Abstract
<title>Abstract</title> <p>Background Bedside teaching is central to medical education, yet patient autonomy, dignity, and ethical boundaries are frequently strained, particularly in resource-constrained and culturally hierarchical healthcare settings. Limited evidence exists on how patients actively negotiate consent, vulnerability, and personal boundaries during clinical teaching encounters. This study explored how patients and parents in a Sri Lankan public teaching hospital construct ethical thresholds for participation in bedside clinical teaching. Methods This qualitative study involved a secondary analysis of semi-structured interviews originally conducted for a broader investigation of patient perspectives in medical education. Guided by an interpretivist–constructivist framework, fifteen interviews with patients and parents from medical, surgical, paediatric, obstetric, and gynaecological wards were analysed thematically using an inductive grounded theory approach. Results Four interrelated themes were identified: (1) informed and meaningful consent, (2) supervision and safety, (3) intimacy, gender, and invasiveness, and (4) privacy and contextual vulnerability. While participants frequently expressed altruistic motivations to support medical education, their willingness was highly conditional. Consent was experienced as a dynamic, relational process shaped by sociocultural deference to medical authority, fear of compromised care, and limited understanding of student roles. Visible supervision fostered trust and reassurance, whereas its absence contributed to emotional uncertainty and perceived abandonment. Intimate and gender-discordant examinations evoked shame, discomfort, and self-silencing, particularly among female and Muslim participants. Privacy breaches and contextual vulnerability intensified resignation, leading many patients to internalize the belief that asserting boundaries was futile. Conclusions Ethical bedside teaching requires more than patient willingness; it demands conditions that uphold dignity, transparency, and respect. Autonomy must be understood as contextually constrained and relational rather than procedural. Practice implications Medical education should prioritize dynamic consent, consistent supervision, gender-sensitive practices, and structural safeguards for privacy. Institutional policies and curricula must embed patient-centred ethics to support respectful and ethically sound bedside teaching, particularly in resource-limited settings.</p>