Beyond technique: The ethics of simulation in care education

To explore the ethical implications of simulation in healthcare education, promoting an approach that integrates technical competence with ethical responsibility and relational sensitivity.

Simulation is widely used in nursing and healthcare education to develop technical, decision-making and relational skills. However, its growing use raises ethical concerns related to psychological safety, authentic representation of diversity, simulation practitioner responsibilities and the risk of reducing educational relationships to performance logics.

This discussion paper critically analyzes recent scientific literature and ethical standards, particularly the Healthcare Simulationist Code of Ethics, integrating philosophical and pedagogical reflections to address the ethical challenges of simulation-based education.

A narrative analysis was conducted, drawing on scholarly literature, ethical guidelines and philosophical perspectives to identify key ethical issues in simulation practices and suggest educational strategies.

Five main ethical concerns were identified: simulation as an ethical imperative for patient safety; safeguarding psychological safety of learners and simulated patients; risks of stereotyping and tokenism; educators' ethical responsibilities; and the potential dehumanization arising from hyperrealistic simulation environments. Additional attention is given to emerging technologies, such as virtual reality and cadaver labs and their ethical implications. The integration of narrative medicine is proposed as a strategy to humanize simulation practices.

Simulation offers an extraordinary educational opportunity but requires a reflective, responsible and ethical approach. Ethical simulation practices should foster professional integrity, psychological safety, cultural sensitivity and relational responsibility, ensuring that learners develop not only technical skills but also the capacity to care ethically and humanely in complex healthcare contexts.