Radiation therapy (RT) is a cornerstone in cancer management in the era of multimodality management but also has a historical and evolving role in treating select benign diseases. The ethical decision-making surrounding RT for benign conditions is complicated, given the non-life-threatening nature of these diseases, the availability of alternative treatments, and the potential for long-term harm, including radiation-induced malignancy. There is a need to explore the ethical considerations inherent in offering RT for benign diseases, with emphasis on the informed consent process. Consent makes accounts of the principles of autonomy, beneficence, non-maleficence, and justice; reviews the clinical rationale for RT in benign settings; analyzes the challenges in risk communication and shared decision-making; and synthesizes current literature and guidelines. Ethically robust clinical practice is essential in the scenario of benign diseases, even more than that required for malignant diseases.