gathered then guided us towards certain normative conclusions and while analyzing it we tried to be open about our own assumptions. This being said there is always the possibility that when other researchers replicate this work, using the same methods, they might come to different normative conclusions. With these comments in mind; let’s return to the question whether our research has led to appropriate normative conclusions, or more specifically: to the best conclusions within the relevant context. As researchers who published this work, we are confident about the quality of the research process and we are convinced that our findings can benefit practice. In our view the systematic review reliably shows that the academic discussion about IPS in the context of PAD, which was mainly theoretical, was not enough to guide clinical practice. By drawing on the practical knowledge of Dutch psychiatrists, we added nuance to the debate and identified previously underreported challenges. By using these findings as input for a Delphi-study we were able to systematically translate these insights into consensus-criteria. Although this process did not lead to a single moral truth regarding when it is or is not permissible to describe a patient’s suffering as ‘irremediable’, it did add clarity to the complex moral problem of establishing IPS in the context of PAD. By doing so we found a way to deal with this problem that is morally defensible in the current context. What ethical theoretical framework can guide the decision about IPS? The normative conclusions from the empirical ethical work can be further strengthened through ethical theory, but which theoretical framework is suited in this context? When establishing IPS in the context of PAD, the psychiatrist is a professional who is tasked with making a complex decision, with fundamental consequences, while facing uncertainty. When we turn to philosophy for guidance, the field of virtue ethics stands out. Aristotle is seen as the founder of virtue ethics. In his work he describes that the highest end is to live a good life and to do so we must act virtuously. In this approach, moral character of the person involved is emphasized, not duties or rules (which is the basis of deontology) or the consequences of one’s actions (the basis of consequentialism). Virtue ethics is a suitable approach when considering IPS in the context of PAD. Indeed, there are rules, laws even, that guide decision making, but these rules will inevitably require interpretation, especially when applied to unique and complex patients. Also, the current ex-post reviewing procedure in the Netherlands puts a lot of trust in the capabilities of the involved psychiatrists and physicians to make a virtuous choice when considering IPS in the context of PAD. (RTE, 2018) But how does a psychiatrist act virtuously when deciding on irremediability? According to Aristotle a moral virtue entails the ability to find the right middle between the two 126 | CHAPTER 7 7
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