Martine Kruijtbosch

143 Mo ra l case de l i be ra t i on INTRODUCTION Most health professionals experience moral dilemmas on a daily basis. Moral dilemmas are characterized by a choice between options neither of which is a clear ‘best’ course of action, because there always will be a conflict between the values and perspectives of the different parties involved (the patient, other health professionals, institutions, society). 1 Moral dilemmas may cause moral distress in health professionals, which subsequently may negatively affect the quality of care they provide. 2,3 Community pharmacists experience a diversity of moral dilemmas. 4 Although the best scientific evidence, clinical experience and critical thinking are fundamental for appropriate pharmacotherapy, they do not provide a sufficient basis for deciding what to do in situations of moral dilemmas. Reflection on the values and perspectives of all parties involved, especially patients, is essential to good clinical decision making. 5-7 Dealing with moral dilemmas thus requires ethical competencies that accompany clinical competencies. In medical professions, moral case deliberation (MCD) is increasingly used to teach such ethical competencies. 7-10 MCD is a structured meeting in which answers to a moral question in a concrete case of one of the participants is jointly examined by a group of health professionals under the guidance of a trained facilitator. 11 This method is characterized by participants’ systematic moral reflections (i.e. value judgments in relation to the case) and continuous dialogical understanding (i.e. learning from other participants’ perspectives) in several methodical steps. 12-14 Research has shown that MCD may improve ethical competencies, reduce moral distress, stimulate collaboration among health professionals, and enhance quality of care. 3,9,15 As far as we know, MCD has only been evaluated among professionals working in multidisciplinary teams in hospitals and long-term care institutions 8,10,11,14,16,17 , and within care for specific patient groups like elderly care 15,18 , mental healthcare 16,19 and care for the homeless 20 . Hence, it would be interesting to explore the effects of MCD among community pharmacists. 4,21 Their dilemmas often happen with the patient waiting at the counter and thus need quick settlement. This leaves limited possibilities for extensive moral deliberation at the time of the dilemma. MCDmay stimulate the ethical competencies necessary for community pharmacists. Although in some countries systematic step-wise decision-making approaches are available, targeted at the self-learning of individual pharmacists and pharmacy students, 22-25 MCD seems not well-established for community pharmacists yet. 26 The aim of this study is to explore whether MCD fosters the moral reflectivity required for community pharmacists to make ethical decisions in moral dilemma cases.