Martine Kruijtbosch

127 De t e rmi nan t s t ha t i n f l uence mo ra l r eason i ng pe r spec t i ves INTRODUCTION Worldwide drug shortages present serious challenges to pharmacists. Pharmacists are professionals that have the responsibility to deliver appropriate drug therapy. This professional duty is hampered when drugs become unavailable. Most research on drug shortages in community pharmacy has focused on the nature and extent of these shortages, on the impact of these shortages on patients and pharmacists and on practical solutions to solve these shortages. 1-7 Although these studies make clear that drug shortages have moral as well as economic implications for pharmacists, the problem is not discussed in terms of its impact on pharmacists’ ethical decision-making in daily practice. 8 ‘What is the ‘right’ thing to do?’ is a moral question for pharmacists when confronted with a shortage of a drug that a particular patient needs for possibly chronic health problems. In such a situation, what is most appropriate for a patient, to dispense a potentially less suitable alternative medicine or a less appropriate dosage form 2,4,9 or to not dispense an alternative medicine at all? In a previous study 10 , three developmental levels of moral reasoning perspectives (MRPs) among pharmacists in situations of drug shortages were investigated. A moral reasoning measure then was developed and validated. That study showed that pharmacists’ intended handling of these shortages was influenced predominantly by the professional ethics MRP (PE-MRP) and to a much lesser extent by the business orientation MRP (BO-MRP) and the rules and regulations MRP (RR-MRP). The moral reasoning scores for each perspective for the total group of pharmacists were calculated. Such scores represent the relative importance participants give to a certain MRP in their moral decision-making process. 11 However, relative MRP scores do not provide information on a dominant MRP in the reasoning of a pharmacist, which may characterize that pharmacist. 12 Thus, it is still unknown if pharmacists differ in their dominant MRPs. It would be interesting to know if there are pharmacist characteristics that may explain different dominant MRPs and if pharmacists with different MRPs handle situations of drug shortages differently. The aim of the present study is to identify determinants of community pharmacists’ MRPs in situations of drug shortages.