Prevalence Rate and Risk Factors of Sexual Assault Among University Students in the Netherlands.

This research documents the prevalence rate and demographic risk factors for sexual assault among undergraduate and graduate students enrolled at a Dutch university. The present study used a sample of N = 2,887 students who filled in responses to a campus climate survey about students' experiences with sexual assault and diverse demographic variables. Results showed that approximately one in four students (25.3%) experience non-consensual sexual touching, and almost one in ten are raped (9.2%). Next, to examine the effects of demographic factors and their interactions on sexual assault, the dataset was divided randomly into two subsamples. Exploratory multiple regression analyses were conducted on the first subsample and confirmatory multiple regression analyses on the second. Variables that increased odds for unwanted sexual touching, rape, and any type of sexual assault were gender; being a member of a student or a study association; having a disability; and being in a relationship (in this context, "any type of sexual assault" refers to any incident that included unwanted touching, attempted rape, or rape). LGBQ+ sexual orientation was significant for any kind of sexual assault and for rape; and being a member of a sport association was significant for any kind of sexual assault and for sexual touching.

The impact of twenty-first century personalized medicine versus twenty-first century medicine's impact on personalization.

BACKGROUND: Over the past decade, the exponential growth of the literature devoted to personalized medicine has been paralleled by an ever louder chorus of epistemic and ethical criticisms. Their differences notwithstanding, both advocates and critics share an outdated philosophical understanding of the concept of personhood and hence tend to assume too simplistic an understanding of personalization in health care. METHODS: In this article, we question this philosophical understanding of personhood and personalization, as these concepts shape the field of personalized medicine. We establish a dialogue with phenomenology and hermeneutics (especially with E. Husserl, M. Merleau-Ponty and P. Ricoeur) in order to achieve a more sophisticated understanding of the meaning of these concepts We particularly focus on the relationship between personal subjectivity and objective data. RESULTS: We first explore the gap between the ideal of personalized healthcare and the reality of today's personalized medicine. We show that the nearly exclusive focus of personalized medicine on the objective part of personhood leads to a flawed ethical debate that needs to be reframed. Second, we seek to contribute to this reframing by drawing on the phenomenological-hermeneutical movement in philosophy. Third, we show that these admittedly theoretical analyses open up new conceptual possibilities to tackle the very practical ethical challenges that personalized medicine faces. CONCLUSION: Finally, we propose a reversal: if personalization is a continuous process by which the person reappropriates all manner of objective data, giving them meaning and thereby shaping his or her own way of being human, then personalized medicine, rather than being personalized itself, can facilitate personalization of those it serves through the data it provides.

Palliative sedation versus euthanasia: an ethical assessment.

The aim of this article was to review the ethical debate concerning palliative sedation. Although recent guidelines articulate the differences between palliative sedation and euthanasia, the ethical controversies remain. The dominant view is that euthanasia and palliative sedation are morally distinct practices. However, ambiguous moral experiences and considerable practice variation call this view into question. When heterogeneous sedative practices are all labeled as palliative sedation, there is the risk that palliative sedation is expanded to include practices that are actually intended to bring about the patients' death. This troublesome expansion is fostered by an expansive use of the concept of intention such that this decisive ethical concept is no longer restricted to signify the aim in guiding the action. In this article, it is argued that intention should be used in a restricted way. The significance of intention is related to other ethical parameters to demarcate the practice of palliative sedation: terminality, refractory symptoms, proportionality, and separation from other end-of-life decisions. These additional parameters, although not without ethical and practical problems, together formulate a framework to ethically distinguish a more narrowly defined practice of palliative sedation from practices that are tantamount to euthanasia. Finally, the article raises the question as to what impact palliative sedation might have on the practice of palliative care itself. The increasing interest in palliative sedation may reemphasize characteristics of health care that initially encouraged the emergence of palliative care in the first place: the focus on therapy rather than care, the physical dimension rather than the whole person, the individual rather than the community, and the primacy of intervention rather than receptiveness and presence.

Patients' priorities in assessing organisational aspects of a general dental practice.

OBJECTIVES: To explore which organisational aspects are considered most important by patients when assessing a general dental practice, and which patients' characteristics influence their views on these aspects by a paper questionnaire. PARTICIPANTS: The questionnaire was handed out to a sample of 5,000 patients in the Netherlands. RESULTS: The response rate was 63%. Six organisational aspects out of a list of 41 aspects were valued as most important by at least 50%. In decreasing order of importance, these were: accessibility by telephone; continuing education for general dental practitioners; Dutch-speaking general dental practitioners; in-office waiting times; information about treatments offered; and waiting lists. For four out of these six aspects, respondents' age and education significantly influenced their preferences. CONCLUSIONS: Aspects concerning the infrastructure of a general dental practice were chosen more often than aspects such as working to professional standards, working according to protocols and guidelines, quality assessment and guaranteed treatment outcomes. The findings will enable organisations to increase the transparency of health-care delivery systems to focus on those organisational aspects of dental practices that patients themselves consider most important. These findings can also assist general dental practitioners in adapting their organisational services to the preferences of patients or specific patient groups.

Social contract theory as a foundation of the social responsibilities of health professionals.

This paper seeks to define and delimit the scope of the social responsibilities of health professionals in reference to the concept of a social contract. While drawing on both historical data and current empirical information, this paper will primarily proceed analytically and examine the theoretical feasibility of deriving social responsibilities from the phenomenon of professionalism via the concept of a social contract.

Current status of nitrous oxide as a behavior management practice routine in pediatric dentistry.

Nitrous oxide (N(2)O) as a behavioral management intervention in children has attained an excellent safety record and is, therefore, used widely. As is true of any diagnostic or therapeutic dental intervention, however, its usage merits periodic review, even if-or particularly when-it is routinely applied. For example, when N(2)O is used in combination with other sedatives, such polypharmacy can produce potentially serious side effects. There are also bioenvironmental risks to patients and staff if ambient air is not properly monitored. Using historical publications, current empirical articles, professional usage policies, and educational textbooks, the purpose of this article was to review indications and contraindications of N(2)O and discuss various factors that should or should not be considered about its use in the United States. Even though today's parents may be more accepting of pharmacologic approaches such as N(2)O, the choice to use it should always be made with the child's best interest in mind.

The challenges of oral-based diagnostics in extending the role of dentistry as a health care profession: property rights, privacy, and informed consent.

Saliva may be a legal and ethical counterpart of other bodily fluids in diagnostic testing to blood and urine, with regard to its role in diagnostic testing. Two paradigms that have been proposed in the literature to address these challenges are reviewed in this paper. The first is centered on ownership and property rights to saliva, including financial compensation from commercially developed products using saliva. The commodification of saliva as property is also discussed. The second paradigm is related to privacy and the potential for genetic discrimination, given the unwarranted disclosure of confidential information. The management of saliva specimens from dental patients and research participants will also require the implementation of innovative approaches to obtain informed consent.

The chasm between knowing and choosing the ethical course of action. A survey of dental students in the Netherlands.

The dental profession is gradually becoming more aware of the importance of practitioner competence in dental ethics and law. Indicative of that awareness is the explicit attention paid by ever more dental school curricula to these disciplines through courses and other dedicated learning activities. Concurrently there is also increasing professional concern about reports of illegal and unethical behaviour by dental students and practitioners. This paper discusses the results of a survey among first and fifth year students enrolled in the three Dutch dental schools, examining their ethical and legal knowledge and perceptions. Students were presented with five ethical and five legal case vignettes and asked which of three courses of actions is correct, as well as which of those courses they would undertake themselves. The study shows that the knowledge level of students in the area of health law increases between the first and fifth year but their knowledge of ethics decreases. Even more remarkable is the finding that large numbers of students are not consistent, that is, the way they plan to behave does not coincide with what they say is the morally correct way to behave.

Ethical considerations in the use of nitrous oxide in pediatric dentistry.

Nitrous oxide (N2O) has become a routine intervention in contemporary American dental practice, especially in the management of children. However, routines translate to confidence which in turn may lead to overconfidence, such that possible risks and misuses are insufficiently acknowledged. This article ethically evaluates the use of nitrous oxide as a practice routine in treating children. Nitrous oxide administration is analyzed in reference to three internationally acknowledged principles of dental ethics: nonmaleficence, beneficence, and patient autonomy. In reference to the principle of nonmaleficence, the potential for adverse effects of N2O is discussed, particularly when it is administered in conjunction with other sedatives and anesthetics. The importance of abiding by clinical protocols is emphasized. Next, in reference to the principle of beneficence, the authors address the problematic application of N2O for the benefit of individuals other than the patient (e.g., dentists and parents). Finally, the importance of respecting patient autonomy is discussed, specifically the need to obtain explicit consent for N2O. The article supports the continued use of nitrous oxide but advises greater attention to how and why it is administered. Four recommendations are offered for an ethically sound usage.

Deciding about patients' requests for extraction: ethical and legal guidelines.

BACKGROUND: and Overview. Dentists frequently are faced with patients' requests for an extraction, sometimes of the entire dentition. In this article, the authors offer guidelines to help dentists and oral surgeons make decisions regarding such requests for extraction. CONCLUSIONS: In most cases of patients' requesting extractions, the ethical principle of nonmaleficence will play a decisive role in the dentist's decision making. In cases in which the request appears influenced by a specific mental condition such as a phobia of dental treatment, extraction rarely is justifiable. Practice Implications. Dental professionals should keep in mind that they cannot be forced to carry out treatment that is at odds with the ethical principle of nonmaleficence or that is outside of the bounds of accepted treatment. To aid dentists in making treatment decisions in such cases, the authors present a flowchart that integrates possible considerations.

The dilemma of access to care: symptom of a systemic condition.

The standard ethical arguments that prescribe dentistry's involvement in improving access to oral health care are based on the ethical principle of social justice. The authors underwrite this principle but argue that, as with other ethical principles, this principle alone will fail to have a practical impact. The authors show that the issue of access is a symptom of a more systemic problem in dentistry, namely the lack of connectedness that dentists feel between themselves and their profession, their community, and society at large. The second half of the article develops a plan for boosting "connectedness." Successful implementation should help resolve many of the systemic problems that dentistry currently faces, including the issue of disparities in oral health.

Preventing dentists' involvement in torture: the developmental history of a new international declaration.

BACKGROUND: For more than half a century, the risk of physicians participating in torture has received thoughtful attention in the field of medicine, and a number of international organizations have issued declarations decrying such involvement. Despite publications that provide evidence of dentists' having participated in torture as well, until recently the dental profession was quiescent on the subject. METHODS: The authors describe the historical background for a new declaration against dentists' participation in torture developed by the International Dental Ethics and Law Society and the Fédération Dentaire Internationale (FDI) World Dental Federation. They review various levels of involvement by dentists in torture and related activities in reference to existing World Medical Association declarations. Finally, they outline the process of drafting the new dental declaration, which was adopted by the FDI in October 2007. CLINICAL IMPLICATIONS: The authors provide insight and guidance to clinicians who diligently serve their patients, unaware that they may face military or other pressures to participate in torture.

Dentists in double trouble: the (un)fairness of punishing for the same mistake twice.

BACKGROUND: and Overview. Many state dental practice acts allow for the suspension or revocation of a dentist's license on the basis of a previous conviction for illegal behavior, even if the behavior is not related to the practice of dentistry. Penalizing a dentist twice for the same behavior appears to violate the legal principle "ne bis in idem"-that is, no double penalty for the same socially undesirable behavior. However, disciplinary measures are not intended primarily to penalize the offender but rather to protect the public and the reputation of the profession. In this article, the authors review various cases in which boards disciplined convicted dentists and propose criteria for discerning between situations in which such "double trouble" is fair and unfair. CONCLUSIONS: and Practice Implications. The authors conclude that such disciplinary actions are fair only if four criteria concerning the following are fulfilled: the relationship between the dentist's illegal behavior and dental treatment or privileges of the dentist; the severity of the crime; the frequency of the illegal behavior; and the balance between crime and punishment.

Is dentistry a profession? Part 3. Future challenges.

In 2 earlier articles a definition of professionalism was developed, and several specific professional responsibilities were deduced. This third and final article in the series examines whether dentistry qualifies as a profession. On various levels, the professionalism of dentistry is found wanting. However, attaining the status of a profession is a work in progress, which means that each profession will always have some deficiencies. The author concludes that dentistry qualifies as a profession but that it is also exhibiting a trend toward once again becoming a business (as it was before the 19th century). For the sake of honesty with the public, dentistry must make a choice between these 2 models.

Is dentistry a profession? Part 2. The hallmarks of professionalism.

In this second in a series of 3 articles, the author builds on the definition of professionalism developed in the first article, arguing that the social contract between the profession and the public entails a collective responsibility of the members of the profession to serve the public good. Several specific professional duties are deduced, such as the duties to attain and maintain competence, to review one's peers, and to serve all in need of expert care. The third and final article will examine whether and to what extent dentistry fulfills these responsibilities and outlines some future challenges.

Is dentistry a profession? Part 1. Professionalism defined.

Individual dentists and organized dentistry alike invariably claim to be (members of) a profession. This label is cherished because it suggests special social, moral and political status. However, almost every self-respecting occupation nowadays claims to be a profession. Hence, the question arises as to what exactly is meant when dentists claim to be professionals and, more important, whether they can justifiably lay claim to this label. Rather than reviewing the manifold and divergent discussions in the literature about professionalism, the author proposes--in this first of 3 consecutive articles--a definition of the term "profession" that is based on the literal origins of the word. Next, it is argued that a profession arises out of a social contract between the public and a service occupation that professes to give priority to the existential needs of the people served. In the second article, the author deduces several professional responsibilities. The third and final article examines whether and to what extent dentistry fulfills these responsibilities and outlines some future challenges.

The ethics of roles.

A distinction is made between ethical reasoning and moral behavior. Ethics courses in dental schools can aspire to improve the ability of students to reflect on ethical alternatives, but the most powerful influence for professional behavior comes from the role modeling of faculty members. The psycho-social, pedagogical, meta-ethical, and moral implications of faculty roles are examined. An example is given of how faculty assume this responsibility as they accept membership in the school community.

Ignatius of Loyola on medical education. Or: Should today's Jesuits continue to run health sciences schools?

There are present 28 Jesuit colleges and universities in the United States, which together offer more than 50 health sciences degree programs. But as the Society's membership is shrinking and the financial risks involved in sponsoring health sciences education are rising, the question arises whether the Society should continue to sponsor health sciences degree programs. In fact, at least eight Jesuit health sciences schools have already closed their doors. This paper attempts to contribute to the resolution of this urgent question by reexamining Ignatius own views on health sciences education and, more specifically, his prohibition of the Society's sponsoring medical education. It concludes on the basis of an historical analysis of Ignatius' views that there is insufficient support for today's Jesuits to maintain their engagement in medical and health care education.