The demand for cosmetic care in dermal therapy practices is experiencing rapid growth in the Netherlands, fueled by advancements in technology and the desire for everlasting youthful skin. While the pursuit of beauty greatly impacts self-esteem and self-confidence, it is vital to recognize the negative consequences of unrealistic beauty standards. Therefore, adopting a healthy and balanced approach to beauty that celebrates individuality and diversity is crucial. This presents both opportunities and challenges in maintaining an ethically responsible dermal therapy practice. 

Dermal therapists, recognized as paramedical experts in both healthy and diseased skin, are registered under the BIG Act Article 34, and are increasingly involved in cosmetic interventions. Consequently, dermal therapists are now faced with novel ethical dilemmas. These include ensuring autonomy in choosing the right treatment, promoting inclusivity and fairness (ensuring widespread access to cosmetic care), and addressing sustainability concerns (evaluating the enduring impact of cosmetic treatments on general well-being). This shows the need for a reevaluation of their ethical framework.

To address this issue, the researcher initiated two preliminary studies as a foundation for her PhD research:

  1. A study aimed to update the professional code for the Dutch Association of Dermal Therapists (NVH) in 2021. This involved conducting a literature review, organizing focus groups, and conducting interviews to develop a new professional code. The focus was on promoting ethical conduct in non-medical (cosmetic) treatments and being vigilant towards conflicts among healthcare providers, entrepreneurs, and societal interests.
  2. A comprehensive literature review was conducted to explore the factors influencing beauty ideals and norms in cosmetic care, resulting in a manuscript for scientific publication.

While these studies provided dermal therapists with an ethical framework, they did not offer guidance on the necessary competencies for adhering to this code and how to develop them. Existing international literature or professional profiles were not very helpful, which poses a challenge for Dermal Therapy courses at institutions like The Hague University of Applied Sciences and Utrecht University of Applied Sciences. Graduates often report a gap between theoretical training on Moral Action in Ethical Dilemmas in Cosmetic Care and practical requirements, especially in balancing the roles of caregiver, entrepreneur, and global citizen.

Purpose of the research

To address this gap, it is important to:

  • Define the competencies required for handling ethical dilemmas in cosmetic practice.
  • Develop an assessment tool to measure competency levels and progress.
  • Design an educational intervention to nurture these competencies among students and practitioners.

Recent research emphasizes the significance of not only imparting moral reasoning skills to students but also providing practical training in ethical decision-making to ensure ethical behavior. Studies advocate for the effectiveness of simulations, such as role-playing, in enhancing ethical competencies. Thus, an intervention incorporating role-play will be developed, targeting Dermal Therapy students and practicing dermal therapists. Previous research has shown that such interventions encourage diverse perspectives on ethical dilemmas, leading to improved competency development.

Consequently, the central research question arises:

To what extent does participation in an intervention utilizing role-play facilitate the development of moral competencies in cosmetic care among Dermal Therapy students and practicing dermal therapists?


This PhD research has three sub-studies: a design study (study 1), a study in which a measuring instrument is developed (study 2) and an effect study (study 3). The basis for this research is the model for educational design research by McKenney and Reeves (2019).

Based on literature review, context analysis, and prototyping in Study 1, an intervention will be designed featuring precise definitions of competencies and design principles. 

In Study 2, a tool will be developed to assess the level and progression of competencies essential for ethical conduct in cosmetic care, which will be validated through a pilot study.

Study 3 aims to evaluate the efficacy of the intervention by employing the tool developed in Study 2. This evaluation will involve conducting interviews and administering questionnaires among participants who have undergone the intervention, thereby providing valuable insights into its effectiveness.

Involved educational programme

Bachelor Skin therapy 

Collaboration partners

  • Dutch Association of Dermal Therapists (NVH)
  • Utrecht University of Applied Sciences – Dermal Therapy Programme
  • Erasmus University Rotterdam – Health Sciences – Medical Ethics, Philosophy and History of Medicine
  • Victoria University (Melbourne, Australia) – Programme of Dermal Therapy

Duration of the project

This research started in 2021 and will run for at least 4 years.

More information

Read more about what beauty and human rights have to do with each other in the article 'Right to beauty'.

Listen to the podcast 'Cosmetic treatments, how far do we go?' (14:28 minutes, Dutch) in which researcher Natasha Labohm talks about the norms and values ​​regarding cosmetic treatments.


Would you like to know more about this research? Please contact researcher Natasha Labohm (