I agree with you about Sarah Palin’s privacy and respecting what her family is dealing with.

What bothers me is this: if Sarah Palin gets elected, she will be pushing abstinence education all over the country.

No, I’m NOT proposing that teens have sex. I’m saying that teens need a place to talk openly and honestly, they need adults whom they can trust. Clearly, setting up strict rules around sex — like no-abstinence education — does not work. Look at what happened with priests in our country.

If Sarah Palin is supporting her daughter as a teen mom — and insisting that she get married — that’s her business. But I fear this will be her message to girls all around the country.

First, it’s not certain that she would have to falsify any medical records. All the involved parties’ records (those of the grandmother, the mother, and the newborn) could be medically accurate, and they could simply state publicly that the grandmother was the mother, relying on medical confidentiality, like priestly confession, to prevent the release of the truth even though the medical staff would know the story was false. That’s obviously taking a big risk (and note, too, that it’s not just medical records, but insurance company records as well, that are relevant). In practical terms, it would be hard to keep such a story secret. But it would not likely be the actual written medical record that would be the problem.

As for those records, the accuracy and security of medical records is of great importance, but it is emphasized as an ethical issue for the protection of the patient. Though there are obviously practical reasons why, in general, you don’t want false information in your medical history, I have no problem with people faking their own records if necessary to protect some important personal value – and in these days of decreasing privacy, that is a more-than-plausible scenario.

In this case, the records in question include those of her almost-adult, reproductively emancipated daughter, and, of course, those of the newborn as well. Both could have serious consequences if, for instance, the daughter needed treatment for a post-natal condition and her records did not reveal that she had ever actually been pregnant, or if the newborn has some genetic condition (not Down Syndrome) in which parentage is a relevant factor, and the child’s records were inaccurate in that regard. Those are unlikely but very real possibilities that up the ante on the practical risk falsifying these records poses. But those are, again, mostly practical questions.

As to the ethics of leaving false information in both her daughter’s and the newborn’s medical records, for the adult daughter there is the question of whether she herself gave a fully informed consent to such a deception, or perhaps does not realize the implications of what is being done. For the newborn, the grandmother would obviously be acting as the healthcare proxy, and there is no question of the child’s giving consent; however, the grandmother is obviously acting in this case out of regard for her own public reputation and that of her daughter, not the immediate interests of the newborn, so there is a real conflict there. The summary, from an ethical point of view, is that being deceptive about the newborn’s parentage would certainly be questionable in respect of the adult daughter’s rights and interests, and there is a clear conflict between the grandmother’s role and interests in respect of her public persona, and her obligations to promote the newborn’s interests in her role as decisionmaker. Arguably, that child’s interests might include knowing who her real mother is.

That does not make the deceptive practice obviously wrong – but it makes it obviously questionable. It requires much more in the way of defense or justification to explain why it would be OK to do this, given that at least three people’s interests are involved but only one of them (it seems) is making the decisions, and largely for her own benefit. But such a justification could perhaps be given: the real mother understands the situation and feels satisfied with it; there are tangible benefits to the baby in not being associated with a teenage mother because the family belongs to a highly judgmental and repressive church, for instance.

So, like so many issues, the bottom line is: “it depends”. But note that it depends on a variety of contingent, practical factors having to do with the interests and consent of the parties involved, not, I think, a bald rule about the sanctity of medical records.

As for the legal aspects, that also depends on just what was falsified. It’s not illegal to falsify medical records, either in the hospital or at your doctor’s office – it’s just a bad idea. If the grandmother made a claim for insurance benefits in her own name, that would be insurance fraud and breach of contract, which have criminal and civil legal implications, respectively. The one form I can think of that is legally required and would have to be falsified is the record of birth, which lists the child’s parents and is the basis for the birth certificate. I have no idea what the penalty is for falsifying that information, but I doubt it’s very high, and I suspect it’s fairly commonly done. (It was the standard method of informal adoption of babies of “wayward girls” for generations.)

As for motives, I’m never very impressed by that. I’m more interested in the questions “What did/will you do?” and “What were/will be the consequences?” But, as I note above, listing non-birth parents, including aunts/uncles or grandparents, as the birth parents of a “love child”, as a means of putting over a de facto adoption, is an old practice. The motive is fairly obvious.

You can certainly argue that it would be better if we simply had a society that did not condemn people for their choices regarding pregnancy and parenting, and you can argue at least as strongly that the far-right religious people who are largely the source of that problem deserve less sympathy than others when it becomes their problem all of a sudden. But, given who we are and where we’ve come from, it’s easy to understand why people do these things, even as we hope the necessity of them will eventually pass away. And we can have sympathy for those motives, as distorted and unhealthy as they are.

It seems to me that if Palin is claiming her daughter’s child as her own (my own guess is that she isn’t, but let’s say, for the sake of argument, she is), the deception is most likely going to require some falsification of medico-legal documents: birth records, insurance claims, that pile of forms that you fill out when you take your kid to a new pediatrician for the first time. So here’s my question: what’s your take on the ethics of falsifying another person’s medical records? Are there times when it’s okay and times when it’s not? Do your motives matter? What’s your sense of the terrain here?