Objective Traditional methods of research and care for patient with epilepsy are increasingly challenged by ethical standards that demand active involvement of affected patients. By focusing on the concept of “informed consent” I will look at four daily life situations in epileptic care from an ethical viewpoint, while trying to give tentative answers to the following four questions. Methods 1. How can confidentiality between doctors and patients be maintained if the patient wants to continue driving while (s)he is not seizure free? 2. How can we gain knowledge about teratogenic effects of AED's on the fetus if pregnant women are not included in clinical studies? 3. In the selection process for epileptic surgery how can the principles of beneficence, nonmaleficence, justice and autonomy be adhered to? 4. How can privacy and data security be maintained in participant led research and large data acquisition? Results 1. Mandatory reporting of drivers with active epilepsy is a breach of confidentiality, and has not shown to result in a reduction of seizure related accidents. 2. A low regulatory threshold for including AED-dependent pregnant mothers in voluntary observational studies should lead to the acquisition of large and interpretable databases. 3. Selection for surgery and postoperative outcome measures should be individualized to preoperative expectations primarily of patients and consecutively of caregivers. 4. Online transmitted patient data must be reencrypted before being pooled and initial ownership should lead to automatic notification of secondary research results. Conclusion Respecting ethical consideration in research and care for patients with epilepsy should not be viewed as a hindrance but rather as an attractive mean to secure a better quality of care even if the underlying disease cannot be cured.