Martine Kruijtbosch

155 Mo ra l case de l i be ra t i on Phase 3: Decision-making In MCD session 1, the deliberation in phase 3 revolved around the moral arguments of four participants who chose action option B (‘ I dispense the double anticoagulant therapy as per prescription and contact the specialist on Tuesday ’) and two participants who chose alternative action option E ( ‘I first contact the patient myself’ ). Themoral arguments behind the two decisions differed in the necessity of the pharmacist knowing the perspective from the patient himself to be able to provide the wife with advice about the medication. Based on the profession’s core values reliable and caring, commitment to the patient’s well-being and pharmaceutical expertise, two participants substantiated their judgment for alternative action option E: ‘We always feel ourselves the home pharmacist of the patient; like the case presenter says, she knows the family, she knows the couple, but that can sometimes be a trap. So if I have the possibility to talk to the patient, then I prefer that action, because then I might prevent a lot of unrest’ (Participant). ‘ I see the bleeding risk, but I want to assess that from my own observation . . . What are the patient’s experiences? . . . And then on the basis of that information, I can choose the next action. ’ (Participant) The CP became more aware of the relevance of these viewpoints: ‘ Maybe the worries of the wife are not justified. Yes, if I had talked to the patient himself, if he was open to that, then you would get a little more background and then you might be able to substantiate better which actions you will choose next. ’ (CP) Due to the moral deliberation, the CP and two other participants changed their initial judgments made in step 7 and chose alternative action option E accordingly. Although contacting the patient himself was agreed upon as being important in answering the CP’s moral question, some participants still did not see that as the action to take, as one participant formulated this in the context of the value pharmaceutical expertise: ‘ What information could the patient give you on the basis of which you are now going to stop one of the two anticoagulants? I can make the risk judgment with my pharmaceutical expertise alone with the thought that the specialist has started that double anticoagulation after all and that it has been used for six weeks thereafter in the revalidation centre; that is sufficient information. I will still reassure the wife of the patient on the basis of my pharmaceutical expertise. ’ (Participant) In MCD session 2, the participants were divided in their viewpoints regarding the decision- making phase over action option A (‘ I dispense the two extra lithium pills without consent of the primary care physician ’ [three participants]), action option C (‘ I contact the psychiatrist ’ [two