When a psychologist is diagnosed with a serious medical condition and faces the prospect of an arduous treatment regimen and perhaps a bleak prognosis, it may be difficult to attend to one’s level of professional competence. Like their clients, psychologists are vulnerable to distress and diminished functioning caused by a life-threatening illness. Psychologists have an ethical responsibility to monitor and ensure professional competence, yet the distress and distraction that accompany serious health problems can inhibit and undermine self-assessments of competence in many ways; distressed psychologists may react with denial, shame, fear, and problematic countertransference responses. The limitations associated with evaluating competence in the context of distress are discussed and several recommendations are offered for psychologists who deliver services, support gravely ill colleagues, and serve in credentialing and regulatory capacities. (PsycINFO Database Record (c) 2011 APA, all rights reserved)