participants. Also, because in a Delphi-methodology the criteria ultimately derive their validity from consensus, the participants with practical knowledge have the final say. So, the normative conclusions in this dissertation about how to establish IPS in the context of PAD are based on consensus through dialogical empirical ethical methods. But are they right? In order to answer this question, we must first regard two important points. First, this seems to assume that for every moral problem there is a single normative conclusion that is right. We do not believe this to be true for a complex topic such as IPS in the context of PAD, where so many medical, psychological, social and cultural phenomena interact with each other. It is hard to imagine that there are conclusions about IPS in the context of PAD that are universally acceptable for everyone in the world for all time. Therefore, it is more reasonable to aim to find conclusions that are right for the current legal and moral context: the Netherlands and Belgium at the start of the 21st century. However, these conclusions can also act as an important starting point for moral deliberation in other contexts. A practical example of this is the conclusion from the Delphi-study that a mandatory 2nd opinion by an expert psychiatrist is an important due diligence step of establishing IPS in the context of PAD. When this was discussed with a Canadian expert panel, tasked with designing the due diligence criteria for PAD for psychiatric suffering in their country, it soon became clear that this was practically unfeasible in a low populated country such as Canada. Adopting this criterium would seriously hamper equal access to PAD for people in rural areas where psychiatrists are scarce. The change of geographical context does not make the normative conclusions in our research less valuable. But it does call for a new weighing of local considerations and concerns that may result in diverse criteria for establishing IPS, for instance by demanding an e-consult by an independent expert. Second, when discussing whether our empirical ethical methods led to acceptable normative conclusions, we must also accept that our own normative views about what is permissible and desirable in relation to establishing irremediable suffering, likely influenced the results of the research to some extent. Although all conclusions throughout this dissertation were based on empirical data, it would be naive to think that our own views did not influence the research questions we posed or the process of analysis. This does not have to be problematic. As the dialogical empirical ethical approach dictates, we adopted a reflexive stance throughout the dissertation. At the start of this research all authors had their own moral intuitions and views about the topic of IPS in the context of PAD, based on previous personal, clinical and scientific experience. The presuppositions and experiences of the people in the research group differed from each other and were the subject of recurrent discussions. In the empirical ethical articles, we also described these views in the methods section. The data we GENERAL DISCUSSION | 125 7