Beyond Legal Compliance: Ethical Obligations for Lactation Accommodations in Dermatology Residency.

Women now comprise the majority of dermatology residents, and residency training coincides with a childbearing timeline that residents do not control. Federal legal and national accreditation frameworks establish meaningful minimum standards for lactation accommodations. Yet compliance with these standards does not guarantee that accommodations function in practice. The central ethical failure is not scheduling conflicts that inevitably arise and interfere with the usage of such accommodations, but the absence of a functional process through which a resident can flag that an accommodation is not working under real clinical conditions. Closing this gap between policy and practice requires shared responsibility: residents communicating needs proactively, and programs providing confidential, non-evaluative structures for residents to voice their needs. When responsibility is shared rather than individually absorbed, dermatology residency programs honor the ethical principles of autonomy, beneficence, non-maleficence, and justice.