Ethical competence is widely invoked in health-professions education, yet the term encompasses heterogeneous claims about knowledge, moral reasoning, sensitivity, judgement, character, communication, action and professional conduct. Instruments intended to assess these capacities frequently operationalise narrower constructs, creating uncertainty about what particular scores establish and whether measured performance represents ethically desirable professional practice. This critical review used a transparent, interpretive design rather than an exhaustive effectiveness-review methodology. Literature published between 2017 and 2026 was identified through bibliographic and publisher-based searching focused on ethical and moral competence, professionalism, moral sensitivity and courage, professional resistance, ethics assessment, epistemic justice, patient participation, educational interventions and emerging artificial-intelligence ethics. Sources were compared for construct definitions, operationalisations, measures, validity claims, educational assumptions, contextual boundaries and normative implications. Analysis distinguished empirical findings from conceptual and normative reconstruction. The literature does not support a single settled conception of ethical competence. Existing approaches variously privilege ethical knowledge, reasoning, sensitivity, professional identity, dispositional qualities or action, while assessments often capture only selected components. Educational models may consequently embed assumptions that competence is individually located, measurable independently of context, transferable between situations and aligned with prevailing professional norms. Evidence concerning hidden curricula, professional resistance, epistemic injustice and patient partnership complicates those assumptions. The review therefore proposes a reconstructed account in which ethical competence includes contextual recognition, deliberation, epistemic responsiveness, justified moral agency and responsible action, while remaining sensitive to professional, cultural, institutional and technology-mediated conditions. Ethical competence should not be equated with conformity, a single psychometric construct or successful performance on one assessment format. The proposed reconstruction is a critical synthesis rather than a validated competency standard and requires cross-professional, cross-cultural, longitudinal and consequential validation.
