Neglected ethical dimensions of the professional liability crisis.

In response to the professional liability crisis, self-interest can become dominant and displace fiduciary professionalism from its central place in the moral lives of physicians and physician leaders. We provide preventive ethics tools to address this neglected ethical dimension of the professional liability crisis. We develop these tools on the basis of the concept of the physician as fiduciary of the patient, which was introduced in the English-language literature of medical ethics by Dr John Gregory (1714-1773). These tools are designed to preserve and strengthen 4 professional virtues: integrity, compassion, self-effacement, and self-sacrifice. Acceptable and unacceptable responses to the professional liability crisis are identified with the use of these 4 virtues. These virtues should be supported by an organizational culture of fiduciary professionalism. An organizational culture that is shaped by these 4 professional virtues should be used by physicians and physician leaders to create ethical best-practice models.