Martine Kruijtbosch

150 Chap t e r 4 Two MCD sessions The summary of the dilemma cases investigated in MCD sessions 1 and 2 can be found in Box 3. The results from the two MCD sessions are presented along two lines: (1) the participants’ moral reflectivity within the three phases of the dilemma method and (2) the participants’ evaluations of the MCD sessions. Each session had a duration of two hours. BOX 3: Summary of the two moral case deliberation (MCD) dilemma cases Moral dilemma case 1, case presenter 1 For a 74-year-old man, the pharmacist had received a discharge prescription for double anticoagulant therapy (i.e. Pradaxa 2 dd 110 mg and acetylsalicylic acid 1 dd 80 mg) from a geriatrician at a rehabilitation centre. The man’s wife consulted the pharmacist about her husband’s medication. Neither the surgeon (first prescriber) in the hospital nor the geriatrician who had treated her husband had explained to her why certain medicines were prescribed or changed. She had lost trust in these physicians and asked the pharmacist for advice. In the consult, the pharmacist was confronted with a very worried wife because her husband was suffering from blue bruises and was restless and anxious. The pharmacist could not clarify the indication for the double anticoagulant therapy from the prescribers who had been involved in the patient’s treatment. The geriatrician had continued the therapy after the surgeon in the hospital and did not know the indication. The surgeon was absent. Moreover, the patient’s renal function was not known. The pharmacist could therefore not advise regarding the double anticoagulant therapy. Moral dilemma case 2, case presenter 2 A patient with a mild intellectual disability and bipolar disorder demanded extra lithium tablets for two days because he had lost them. Earlier that month, the patient had a similar request. His most recent (one year ago) serum lithium level was 0.63 mmol/L. His dosage regimen had not been changed since then. Renal function was adequate. The patient told the pharmacist of his fear of running out of lithium because of previous manic episodes. The pharmacist approached the primary care physician two times, but the physician was not willing to prescribe extra lithium. He did not feel any responsibility for the lithium treatment that had been initiated by a former psychiatrist of the patient long ago. The patient’s serum lithium level had not been monitored in a year. The pharmacist wanted the approval of a physician to dispense the extra lithium. In the meantime, the patient had left the pharmacy slightly irritated. The patient’s anxiety and the repeated disruptive attitude of the primary care physician confronted the pharmacist with a dilemma in which the right action was not immediately clear. Phase 1: Image formation In MCD session 1, the initial image the participants received from the CP was that she could not advise the wife of a patient about taking double anticoagulant medication because the CP did not know the indication. The CP shared her two action options with the participants: not dispensing (action option A) or dispensing (action option B) the double anticoagulant medication. She also shared that the professional values pharmaceutical expertise, commitment to the patient’s well-being and reliable and caring were equally problematic to realise in both action options: