Making progress in patient safety poses many challenges to the way physicians practice medicine. The ethical challenges are among the most profound. They include the ethical imperative to do all things practical to prevent errors and injury to patients, the need to respond appropriately when things go wrong to find new methods to prevent recurrence, the requirement for honesty and openness in dealing with patients when things go wrong, and taking responsibility for ensuring that colleagues are safe and competent. Much needs to be done in all of these areas.