This essay is a part of our “In the News…” series, where bioethicists give their take on popular news stories.
The medical record rarely makes headlines. In the Lindsay Clancy murder trial, however, the medical record has become part of the evidence used to understand the mental state of a mother accused of killing her three children.
In January 2023, Clancy was accused of strangling her three children in the family’s Massachusetts home before attempting suicide. Clancy survived the suicide attempt and has pleaded not guilty to murder by reason of insanity. Her trial began on July 27, 2026, in which her defense argued that she was experiencing severe mental illness, including postpartum psychosis, and therefore was not criminally responsible for her actions. The prosecution has argued that the killings were deliberate and premeditated. Consequently, testimony about Clancy’s psychiatric symptoms, diagnoses, medications, and treatment in the months preceding the deaths has become central to the trial, with numerous medical professionals testifying.
Among the many clinicians whose treatment of Clancy has been examined during this trial is psychiatrist Jennifer Tufts, who had treated Clancy for months leading up to the alleged murder. On August 10, Tufts was cross-examined about her treatment of Clancy in the months preceding the deaths of her three children. During questioning, Clancy’s defense attorney, Kevin Reddington, referred to a note in which Tufts documented “pressured speech.” Tufts testified that Clancy did not have pressured speech; however, her note stated “pressured speech.” When Reddington challenged Tufts about the discrepancy between her testimony and the language in her note, Tufts responded, “I don’t care what it says. I know what I meant.” She subsequently clarified that she had written the note but maintained that Reddington had misinterpreted it.
The exchange illustrates an ethical issue that extends well beyond this particular case and serves as a great reminder of clinicians’ responsibility to document accurately and clearly in the medical record.
Clinical documentation is often discussed in terms of accuracy, completeness, billing, liability, or regulatory compliance. These are important considerations, but they do not exhaust the ethical significance of the medical record. Documentation is also a form of clinical communication. Information gathered and interpreted by one clinician becomes available to others who may subsequently participate in a patient’s care. The record, therefore, carries an ethical obligation similar to other forms of professional communication: information should be represented truthfully, with sufficient precision for its clinical purpose, and in a manner that does not create a misleading impression.
This creates an important distinction between what a clinician intended to communicate and what the record actually communicates. A clinician may know what was intended when a note was written. A subsequent clinician does not have access to that intention. The subsequent clinician has access to the words documented in the record. If those words reasonably communicate something different from what the author intended, the discrepancy becomes clinically and ethically significant.
The ethical obligations associated with clinical documentation can be understood through several familiar principles. Veracity requires clinicians to represent clinical information truthfully. Nonmaleficence requires consideration of the potential harms that may result when inaccurate or misleading information is introduced into a patient’s record and subsequently relied upon. Fidelity is also relevant because patients and clinicians depend upon the medical record to communicate information across professional and temporal boundaries. Documentation, therefore, participates in relationships of trust not only between clinicians and patients but also among members of the healthcare team.
The Clancy trial provides an unusually visible illustration because the medical record is now being examined in a courtroom. Yet the ethical issue does not depend upon litigation. Every clinical record is potentially a handoff to someone who was not present for the original encounter. The author may not be available to explain what a particular phrase meant, and the patient should not bear the consequences of ambiguity that could reasonably have been avoided through more precise documentation and attention to detail.
The relevant question for clinicians, therefore, is not simply whether they know what they meant when documenting an encounter. The more important question is whether another reasonable clinician reading the record would understand what was meant. If the answer is uncertain, the responsibility rests with the author to improve the documentation rather than with the subsequent reader to reconstruct the author’s intention.
Documentation is part of patient care. By entering information into the medical record, clinicians create a representation of a patient’s clinical history that will inform the work of others. That representation carries ethical obligations of accuracy, clarity, and fidelity to what was actually observed and assessed. “I know what I meant” may explain a clinician’s intention, but intention alone does not determine what a medical record communicates. The ethical responsibility of clinical documentation is to ensure that the record communicates the patient’s clinical reality as accurately and clearly as possible without room for interpretation, including to those who will read it after the author is no longer present to explain it.
The Clancy trial highlights the potential consequences of imprecise clinical documentation and offers a broader wake-up call for clinicians: a medical record may one day be scrutinized far beyond the clinical setting. Clinicians cannot know whether a note will be read by another member of the care team years later, examined in litigation, or, as in this case, displayed before the public and scrutinized in a courtroom. The ethical obligation is therefore not simply to know what was meant, but to document it accurately and clearly enough that the record does not require the author to explain what the words were intended to mean.
Mariah Chobany, PhD, HEC-C is a Clinical Ethicist at Sanford Health