Kevin Doherty

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.

Public understanding of artificial intelligence (AI) is essential for navigating the increasingly significant impacts of AI on society. Existing research provides guidance, but more work is needed to develop effective strategies for promoting AI literacy. The authors are part of a multidisciplinary team that organized an “Interactive AI Fair” at a large university. The authors conducted multi-method research during and after the Fair, including ethnographic observation, semi-structured intercept interviews, and a feedback survey. We found that a majority of Fair attendees used AI programs on a daily basis, and that most were interested in learning about the social and cultural impacts of AI. Moreover, we found that many attendees sought information about what we describe as the “metacognitive” effects of AI—i.e., the impact of using AI on thought processes, belief formation, knowledge production, reasoning, and interpersonal communication. Our findings suggest that efforts to promote AI literacy should address these metacognitive effects of AI.