In this article I discuss the ethical ramifications for medical ethics training of the availability of large language models (LLMs) for medical students. My focus is on the practical ethical consequences for what we should expect of medical students in terms of medical professionalism and ethical reasoning, and how this can be tested in a context where LLMs are relatively easy available. If we continue to expect ethical competences of medical professionalism of future physicians, how much – if at all (...) – should we worry that such generative AI may compromise adequate testing of medical students’ abilities in this regard? I mainly focus on assessment methods based on written assignments of the ‘student paper’ type and consider whether LLMs make it unfeasible for assessors to gauge whether output is student-generated or ‘machine-generated’ and, if so, whether this is a problem. My take on this research question unfolds in three interwoven arguments, claiming that the advent of LLMs may offer a momentum (i) to reaffirm the importance of context-sensitive interpretation and specification of ethical principles in medical ethics training, (ii) to provide more supportive circumstances to assessors to allow them to meet scoring demands entailed by the importance that is placed on medical professionalism, and (iii) to complement written assignments with verbal (group) discussion to train and test students’ skills to habitually recognize that ‘moral solutions’ can be normatively questioned and specified from various perspectives. (shrink)

BackgroundBreakthroughs in animal studies make the topic of human application of ectogenesis for medical and non-medical purposes more relevant than ever before. While current data do not yet demonstrate a reasonable expectation of clinical benefit soon, several groups are investigating the feasibility of artificial uteri for extracorporeal human gestation.Main textThis paper offers the first comprehensive and up to date discussion of the most important pros and cons of human ectogenesis in light of clinical application, along with an examination of crucial (...) ethical (and legal) issues that continued research into, and the clinical translation of, ectogenesis gives rise to. The expected benefits include advancing prenatal medicine, improving neonatal intensive care, and providing a novel pathway towards biological parenthood. This comes with important future challenges. Prior to human application, important questions have to be considered concerning translational research, experimental use of human fetuses and appropriate safety testing. Key questions are identified regarding risks to ectogenesis’ subjects, and the physical impact on the pregnant person when transfer from the uterus to the artificial womb is required. Critical issues concerning proportionality have to be considered, also in terms of equity of access, relative to the envisaged application of ectogenesis. The advent of ectogenesis also comes with crucial issues surrounding abortion, extended fetal viability and moral status of the fetus.ConclusionsThe development of human ectogenesis will have numerous implications for clinical practice. Prior to human testing, close consideration should be given to whether (and how) ectogenesis can be introduced as a continuation of existing neonatal care, with due attention to both safety risks to the fetus and pressures on pregnant persons to undergo experimental and/or invasive procedures. Equally important is the societal debate about the acceptable applications of ectogenesis and how access to these usages should be prioritized. It should be anticipated that clinical availability of ectogenesis, possibly first as a way to save extremely premature fetuses, may spark demand for non-medical purposes, like avoiding physical and social burdens of pregnancy. (shrink)

The centrality of trust in traditional doctor–patient relationships has been criticized as inordinately paternalistic, yet in today's discussions about medical ethics—mostly in response to disruptive innovation in healthcare—trust reappears as an asset to enable empowerment. To turn away from paternalistic trust‐based doctor–patient relationships and to arrive at an empowerment‐based medical model, increasing reference is made to the importance of nurturing trust in technologies that are supposed to bring that empowerment. In this article we stimulate discussion about why the move towards (...) patient empowerment may not be able to keep clear of the criticism of trust in traditional patient–doctor relationships. First, we explore how such a shift in trust dynamics might corrode patient empowerment in the name of patient empowerment. Second, we examine how a translocation of trust may at best push the “trust issue” elsewhere and at worst make it harder to evaluate trustworthiness. (shrink)

In this paper, we aim to stimulate ethical debate about the morally relevant connection between ectogenesis and the foetus as a potential beneficiary of treatment. Ectogenesis could facilitate foetal interventions by treating the foetus independently of the pregnant woman and provide easier access to the foetus if interventions are required. The moral relevance hereof derives from the observation that, together with other developments in genetic technology and prenatal treatment, this may catalyse the allocation of a patient status to the foetus. (...) The topic of foetal medicine is of growing interest to clinicians, and it also deserves due attention from an ethical perspective. To the extent that these developments contribute to the allocation of a patient status to the foetus, normative questions arise about how moral responsibilities towards foetal interests should be balanced against the interests of the pregnant woman. We conclude that, even if ectogenesis could facilitate foetal therapy, it is important to remain sensitive to the fact that it would not circumvent the key ethical concerns that come with in utero foetal treatment and that it may even exacerbate potential conflicts between directive treatment recommendations and the pregnant woman's autonomous decision to the contrary. (shrink)

People who are involuntarily childless need to use assisted reproductive technologies if they want to have a genetically related child. Yet, from an ethical point of view it is unclear to what extent assistance to satisfy this specific desire should be warranted. We first show that the subjectively felt harm due to the inability to satisfy this reproductive desire does not in itself entail the normative conclusion that it has to be met. In response, we evaluate the alternative view according (...) to which the satisfaction of this desire is regarded as a way to meet one’s presumed intermediate need for parenthood. This view presupposes that parenthood is one of those general categories of experiences and activities that contribute an irreplaceable value to people’s lives, but the central difficulty is to find those characteristics that mark out parenthood as an irreplaceable constituent of a valuable life. We go on to argue, however, that even if one assumes that parenthood is such an irreplaceable constituent that makes life more valuable, this does not necessarily entail a moral duty to satisfy the desire for genetic parenthood. We conclude that there is a pro tanto obligation to help people conceive a genetically related child (if this is what they prefer), but that this can be outweighed by other moral considerations, such as safety and justice concerns. (shrink)

Paragraph 12 of the revised International Code of Medical Ethics (ICoME) states that ‘the physician should strive to practise medicine in ways that are environmentally sustainable with a view to minimising environmental health risks to current and future generations.’ 1 This emphasis on environmental sustainability is in line with popular discourse as well growing scholarly attention in medical ethics for healthcare’s contribution to climate change. Recent research analyses, for instance, the ‘greening’ of informed consent and related bioethical principles. 2 3 (...) It is unclear what the duty of practising sustainable healthcare means at the level of doctor–patient interaction. Parsa-Parsi _et al_ flag the potential conflict in the ICoME’s provisions if ‘the actions of physicians are influenced by environmental considerations to the detriment of patients’ (p. 2), noting that the ICoME does not provide a handhold to improve understanding of such tensions. The code ‘does not... (shrink)

The implementation of care robotics in care settings is identified by some authors as a disruptive innovation, in the sense that it will upend the praxis of care. It is an open ethical question whether this alleged disruption will also have a transformative impact on established ethical concepts and principles. One prevalent worry is that the implementation of care robots will turn deception into a routine component of elderly care, at least to the extent that these robots will function as (...) simulacra for something that they are not (i.e. human caregivers). At face value, this may indeed seem to indicate a concern for how this technology may upend existing practices and relationships within a care setting. Yet, on closer inspection, this reaction may rather point to a rediscovery and a revaluation of a particularly well-entrenched value or virtue, i.e. veracity. The virtue of veracity is one of the values that is mobilized to argue against a substitution of human caregivers (while a combination of care robots and human caregivers is much more accepted). The subject of this paper is to explore how the moral panic surrounding care robots should not so much be interpreted as an anticipated and probable disruptor in a care setting, but rather as a sensitizing – in a way conservationist – argument that identifies veracity as an established value that is supposed to be protected and advanced in present day and future care settings. (shrink)

People have various desires, but it is a contested moral issue when a desire becomes of such importance that it legitimizes a moral claim on others. This paper explores how the normative significance of desire satisfaction can be assessed and argues that a normatively significant desire can constitute a pro tanto obligation to help satisfy it. The paper presents a framework that relates the normative significance of a given desire to the general goal of living a reasonably valuable life and (...) inquires how the latter can be given determinate content without excluding a heterogeneity of the personal good. The paper contends that the set of possibly normatively significant desires is thus restricted by considerations about intelligibility, adequacy, and replaceability, which are mediated by societal background theories. (shrink)

We expand on Della Croce’s ambition to interpret “epistemic injustice” as a specification of non-maleficence in the use of the influential four-principle framework. This is an alluring line of thought for conceptual, moral, and heuristic reasons. Although it is commendable, Della Croce’s attempt remains tentative. So does our critique of it. Yet, we take on the challenge to critically address two interrelated points. First, we broaden the analysis to include deliberations about hermeneutical injustice. We argue that, if due consideration of (...) epistemic injustice is to require more than negative ethical obligations in medicine, dimensions of hermeneutical injustice should be explored as an avenue to arrive at such positive duties. Second, and relatedly, we argue that this may encompass moral responsibilities beyond the individual level, that is: positive obligations to take action on a structural level. Building on Dotson’s concept of “contributory injustice” and Scheman’s concept of “perceptual autonomy,” we suggest that the virtues of testimonial and hermeneutical justice may provide additional content not only to negative prohibitions of action (i.e. non-maleficence) but also to positive requirements of action, like respecting patient autonomy. (shrink)

Despite the frequent invocation of ‘false hope’ and possible related moral concerns in the context of assisted reproduction technologies, a focused ethical and conceptual problematisation of this concept seems to be lacking. We argue that an invocation of ‘false hope’ only makes sense if the fulfilment of a desired outcome (eg, a successful fertility treatment) is impossible, and if it is attributed from an external perspective. The evaluation incurred by this third party may foreclose a given perspective from being an (...) object of hope. However, this evaluation is not a mere statistical calculation or observation based on probabilities but is dependent on several factors that should be acknowledgeable as morally relevant. This is important because it allows room for, and encourages, reasoned disagreement and moral negotiation. Accordingly, the object of hope itself, whether or not based on socially embedded desires or practices, can be a topic of debate. (shrink)

Recent medical innovations like ‘omics’ technologies, mobile health (mHealth) applications or telemedicine are perceived as part of a shift towards a more preventive, participatory and affordable healthcare model. These innovations are often regarded as ‘disruptive technologies’. It is a topic of debate to what extent these technologies may transform the medical enterprise, and relatedly, what this means for medical ethics. The question of whether these developments disrupt established ethical principles like respect for autonomy has indeed received increasing normative attention during (...) the past years. Yet, more fundamental ethical considerations of a possible disruption of the concept of ‘medical necessity’ (and the potential ensuing clinical ramifications) have been limited if not absent. It is our modest – though morally and practically relevant – aim to address this objective in this article, by exploring how the current wave of allegedly disruptive innovation is invoking a resurgence of this concept and related debates on ‘the’ goal(s) of medicine. (shrink)

Germline genome editing is often disapproved of at the international policy level because of its possible threats to human dignity. However, from a critical perspective the relationship between this emerging technology and human dignity is relatively understudied. We explore the main principles that are referred to when 'human dignity' is invoked in this context; namely, the link with eugenics, the idea of a common genetic heritage, the principle of equal birth and broader equality and justice concerns. Yet the concept is (...) also used in favour of germline genome editing as it might improve the overall well-being of future generations. We conclude that dignity concerns do not justify a complete ban on safe heritable genome editing but should inform the implementation of side constraints to ensure that the value judgements about human traits that are inherent in this practice do not result in a diminished basic respect for those people affected by them. (shrink)

Many pregnant women use pregnancy related mHealth applications, encompassing a variety of pregnancy apps and wearables. These are mostly directed at supporting a healthier fetal development. In this article we argue that the increasing dominance of PRmHealth stands in want of empirical knowledge affirming its beneficence in terms of improved pregnancy outcomes. This is a crucial ethical issue, especially in the light of concerns about increasing pressures and growing responsibilities ascribed to pregnant women, which may, in turn, be reinforced by (...) PRmHealth. A point can be made that it would be ethically askew if PRmHealth does not lead to improved pregnancy outcomes, while at the same time increasing maternal duties to closely monitor fetal development. We conclude that more research is needed to get a view on the benefits and burdens of PRmHealth in order to ethically assess whether the latter are proportionate to the former. If not, there is a case in saying that endorsement of PRmHealth is overdemanding. (shrink)

I am happy to comment on T S Petersen’s1 examination of the ‘individualization argument against non-medical egg freezing ’. Petersen intervenes in the ethical discussion on egg freezing by critically reconsidering a specific type of argument against oocyte cryopreservation for reasons that are not directly related with medical issues. Petersen dissects the claim that such non-medical usage is ‘an individualistic and morally problematic solution to the social problems that women face, for instance, in the labour market’.1 Proponents of this argument (...) believe that egg freezing should not be used by women on an individual level to solve social problems but that one should instead address gendered inequalities on the labour market. Petersen asserts that this individualisation argument is unconvincing—although morally appealing—because of empirically and ethically flawed assumptions. I am enthusiastic—with some minor reservations—about his unravelment of the individualisation argument and his call for more empirical backing. As I understand his presentation, the argument that is the subject of Petersen’s analysis is a recurring argumentative trope in the broader realm of assisted reproduction ethics. For instance, the anticipated positive effect of artificial womb technology in terms of liberation from reproductive and related social inequalities is one of the most dominant ectogenesis …. (shrink)

Tensions between respect for autonomy and paternalism loom large in Ferrario et al ’s discussion of artificial intelligence (AI)-based preference predictors.1 To be sure, their analysis (rightfully) brings out the moral matter of respecting patient preferences. My point here, however, is that their consideration of AI-based preference predictors in treatment of incapacitated patients opens more fundamental moral questions about the desirability of over-ruling considered patient preferences, not only if these are disclosed by surrogates, but possibly also in treating competent patients. (...) I do not advocate such an evolution—the moral desirability of that calls for a much broader debate, one in which the meaning of ‘doing good’ in medicine, and how this intersects with normative views on ‘the goal(s) of medicine’ would be central elements. While my aim in this piece is more modest, I nonetheless hope to approach it sideways, by indicating how the contribution by Ferrario et al reopens discussion about paternalism and the normativity of preferences in medicine. This follows from what these authors give as reason for endorsing this technology in care for incapacitated patients. Their argument for employing such tools in case of incapacitation is based on the premise that advice of surrogate decision-makers about care preferences is suboptimal because of their biased perception …. (shrink)

It has been suggested that future application of stem-cell derived gametes might lead to the possibility for same-sex couples to have genetically related children. Still, for this to become possible, the technique of gamete derivation and techniques of reprogramming somatic cells to a pluripotent state would have to be perfected. Moreover, egg cells would have to be derived from male cells and sperm cells from female cells, which is believed to be particularly difficult, if not impossible. We suggest a more (...) plausible scenario to provide same-sex couples with the possibility to parent a child who is genetically related to both parents. Although technical feasibility is an advantage, disadvantages are that cooperation of a donor of the opposite sex is still required and that the partners are genetically linked to the resulting child in a different degree. However, since in our scenario the donor's genetic contribution would not outweigh any of the parents' genetic contribution, this alternative route may ease the fear for a possible parental claim by the donor. Like many other applications in the field of infertility treatment, the goal to create SCD-gametes for reproductive purposes is largely based on the high value attributed to genetic parenthood. Although we believe that genetic relatedness is neither a necessary nor a sufficient condition for ‘good’ parenthood, we do believe that many people may consider our scenario a welcome alternative. (shrink)

Abstract:Research into the development of stem cell-derived (SCD) gametes in humans, otherwise known asin vitrogametogenesis (IVG), is largely motivated by reproductive aims. Especially, the goal of establishing genetic parenthood by means of SCD-gametes is considered an important aim. However, like other applications in the field of assisted reproduction, this technology evokes worries about the possibility of creating so-called ‘designer babies.’ In this paper, we investigate various ways in which SCD-gametes could be used to create such preference-matched offspring, and what this (...) would mean for the acceptability of IVG, if it is premised that it is morally problematic to ‘design’ offspring. We argue that IVG might facilitate the creation of preference-matched offspring, but conclude that this should not undermine the moral acceptability of IVG altogether—even if one concedes the premise that creating ‘designer babies’ is morally problematic. In the light of this, we also point at a possible inconsistency for a position that condemns the creation of ‘designer offspring,’ while accepting the various endeavors to have genetically related offspring. (shrink)

In vitro gametogenesis (IVG) is believed to be the next big breakthrough in reproductive medicine. The prima facie acceptance of this possible future technology is notable when compared to the general prohibition on human reproductive cloning. After all, if safety is the main reason for not allowing reproductive cloning, one might expect a similar conclusion for the reproductive application of IVG, since both technologies hold considerable and comparable risks. However, safety concerns may be overcome, and are presumably not the sole (...) reason why cloning is being condemned. We therefore assess the non‐safety arguments against reproductive cloning, yet most of these can also be held against IVG. The few arguments that cannot be used against IVG are defective. We conclude from this that it will be hard to defend a ban on reproductive cloning while accepting the reproductive use of IVG. (shrink)

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Die Beiträge dieses Buches unternehmen den Versuch, Praktische Philosophie in Begriffen einer negativistischen Sozialphilosophie zu rekonstruieren, die ein breites Spektrum von Phänomenen negativer Sozialität in ihrem eigenen Recht beschreibt und dabei davon ausgehen muss, dass sich diese Phänomene nicht in einer voll integrierten Gemeinschaft oder Gesellschaft aufheben lassen. Eine solche Sozialphilosophie geht den Gründen für die Irreduziblität des Negativen einerseits auf einer begrifflichen Ebene, andererseits aber auch in konkreten historisch-sozialphilosophischen, lexikalisch angeordneten Analysen nach. Getragen sind die Analysen von der Überzeugung, (...) dass ohne „Reibung“ an diesen Phänomenen auch ein Leben im Zeichen des Guten oder Gerechten jeglichen Halt an einem leibhaftigen In-der-Welt-Sein verlieren muss. Wir sind nicht nur unaufhebbarer Negativität ausgesetzt, sondern müssen auch verstehen, wie das der Fall ist, und welche Spielräume des Verhaltens sich uns darin eröffnen. (shrink)

L’auteur s’appuie sur le travail de F. André, L’enfant insuffisamment bon (1985), pour explorer l’idée que le handicap et la souffrance qu’il procure à son contact met en question l’identification humaine sur un plan familial et sociétal et entraîne des mécanismes d’indifférenciation entre l’humain et le non-humain, le vivant et le non vivant. Situés dans un mouvement protecteur au départ, ces mécanismes aggravent ensuite les effets du handicap au sein des familles ou des établissements spécialisés en empêchant le développement de (...) la sub-jectivité de chacun. Pour le comprendre, l’auteur expose deux exemples de thérapies familiales psychanalytiques, l’un dans le cas d’une enfant gravement handicapée (atteinte neurologique et psychose symbiotique), et l’autre dans le cas d’un enfant dont le handicap se trouve majoré par les éléments trans-générationnels réactivés à sa naissance et dont il va se retrouver porteur. (shrink)

L’adoption a la particularité d’activer un champ fantasmatique dont l’auteur se propose d’éclairer certains aspects. La résonance entre la situation adoptive et ce que Freud a appelé le « roman familial » en fait un lieu possible d’exacerbation des rivalités, des fantasmes de rapt, des mécanismes d’idéalisation, aussi bien au sein des familles adoptantes que dans leurs relations avec les professionnels chargés de les accompagner. L’idéalisation conjointe parents-pro-fessionnels de la situation adoptive a pour effet d’empêcher la reconnaissance de la négativité (...) présente dans toute forme de transmission. Elle peut empêcher aussi le repérage de ce que l’auteur propose d’appréhender comme une clinique de la rupture de transmission. Cette rupture a parfois comme conséquence la mise en place de clivages internes à chacun des protagonistes, clivages qui vont se redoubler et diffuser sous forme de sidération ou de conflits dans l’agencement des professionnels gravitant autour de ces situations. Ces situations complexes, bouleversant profondément chacun, nécessitent des espaces spécifiques de traitement et de réflexion pour en construire des modalités de compréhension. (shrink)

In this study, we directly contrast two approaches that have been proposed to explain the SNARC effect. The traditional direct mapping account suggests that a direct association exists between the position of a number on the mental number line and the location of the response. On the other hand, accounts are considered that propose an intermediate step in which numbers are categorized as either small or large between the number magnitude and the response representations. In a magnitude comparison task, we (...) departed from the usual bimanual left/right response dimension and instead introduced the unimanual close/far dimension. A spatial-numerical association was observed: small numbers were associated with a close response, while large numbers were associated with a far response, regardless of the movement direction (left/right). We discuss why these results cannot be explained by assuming a direct mapping from the representation of numbers on a mental number line to response locations and discuss how the results can be explained by the alternative accounts. (shrink)

Dissociative identity disorder (DID; called multiple personality disorder in DSMIII-R) is a psychiatric condition in which two or more identity states recurrently take control of the person's behavior. A characteristic feature of DID is the occurrence of apparently severe amnestic symptoms. This paper is concerned with experimental research of memory function in DID and focuses on between-identity transfer of newly learned neutral material. Previous studies on this subject are reviewed and a pilot study with four subjects is described. This study (...) is specifically concerned with the question whether self-reported asymmetries in between-identity transfer can be replicated on experimental memory tests. A secondary aim was to examine whether, in the absence of explicit transfer, implicit transfer of information would occur. The results showed that the apparent amnestic asymmetry for explicit information was substantiated in the laboratory, although at least some leakage was present between the apparently amnestic identities. No evidence was found for better performance on implicit than on explicit memory tests in the apparently amnestic identities. In the discussion, parallels between apparent amnesia in DID and state-dependent memory are drawn, and the question of simulated amnesia is addressed. (shrink)

Social interactions are essential aspects of social relationships. Despite their centrality, there is a lack of a standardized approach to systematize social interactions. The present research developed and tested a taxonomy of social interactions. In Study 1, we combined a bottom-up approach based on the grounded theory with a top-down approach integrating existing empirical and theoretical literature to develop the taxonomy. The resulting taxonomy comprises the components Actor, Partner, Relation, Activities, Context, and Evaluation, each specified by features on three levels (...) of abstraction. A social situation can be described by a combination of the components and their features on the respective abstraction level. Study 2 tested the APRACE using another dataset with 1,899 descriptions of social interactions. The index scores of the six components, the frequencies of the features on the most abstract level, and their correlations were largely consistent across both studies, which supports the generalizability of the APRACE. The APRACE offers a generalizable tool for the comprehensive, parsimonious, and systematic description of social interactions and, thus, enables networked research on social interactions and application in a number of practical fields. (shrink)

It is widely acknowledged that high-level AI principles are difficult to translate into practices via explicit rules and design guidelines. Consequently, many AI research and development groups that claim to adopt ethics principles have been accused of unwarranted “ethics washing”. Accordingly, there remains a question as to if and how high-level principles should be expected to influence the development of safe and beneficial AI. In this short commentary I discuss two roles high-level principles might play in AI ethics and governance. (...) The first and most often discussed “start-point” function quickly succumbs to the complaints outlined above. I suggest, however, that a second “cultural influence” function is where the primary value of high-level principles lies. (shrink)

The complexity of the physiological phenotype currently prevents us from identifying an integrative measure to assess how the internal state and environmental conditions modify life‐history strategies. In this article, it is proposed that shorter telomeres should lead to a faster pace‐of‐life where investment in self‐maintenance is decreased as a means of saving energy for reproduction, but at the cost of somatic durability. Inversely, longer telomeres would favor an increased investment in soma maintenance and thus a longer reproductive lifespan (i.e., slower (...) pace‐of‐life). Under this hypothesis, telomere dynamics could be such an integrative mediator, which will assemble the information about oxidative stress levels, inflammation status and stress reactivity, and relate this information to the potential lifespan of the organism and its pace‐of‐life strategy. The signaling function of telomere dynamics can also reach over generations, a phenomenon in which the telomere lengths of gametes would provide a channel through which offspring would receive information about their environment early in their development, hence increasing the possibilities for developmental plasticity. -/- . (shrink)

The importance of employee social media policies is recognized in today’s increasingly connected organizations. Yet these policies are adopted at varying rates in different sectors and geographical regions. In the present study, an institutional approach was employed to investigate the predictors of the adoption of employee social media policies by organizations. Six predictors were examined, namely, organizational size, industry, and the national culture dimensions of power distance, individualism, masculinity, and uncertainty avoidance. Results of a logistic regression analysis of 558 online (...) survey responses from human resource professionals worldwide showed that all six predictors were associated with the adoption of employee social media policies. These findings have implications for multinational companies, as well as for policy makers in the legal, human resources, information technologies, and public relations departments who are the primary parties involved in establishing employee social media policies. Study limitations are presented and future research avenues are suggested. (shrink)

We challenge the arguments of Cohen Kadosh & Walsh (CK&W) on two grounds. First, interactions between number form (e.g., notation, format, modality) and an experimental factor do not show that the notations/formats/modalities are processed separately. Second, we discuss evidence that numbers are coded abstractly, also when not required by task demands and processed unintentionally, thus challenging the authors' dual-code account.

This study focuses on students’ learning approaches in the context of a competency‐based program on Applied Sciences, with portfolio assessment as its core mode of assessment. The study examines students’ perceptions of these assessment practices and the relationships to their learning approaches. Additionally, differences in perceptions and learning approaches between first‐year students and second‐year students, who already have one year of experience with the portfolio assessment practice, are investigated. A total of 110 students completed two questionnaires at the end of (...) the academic year: the Revised SPQ was used to measure their approaches to learning and the AEQ was used to measure their perceptions of the assessment practice. The results indicate that, when implementing portfolio assessment, feedback is essential. Moreover, it seems not to be the assessment design, but rather how it is implemented, and how students’ learning is stimulated through the assessment, that influences the quality of learning. (shrink)