Martine Kruijtbosch

15 I n t roduc t i on BOX 1: Professional core values in the Dutch Charter of Professionalism 3 Commitment to the patient’s well-being Every pharmacist is directly or also indirectly involved in the patient’s well-being: as a direct care provider, as a compounder or developer of medicines or within the educational sector or regulations. Pharmaceutical expertise Like any other professional, the pharmacist also has specific expertise and competences that he can use to provide the best possible service to society. The expertise is related to the pharmacist’s specific knowledge domains. It is systematically and frequently maintained. Reliability and care Medicines in general are powerful substances. They can be highly effective, but at the same time unsafe. The quality assurance of the pharmacist’s actions must therefore be beyond doubt. Social responsibility This core value emphasizes that the pharmacist’s actions are efficient and transparent not only for the individual patient but also for society, and that the pharmacist feels a sense of responsibility for the social consequences of his actions. Professional autonomy The autonomy of the pharmacist stands in an independent relationship with that of other care providers, healthcare insurers and the patient’s right of self-determination. The pharmacist is responsible for his decisions and adheres to the frameworks established by society. He ensures the pharmaceutical judgment whilst maintaining a balance between commitment to the patient and the socially responsible course of action. When there is a moral dilemma the pharmacist must reflect on the values and perspectives of all parties involved and consider these in the decision-making process. 25 For example, a patients can refuse the pharmacotherapy that the pharmacist considers the best therapy for that patient based on his pharmaceutical-scientific expertise. Pharmacists must then become aware of their own and professional values and perspectives, as well as the perspectives and experiences of their patients. Likewise, the collaboration between pharmacist and physician should involve reflection on each other's values and perspectives regarding professional judgments about pharmacotherapy for the patients for which they are both responsible. Moral dilemmas can lead to moral distress, a stress reaction that arises by acting against one’s conscience and (professional) values, often accompanied by a feeling of having no control over work situations. 21 Ethical competencies The above examples illustrate that in order to deal with the complexity of moral dilemmas, pharmacists need ethical competencies. The pharmaceutical expertise of community pharmacists may be insufficient to resolve these dilemmas. In addition to the competencies required for their pharmaceutical expert role, community pharmacists also need competencies for their role as communicator, collaborator, health advocate, scholar,