Beyond Transparency

Abstract The 2021 Cures Act Final Rule mandated that patients have immediate and complete access to their health records. This policy change fundamentally altered the ethical significance of documentation, transforming the note from a useful clinical artifact to direct testimony from practitioners to clients. Drawing on conceptual and empirically informed resources from philosophy, psychiatry, and public health, we identify six ethical note obligations (ENOs) as a principled theoretical framework to support ethical documentation in a post- Cures Act context. Unfortunately, in nonideal circumstances, these new obligations present an undue burden that is contrary to the aim of care, posing a dilemma between ethical note obligations and documentation burden. We reject note-taking contrary to care, which entails a call for strategies to reduce documentation burden to achieve the aims of the ENOs framework. To this end, we call for the ethical adoption of AI-assisted documentation to meaningfully alleviate documentation burden, thereby enabling ethical notes.