Forced disappearances in Latin America, particularly in Mexico, have become a humanitarian and ethical crisis that transcends legal and political dimensions [1]. The involvement of medical institutions-through forensic identification, psychological care, and documentation-places bioethics at the core of the response to such tragedies. Healthcare professionals are often confronted with the moral tension between state authority and their ethical duty to the truth [2]. Within this framework, the bioethical principles of autonomy, beneficence, nonmaleficence, and justice must be revisited to address structural violence and the silencing of victims’ identities [3].

The right to truth, recognized as a fundamental human right, implies an obligation of states and medical entities to clarify the fate of disappeared persons [4]. However, systemic corruption, fear of reprisals, and lack of institutional transparency perpetuate impunity. This article aims to explore how healthcare workers ethically navigate these situations, emphasizing the bioethical implications of truth-telling, confidentiality, and moral resilience in contexts of forced disappearance.

A qualitative phenomenological design was employed to explore the ethical perceptions and moral experiences of participants. Twenty-two semi-structured interviews were conducted in 2024 with three groups: healthcare professionals (n = 8), forensic specialists (n = 6), and relatives of disappeared persons (n = 8) from Mexico City, Guerrero, and Morelos. Interviews lasted between 60 and 90 minutes and were recorded with informed consent.

Data were analyzed through thematic coding using NVivo 14, focusing on ethical categories: truth, autonomy, justice, and moral distress. Ethical approval was obtained from the Bioethics Committee of the Universidad Autonoma Del Estado de Mexico (Code: UAPH-BIOET-2024-15). Pseudonyms were used to protect participants’ identities.

Three core themes emerged from the data: (1) Institutional Silence and Moral Distress, (2) Truth as a Form of Healing, and (3) Bioethical Resilience in Healthcare Practice.

The data in Table 1 indicate that moral distress arises when institutional demands conflict with bioethical duties. Healthcare professionals express a profound sense of ethical tension, where silence becomes a mechanism of survival but also of complicity. Families, in turn, associate truth with dignity, framing it as an ethical imperative for healing.

Table 1: Ethical Themes, Participant Categories, and Representative Quotations.

The findings demonstrate that forced disappearances create a unique field of bioethical conflict where professional ethics intersect with human rights obligations. Moral distress among healthcare workers aligns with previous studies linking systemic violence to ethical disempowerment [5]. The concealment of forensic information and lack of institutional transparency directly violate the principles of autonomy and justice. In such scenarios, truth-telling becomes not only an ethical duty but also an act of resistance [1].

This study expands the application of bioethical principles to contexts of political violence, suggesting that healthcare professionals act as moral agents who must balance confidentiality with the social demand for justice. As per [6], the essence of medical ethics lies in the patient’s dignity, yet when the state becomes an agent of harm, professionals must reaffirm their ethical allegiance to humanity rather than authority.

The families’ testimonies also highlight a therapeutic dimension of the right to truth. The identification of remains or acknowledgment of disappearance serves as a moral reparation mechanism. From a nursing and healthcare perspective, this reaffirms the importance of compassionate communication, interdisciplinary collaboration, and moral resilience in trauma care.

The intersection of bioethics and forced disappearances reveals a critical space for rethinking the moral responsibilities of healthcare professionals. Institutional silence, while often imposed, perpetuates harm and undermines the ethical foundations of healthcare. Promoting moral resilience and establishing bioethical protocols for truth management can strengthen trust between families and institutions. Future efforts should integrate forensic ethics into nursing and medical curricula, ensuring that healthcare responses to violence are guided by dignity, transparency, and justice.

Annex 1. Interview Guide (Extract)

• How do you define your ethical responsibility when dealing with cases of forced disappearance?
• What moral dilemmas have you experienced when institutional directives conflict with ethical principles?
• How do you manage the emotional burden of moral distress in your daily practice?
• What role do you believe healthcare professionals should play in restoring the right to truth?

Annex 2. Coding Structure (NVivo Output)

Main categories: Truth (n = 78 references), Justice (n = 63), Moral Distress (n = 57), Resilience (n = 44). Subcategories included: Institutional Silence, Emotional Burnout, and Family Healing Narratives.

1. Beristain CM. Rebuilding the social fabric: A psychosocial approach in contexts of violence. Desclee de Brouwer. 2020.
2. Zermeno S. Mexico: State Violence and Crisis of Legitimacy. Siglo XXI Editores. 2021.
3. Beauchamp TL, Childress JF. Principles of biomedical ethics (8th edition). Oxford University Press. 2019; 19: 9-12.
4. United Nations. Report on enforced disappearances in Latin America. Office of the High Commissioner for Human Rights. 2022.
5. Fins JJ. Moral distress, moral resilience, and moral injury: The moral life of clinicians. J Clinical Ethics. 2018; 29: 167-172.
6. Pellegrino ED. Toward a virtue-based normative ethics for the health professions. Kennedy Institute of Ethics J. 2019; 29: 323–340.