Ethical challenges in medical error disclosure among healthcare professionals in teaching hospitals: a qualitative study

Medical error disclosure is a fundamental component of patient safety and professional ethics in healthcare systems; however, in practice, it is frequently influenced by individual, organizational, and contextual factors. Although international research has examined issues such as blame culture and psychological safety, an in-depth qualitative understanding of the ethical challenges surrounding medical error disclosure in Iranian teaching hospitals remains limited. This study aimed to explore the ethical challenges of medical error disclosure among healthcare professionals working in Iranian teaching hospitals. This qualitative study using an inductive qualitative content analysis approach was conducted in 2025 in teaching hospitals affiliated with Bam University of Medical Sciences. Sixteen healthcare professionals were selected through purposive sampling with maximum variation. Data were collected through in-depth semi-structured interviews and analyzed concurrently using the qualitative content analysis approach of Graneheim and Lundman. Data analysis yielded five main themes and 20 categories: conflict between ethical commitment to honesty and perceived organizational insecurity; blame-oriented organizational responses and the suppression of learning; selective concealment and informal management of errors as protective responses; psychological and moral burden following error experiences; and structural and relational conditions shaping error disclosure. Overall, participants described error disclosure as a context-dependent ethical process shaped by the interaction of professional commitment, organizational insecurity, managerial responses, and broader structural conditions. Medical error disclosure emerged as a complex, context-dependent ethical process embedded within organizational and relational contexts rather than an isolated individual decision. The findings highlight the importance of fostering Just Culture and psychological safety to support transparent error disclosure and organizational learning in Iranian teaching hospitals.