Clinical ethical issues regarding functional neurological disorder: the need for patient respect and clinician education

Functional neurological disorder (FND) has been increasingly reconsidered as a diagnostically and therapeutically tractable entity; however, significant ethical challenges remain in clinical practice. This review summarizes the recent literature and classifies the ethical issues regarding FND into four categories: (1) stigma, (2) misdiagnosis and iatrogenic harm, (3) discrepancies in pathophysiological understanding and neglect of patient experiences, and (4) gender-related and historical biases. Patients with FND are frequently stigmatized, which may compromise their dignity and quality of life. A misdiagnosis can result in unnecessary and potentially harmful interventions. Moreover, persistent gaps between patients' and clinicians' perceptions regarding symptom voluntariness and meaning often lead to inadequate communication and care. Historically, FND has been disproportionately attributed to women, reflecting deep-seated gender biases that continue to influence diagnosis and treatment. Addressing these issues requires careful application of the four principles of biomedical ethics-autonomy, beneficence, non-maleficence, and justice-in clinical decision-making and patient care.