Author: Weinberg L
A & A Practice 20(1): e02142, January 2026, 10.1213/XAA.0000000000002142
This point-of-view essay reflects on ethical leadership in medicine, arguing that departments should respond to ethical misjudgments with the same structured curiosity and compassion applied to clinical errors.
The author writes from experience as both a department director and chair of a hospital ethics committee, emphasizing that leadership regularly sits at the intersection of human judgment and consequence. Clinical decisions and interpersonal behaviors are rarely binary. They occur within contexts shaped by intention, pressure, fatigue, and perception.
Core Argument
In medicine, clinical errors are widely acknowledged as inevitable. Teams analyze them through structured processes: fact-finding, systems review, root cause analysis, remediation, and process redesign. These events become opportunities for learning.
In contrast, ethical missteps often trigger distancing, discomfort, or condemnation. A poorly judged comment, tone, or public communication may quickly be viewed as evidence of character failure rather than situational fallibility.
The essay argues that this difference in response is inconsistent. If clinical errors are treated as human and system failures requiring curiosity and improvement, then ethical lapses—often driven by haste, stress, distraction, or unexamined habits—should be addressed with similar discipline.
Psychological Safety
Drawing on Edmondson’s work on psychological safety, the author highlights that departments thrive not because errors never occur, but because individuals feel safe to speak up, question, and disclose mistakes without disproportionate humiliation.
Integrity and empathy are not opposites. Accountability paired with kindness strengthens trust, encourages early disclosure, and protects team cohesion.
Forgiveness as Leadership Discipline
Forgiveness is framed not as permissiveness but as a leadership practice. Leaders correct behavior while preserving dignity. Constructive feedback becomes an invitation to reflect and recalibrate rather than an accusation.
The essay cautions against moral perfectionism, suggesting that unrealistic expectations of flawless conduct may inhibit growth and learning.
The Ethical Pause
The author proposes a practical framework before engaging publicly or digitally:
• Why am I doing this?
• Do I have permission or appropriate authority?
• How might this be received by those directly or indirectly affected?
• Does the potential benefit clearly outweigh possible harm?
When missteps occur:
• Acknowledge promptly
• Engage openly with those affected
• Repair visibly where appropriate
• Reflect together
Central Message
Ethical leadership means holding integrity and grace in tension. Departments should respond to moral missteps with structured inquiry, humility, and compassion—just as they do with clinical errors.
What This Means for Clinical Leadership
For leaders of departments, anesthesia groups, or hospital committees, this essay reinforces:
• Culture is defined by response to error, not absence of error
• Ethical safety, like clinical safety, requires structured reflection
• Accountability can coexist with empathy
• Public moral escalation rarely fosters durable learning
• Quiet, respectful correction may preserve both trust and standards
Key Points
• Ethical missteps often reflect human limitation rather than malice.
• Responses shaped by empathy and accountability strengthen teams.
• Psychological safety underpins honest ethical discourse.
• Forgiveness can coexist with firm professional standards.
• Leadership requires correcting without demeaning.
Thank you to A & A Practice for allowing us to summarize and share this article.