Martine Kruijtbosch

14 Chap t e r 1 prescribing and use of medicines. 8,12,13 Pharmacists increasingly take up this role e.g. by performing medication reviews. 14-17 To further support pharmacists in their role as health professionals, access to laboratory values and indications for prescribing of drugs with small therapeutic windows has also been nationally regulated. 18 Community pharmacists are expected to take joint responsibility for the quality of pharmacotherapy with primary care physicians, e.g. through local Pharmacotherapy Audit Meetings. 19 Professional guidance: the profession’s core values Pharmacists in the Netherlands are professionally guided by the Dutch Charter of Professionalismof the Pharmacist (Charter). 3 The KNMP charged a ProfessionalismWorking Group, consisting of pharmacists working in all sectors in the Netherlands (i.e. hospital and community pharmacy, policy, education and industry), with the assignment to jointly develop this Charter. The Charter provides ethical guidance in pharmacy practice, especially in situations of moral uncertainty. Central to the Charter are the profession’s core values (i.e. professional values): commitment to the patient’s well-being, pharmaceutical expertise, reliability and care, social responsibility, and professional autonomy (Box 1). Pharmacists are encouraged to employ professional expertise and practical wisdom to fulfil these professional values in situations where a balance is needed between what is desirable, what is sensible and what is the right thing to do in the care for the individual patient. 3 No empirical research has yet been conducted into these values in Dutch community pharmacy practice. Moral dilemmas Global changes are affecting healthcare systems and their professionals. For example, new (digital) healthcare technologies are rapidly emerging, market forces in healthcare are increasing, healthcare budgets are increasingly being curtailed, regulations are growing, and payers expect coordinated and value-based healthcare. Simultaneously, health professionals such as community pharmacists are increasingly under pressure due to an ageing population that uses more medicines and demands more pharmaceutical care, and an overall increased health consumerism. 20 Health professionals’ work has become more complex and their workload has increased. Community pharmacists like other health professionals increasingly experience moral dilemmas in this complex context. 21,22 Moral dilemmas are situations where it is not immediately clear what the right course of action is as all options have moral advantages as well as moral disadvantages. 23,24 In such situations values and perspectives of different parties involved are in conflict.