depository          (Patient's Signature)
Collection
Box No         (Witness)
Folder
               (Witness)

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                   SPOUSE'S CONSENT AND RELEASE

     The undersigned spouse of the above-named volunteer has read
the consent and release executed by her spouse and hereby
consents and agrees thereto and releases the State of Washington,
the University of Washington, their agents, employees, and
assigns from any and all claims which may arise directly or
indirectly from said scientific experimentation and from said
operating procedure (vasectomy).

     The results and consequences of said experimentation and
operating procedure have been fully explained to me, and I make
this consent and release with full knowledge of the
aforementioned hazards to my spouse.

(Spouse's Signature)


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