Martine Kruijtbosch

159 Mo ra l case de l i be ra t i on DISCUSSION This explorative descriptive study shows that MCD and the dilemma method may have the potential to foster moral reflectivity in community pharmacists facing moral dilemmas. The quantitative results regarding the participants’ evaluation of the MCD session are in line with the qualitative results described for the image-formation, judgment-formation and decision-making phases. The participants positively reported in the online questionnaire that the facilitated MCD session helped them identify the moral dilemma and underlying moral question. The deliberation and understanding of the CP’s and other participants’ viewpoints and perspectives of parties involved in the dilemma cases made them more aware of their professional values, what these meant to them and what these meant to others in the context of ethical decision-making. 14 The session also encouraged the participants to substantiate their decisions with moral arguments based on their professional values. The deliberation provided space for each participant to compare their own pharmaceutical community care practice with that of other participating pharmacists in the context of the CP’s moral dilemma. For some, this revealed new knowledge about their own professionalism. This was reflected in changes in their initial judgments and their decisions about how to handle the dilemma case. The dilemma method and facilitation thus stimulated systematic moral reflectivity, and this has been found in other studies with health professionals in medical care. 3,14 This study indicates that MCD may stimulate competence-based learning for pharmacists, and this has been shown in other studies with medical professionals. 14,20 In this study, MCD supported and challenged pharmacists’ reflective professionalism as included in the Canadian Medical Education Directions for Specialists’ (CanMEDS) role of a professional. 30,42 The joint imagining, questioning, listening, delaying of judgment and moral reasoning may have enabled the participants to become more sensitive of the role professional values play in a moral dilemma and to understand and reason on the basis of these professional values. They were able to prioritize those values within the justification of the handling of the dilemma case to provide the best care for the patient. In daily pharmaceutical care practice, there is hardly time for such rational deliberation or delayed reflection. As pharmacists make pharmaceutical care decisions throughout the day, with the moral reflectivity developed through MCD, they may do that more consciously and explicitly. MCD has mostly been studied with the aim to structurally implement MCD in a clinic or organisation. 8,10,11,14,16,17 Hence, participants in those studies evaluated a series of MCDs, often within a multidisciplinary team. In our explorative study, rather than introducing MCD to a pharmacy team or pharmacy institution, we aimed to introduce MCD to community pharmacists as individual professionals. In Dutch community pharmacy, besides a team