Ethics is central to medical practice, guiding the moral obligations of both researchers and clinicians.1 Elite sport intensifies ethical risk through marked power imbalances between athletes and organisations, strong commercial incentives to win and constant public scrutiny. This places personal and professional boundaries under sustained strain, bringing core ethical principles into tension and generating bioethical concerns for athletes and the wider sport ecosystem.2 These risks are particularly salient in mental health research, where findings are highly contextual, stigma-laden and may carry direct consequences for selection, contracts and public reputation.3–5

Ethical dilemmas must therefore be addressed at the design stage of all research, regardless of methodological approach. Best practice includes pre-agreed procedures and referral pathways for both reported distress and distress that may be identified or precipitated by participation, alongside safeguards that maintain independence and confidentiality when referral to established clinical care…