Charting the ethical landscape of generative AI-augmented clinical documentation

Generative artificial intelligence (AI) chatbots such as ChatGPT have several potential clinical applications, but their use for clinical documentation remains underexplored. AI-generated clinical documentation presents an appealing solution to administrative burden but raises new and old ethical concerns that may be overlooked. This article reviews the potential use of generative AI chatbots for purposes such as note-writing, handoffs, and prior authorisation letters, and the ethical considerations arising from their use in this context. AI-generated documentation may offer standardised and consistent documentation across encounters but may also embed biases that can spread across clinical teams relying on previous notes or handoffs, compromising clinical judgement, especially for vulnerable populations such as cognitively impaired or non-English-speaking patients. These tools may transform clinician-patient relationships by reducing administrative work and enhancing shared decision-making but may also compromise the emotional and moral elements of patient care. Moreover, the lack of algorithmic transparency raises concerns that may complicate the determination of responsibility when errors occur. To address these considerations, we propose notifying patients when the use of AI-generated clinical documentation meaningfully impacts their understanding of care, requiring clinician review of drafts, and clarifying areas of ambiguity to protect patient autonomy. Generative AI-specific legislation, error reporting databases and accountable measures for clinicians and AI developers can promote transparency. Equitable deployment requires careful procurement of training data representative of the populations served that incorporate social determinants while engaging stakeholders, ensuring cultural sensitivity in generated text, and enhancing medical education.