Martine Kruijtbosch

153 Mo ra l case de l i be ra t i on conversation ’, (F) ‘ I contact the primary care physician to open the conversation again ’, (G) ‘ When the primary care physician does not want to prescribe the extra lithium, I tell him that I will contact the psychiatrist ’ and (H) ‘ I hide behind the law: refer the patient back to the primary care physician ’. TABLE 1: Moral case deliberation (MCD) session 2: Step 5 - Analysing the case in terms of involved parties’ perspectives, values and norms Involved party Value Norm to realise the value Action option* chosen because of this value Patient Own well-being ‘I ask for the extra two lithium pills because I am terrified of falling back into another (mental) episode again.’ A,C (case presenter [CP]) Primary care physician Reliable and caring ‘I realise that I have partly failed because I have not monitored the lithium blood levels and have taken over the patient (from the psychiatrist) just like that, without care. I do not dare; I am unwilling to take responsibility.’ Professional autonomy ‘I make a professional judgment to not dispense in order to discard responsibility.’ B (participant) Commitment to the patient’s well-being ‘I do not know what is and what is not good for the patient. I take it the easy way.’ Pharmacist (i.e. the CP) Commitment to the patient’s well-being ‘I take away the patient’s restlessness.’ Responsibility to society ‘I cooperate with the primary care physician in his treatment plan.’ B (CP) Professional autonomy ‘I undermine the primary care physician’s authority by contacting another care professional. I will pass the primary care physician.’ C (participant) Pharmaceutical expertise ‘I provide arguments for and against dispensing lithium based on the information I do have. I realise that no appropriate monitoring of the patient occurred.’ Reliable and caring ‘The patient can rely on me to deliver responsible care, whether or not I dispense.’ *The CP’s action options formulated in step 4 were the following: Action option A: ‘I dispense the two extra lithium pills without consent of the primary care physician.’ Action option B: ‘I do not dispense the two extra lithium pills and align with the primary care physician’s treatment plan.’ Action option C: ‘I contact the psychiatrist.’