In recent years, research into generative artificial intelligence (AI) for clinical practice and medical research has expanded rapidly. Generative AI models hold great promise in virtually all areas of healthcare. However, alongside their potential benefits, there are significant concerns about the risks and ethical challenges associated with their use. The aim of this chapter is to provide an instructive and stimulating overview of the ethical aspects of generative AI in medicine. It begins with a brief overview of its potential benefits and risks, followed by an ethical evaluation framework for its development and implementation in healthcare. It then examines two critical cross-cutting issues that need to be carefully addressed as generative AI is integrated into clinical practice: the transformation of the social structure of medicine and the trustworthiness of generative AI systems. The fourth step focuses on the ethical challenges that generative AI poses for medical research. The chapter concludes with a forward-looking perspective on the ethics of generative AI in medicine.