Ethics and growing legal crisis in medicine.

This essay presents a preventive ethics to hidden aspects of the professional liability crisis, which is now affecting physicians throughout the world. It draws on the concept of fiduciary responsibility and its four professional virtues of integrity, compassion, self-effacement, and self-sacrifice to identify preventive ethics approaches to the professional liability crisis for practicing physicians and physician leaders. Physicians should adhere to integrity in clinical practice and testimony, to compassion and self-sacrifice by focusing on patients rather than their own needs, and to self-effacement by not allowing risk of litigation to influence patient care. Physician leaders should create organizational cultures to support physicians in this important work. Fiduciary responsibility and professional virtues should guide practicing physicians and physician leaders in creating best-practice models to improve organizational culture and influence health policy.