PMI guidance for responsible and trustworthy AI stresses that ethical performance is not a one-time checkbox; it requires ongoing oversight, including transparency, accountability, and continuous controls. PMI-CPMAI’s exam outline explicitly highlights maintaining audit trails for algorithmic decision-making, implementing compliance monitoring mechanisms, and managing accountability documentation—foundational practices that align directly with continuous monitoring and auditing. In high-stakes healthcare use cases like readmission prediction, model drift, data drift, and shifting patient populations can degrade performance and fairness over time, which can create patient safety risks. Continuous monitoring enables the team to detect deteriorating accuracy, emerging bias, and unexpected failure modes early; auditing supports traceability of decisions, data lineage, and adherence to governance requirements. PMI also emphasizes that ethical AI demands validation and transparency, noting that accountability and continuous monitoring are crucial to maintain ethical standards and minimize undesirable outcomes. Encryption (A) protects confidentiality, and explainability (B) supports transparency, but neither alone ensures sustained ethical compliance. Stakeholder impact analysis (D) is valuable during assessment, yet monitoring/auditing is the most direct operational method to ensure ethics remain intact after deployment.