INTRODUCTION:
High-consequence infectious diseases (HCID) present complex ethical challenges, particularly when balancing public protection, the duty to treat, and societal values in conditions of uncertainty, resource scarcity, and high-stakes scenarios. Common ethical tensions include autonomy versus public protection, utility versus equity, transparency versus panic prevention, national security versus global solidarity, and duty to care versus personal safety for healthcare workers.

METHODS:
This study employs a stepwise conceptual mapping approach to facilitate ethical decision-making in HCID preparedness. The process begins with mapping stakeholder groups, followed by articulating core values and goals. These values are aligned with a set of guiding ethical principles, which are then used to systematically identify critical ethical tensions. Synergies between values and principles are sought to maximize positive outcomes and reduce conflict.

RESULTS:
12 Major stakeholder groups were identified. Key values and goals identified encompass global solidarity, health equity, data transparency, national and population security, staff and patient safety, innovation, efficiency, autonomy, and cultural sensitivity. Twelve core ethical principles are emphasized: justice, equity, transparency, reciprocity, accountability, beneficence, solidarity, proportionality, precautionary principle, non-maleficence, least restrictive means, and autonomy. Principal ethical tensions involve utility versus autonomy, equity versus resource scarcity, and beneficence versus potential harm. Synergies focus on trust-building, early protection, and supporting frontline workers. Special elements include decedent management, waste handling, and medical transportation logistics. The Disease X outbreak workflow demonstrates the application of these principles and tensions in assigning responsibilities, managing resources, and maintaining transparent communication

CONCLUSIONS:
This multilevel ethical framework provides a road map for navigating moral complexity in HCID preparedness and response. By linking stakeholders, values, principles, tensions, synergies, and operational steps, the model strengthens ethical clarity, supports equitable decision-making, and enhances trust and solidarity across communities, health systems, and national and global partners.