Martine Kruijtbosch

17 I n t roduc t i on FIGURE 1: Rest’s Four Component Model of ethical decision-making 31,32 Community pharmacists’ moral dilemmas and ethical competencies: what do we know already? Research into moral dilemmas and ethical competencies of community pharmacists is relatively sparse when compared to other health professionals. 35,36 A limited number of studies has been published that highlight the moral challenges pharmacists face in contemporary health systems. 24,35,37,38 Although previous qualitative research has shown that pharmacists were morally sensitive, pharmacists found it difficult to articulate moral dilemmas in terms of (moral) values and had problems recalling these dilemmas. 21,24,35,38-42 Their moral reasoning in dilemmas rather showed a scientific rationality and tendency to fall back on personal values. 42 The methodology mainly used in these studies was a semi-structured interview and retrospective querying of pharmacists about their experiences with moral dilemmas. Although many themes of dilemmas were collected, this methodology did not result in saturation of themes. Furthermore, the (professional) values that underpinned these dilemmas remained partly unknown. Quantitative research on pharmacists’ moral reasoning, also in relation to potential professional performance in practice, was mostly executed in US. In these studies a non- pharmacy-specific moral reasoning measure was used: the Defining Issues Test (DIT). 35,36 The DIT is a self-report measure which uses a Likert-type scale to give quantitative ratings and rankings to predefined considerations for different hypothetical moral dilemmas. Pharmacists’ moral reasoning scores measured with the DIT were lowest compared to other health professionals. 34 In Australia a pharmacy-specific moral reasoning measure was