The ethical responsibility of psychological safety: Leadership at the intersection of safety culture.

Psychological safety-the belief that one can speak up or report concerns without fear of retribution or humiliation-is a foundational element of highly reliable healthcare teams. While every industry and team can benefit from psychological safety, in healthcare, it is not just a "nice-to-have"-it can be life-saving. In the high-risk, emotionally charged context of cancer care, its importance is magnified. Oncology is one of the many extra high stress and high-stakes areas of medicine and patient care. There is also benefit from establishing a psychologically safe culture in these very well-known areas of healthcare, and that is they can serve as a model and beacon for other areas in healthcare. Conversely, a bad culture in a highly visible area can encourage bad behaviour elsewhere. Yet, while often framed as a quality or cultural issue, psychological safety is also an ethical imperative. Leaders in healthcare have a moral responsibility to cultivate environments where team members feel safe to raise concerns, challenge unsafe practices, and contribute to system learning. This article explores the ethical dimensions of psychological safety, how human factors influence speaking up, and how leadership practices can advance or inhibit a culture of safety. Drawing from safety science, organizational ethics, and the author's experience in oncology safety leadership, the argument is made that fostering psychological safety is not simply best practice-it is a moral obligation grounded in justice, trust, and the prevention of harm.