Martine Kruijtbosch

175 Gene ra l d i s cu s s i on GENERAL DISCUSSION Worldwide pharmacists’ professional role is in a transition from being product-centred to patient-centredness. A patient-centred role brings additional moral responsibilities: pharmacists have to identify patients’ health related needs and concerns and have to collaborate with other health professionals to achieve effective and safe use of medicines. The transition towards that role takes place in more complex health systems with more advanced (digital) healthcare technologies rapidly emerging, enhanced scientific knowledge, increased emphasis on shared decision-making in healthcare, an ageing population, increasing health consumerism, and growing pressure to contain rising healthcare costs. 1-8 In this complex context health professionals increasingly face moral dilemmas when personal, professional, institutional or societal values are in conflict while they aim to provide care in patients’ best interest. 9-12 These value conflicts may cause moral distress among health professionals, including pharmacists. 13,14 Moral distress occurs when one is not able to act according to one’s moral beliefs, i.e. one’s personal or professional value perspective. 14,15 This distress may even affect the quality of care. 16,17 This thesis focuses on community pharmacists who as primary care professionals are directly challenged in their patient-centred care practice. They may be held accountable when patients’ health is negatively affected by suboptimal or inappropriate pharmaceutical care. Communitypharmacistsmayneed appropriate competencies and support to be able to deal with moral dilemmas. Dealing with such situations of moral uncertainty in professional practice presupposes a reflective ability informed by the professional values, hereafter written as moral reflectivity. However, there still is a dearth of empirical studies on how community pharmacists recognise their professional values, notwithstanding the many national codes of ethics that aim to guide pharmacists in situations of moral dilemmas. 18-20 Dutch pharmacists are guided by professional values from the Dutch Charter of Professionalism. 21 They are expected to reflect on these values during their day-to-day clinical care. These values have been formulated after a consensus process with Dutch pharmacists active in all sectors. In order to be able to develop (Dutch) community pharmacists’ competencies further to optimise their pharmaceutical care role, especially in situations of moral dilemmas, we need more insights in these dilemmas and how (professional) values play a role in them. Therefore the overall objective of the thesis was to generate understanding of the moral reflectivity of community pharmacists in situations of moral dilemmas and how professional core values play a role therein.