Martine Kruijtbosch

152 Chap t e r 4 primary or secondary care physician was involved in the patient’s treatment while medicines were prescribed. The CP did not know what to do and was worried about the patient’s health condition and possible unpredictable behaviour due to lack of or overuse of lithium pills. The participants helped the CP formulate her provisional moral question so that it reflected both moral uncertainties: ‘ Is it responsible to let the patient wait two days for extra lithium pills, or do I pass the primary care physician and contact the psychiatrist? ’ (Participant, step 4) The CP formulated in step 4 three action options she felt were available to her at the time of the dilemma: (A) ‘ I dispense the two extra lithium pills without the consent of the primary care physician ’, (B) ‘ I do not dispense the two extra lithium pills and align with the primary care physician’s treatment plan ’, and (C) ‘ I contact the psychiatrist ’. The value perspectives and the related normative actions of all the parties involved were formulated in step 5 (Table 1). Subsequently, the CP was asked to make known which value would motivate her the most to choose action option A, B or C (last column in Table 1). This reflection makes clear the conflicting values involved in the three action options A, B and C that the CP experienced at the time of the dilemma. For example, the participants understood that the CP had serious problems with disruptions in the healthcare chain. She explained that the professional value responsibility to society would motivate her to choose action option B: ‘ What image do pharmacist[s] and primary care physician[s] present to society and towards the patient they treat: to what extent do they collaborate, or do they treat diametrically opposite? ’ (CP, step 5) Opposite, the professional value commitment to the patient’s well-being would motivate the CP most strongly to choose action options A or C. Moreover, with action option C, the CP struggled with her professional autonomy although that professional value did not play a role in her motivation to choose action options A, B or C: ‘ Our relationship with the primary care physician is close with informal gatherings, so now and then. So contacting the psychiatrist felt like passing [the primary care physician]. Will that primary care physician be even more disruptive with [the] next patient? ’ (CP, step 5) The other participants felt the disruptive behaviour of the physician resonated more with professional autonomy than responsibility to society. Professional autonomy perceived from the pharmacist’s perspective motivated one participant to choose action option C (Table 1, last column). In step 6, the participants brainstormed several alternative action options to handle the dilemma: (D) ‘ I consult with a colleague ’, (E) ‘ I approach the patient again to start a