From a Reflective Inquiry to a Proposed Revised Moral Formation of Current and Future Health Professionals

The Lancet Commission on medicine, Nazism, and the Holocaust (LCmNH) presented an innovation for the moral formation of health professionals. Proposing history-informed professional identity formation (HIPIF), it envisioned a morally resilient clinician who exercises moral agency, recognizes the fragility of medicine's core values, pursues lifelong learning in medical ethics beyond principlism, and firmly addresses antisemitism, racism, and hate. Tragically, just before its publication (November 2023), the report gained greater relevance in the wake of the October 7, 2023, Hamas massacre, which led to a surge in antisemitism, including within healthcare and medical education. Unexpected barriers, such as fear of controversy, hampered dissemination of the LCmNH recommendations. Concurrently, the author, an Israeli Jew, physician, and Co-Chair of the LCmNH, grappled with moral distress in the context of the war following October 7 and antisemitism in healthcare. These challenges triggered a reappraisal of the LCmNH moral formation proposal. This reappraisal identified moral distress, antisemitism, and inadequate institutional accountability as central issues requiring attention. The author proposes a revised approach for moral formation, integrating mechanisms to prevent and identify moral distress and antisemitism, provide care for those affected, and pair systemic accountability with individual integrity. Steps for stakeholders to promote the updated approach, along with its expected benefits, are described. A diagram and comparative table illustrate and indicate areas of focus for the proposed enhanced approach. The author also shares how his reflective inquiry, scholarly pursuit, and reappraisal of the LCmNH report worked together to foster his own resilience and generate insights that informed the proposed updated approach to moral formation.