Understanding health behaviors and resilience during pandemics: a systematic review of ethical, cognitive, and existential dimensions

Purpose Pandemic events such as HIV/AIDS and COVID-19 destabilize not only public health systems but also the philosophical and ethical frameworks through which individuals interpret illness. Health behavior influenced by contagion challenges definitions of identity, perceptions of truth, moral reasoning, and core bioethical principles, including autonomy, beneficence, non-maleficence, and justice. This study employs a triadic lens, such as ontology, epistemology, and axiology, to examine how pandemic crises transform embodied experience, cognition, ethical response, and value-laden behavioral choices. From there, the consequences for health behavior are analyzed within both phenomenological and bioethical domains. Methods Using a phenomenological framework, the study draws on interdisciplinary data, including clinical case reports, psychosocial literature, and first-person narratives. Philosophical constructs from Husserl, Merleau-Ponty, and Carel inform the mapping of existential vulnerability, cognitive distortion, and value formation. Bioethical principles from Beauchamp and Childress guide the interpretation of moral tensions arising in pandemic behavior, while public health ethics frameworks (e.g., Kass) contextualize collective obligations. Psychiatric presentations during COVID-19 provide illustrative grounding for abstract principles. Motivations and frameworks for pandemic health behaviors are reported as outcomes. A review of 134 articles helped frame the cognitive and ethical terrain of pandemic prevention and dissemination. Results Pandemics cause overlapping disruptions across ontological, epistemological, axiological, and bioethical levels. Embodied identity becomes fragmented by diagnostic classification, social distancing, and existential uncertainty, raising tensions between autonomy and relationality. Cognitive processing is hindered by emotional stress, misinformation, and isolation, leading to distorted perceptions of truth and reduced rationality, which complicates beneficent and non-maleficent decision-making. Moral behavior reflects value-based tensions—altruism, denial, concealment, stigma—negotiated within shifting contexts of personal risk, communal obligation, and distributive justice. These patterns illustrate how existential dislocation, epistemic fragmentation, and moral ambiguity shape lived experience and ethical behavior during a pandemic. Conclusion Phenomenology offers vital insights into the human impact of pandemics by examining how relational, cognitive, and ethical dimensions shape illness experiences and health behaviors. Integrating bioethical principles clarifies why individuals struggle with autonomy, responsibility, and fairness during crises. To support recovery and coherence, public health governance must move beyond biomedical control toward emotionally attuned, ethically grounded care that emphasizes relational responsibility, moral imagination, and justice-oriented policy.