High fidelity simulations with healthcare personnel can be very powerful experiences that challenge the emotions & psyche of learners. This can be particularly true when the scenario involves either the apparent death of the (simulated) patient, or when it involves the need for some clinicians to challenge the decisions of a senior physician (played by an actual senior doctor). Two original articles and two editorials appearing in the February 2013 issue of the premiere peer-reviewed, indexed journal Simulation in Healthcare address these issues. This set of papers highlights the complex considerations of when and how such challenging scenarios are appropriate and when they might be ill-advised as well as how they can be conducted with best care for the emotions of participants. Important ethical issues are raised: what constitutes “deception” in simulation exercises? What if any deception is warranted to achieve teaching and patient safety goals? What factors might affect the emotions of participants and the short or long-term results of such experiences. Are there important lessons about experiential learning activities stemming from famous and controversial psychology experiments such as the Milgram Obedience Experiments of the Stanford Prison Experiment. These and other issues generate considerable thought and debate that is well-covered in this suite of articles.