Martine Kruijtbosch

176 Chap t e r 5 Main findings of this thesis In this thesis, several studies are presented that provide information about the moral reflectivity of Dutch community pharmacists in situations of moral dilemmas. These dilemmas were either experienced by participating pharmacists themselves (Chapters 2.1, 2.2 and 4), by colleagues (Chapter 4), or were presented to them as possible pharmacy practice scenarios (Chapters 3.1, 3.2, and 3.3). • In Chapter 2.1 we present a taxonomy of moral dilemmas that Dutch pregraduate and postgraduate pharmacists working in community pharmacy experienced in daily practice. Pharmacists faced their moral dilemmas predominantly within their professional relationships, i.e. with patients and other health professionals. Within the context of these relationships pharmacists’ professional autonomous decision-making was often hampered by the behaviour of patients and other health professionals. Other parties such as health insurance companies and regulatory bodies further complicated these troubled relationships. • Chapter 2.2 shows that all professional values (i.e. commitment to the patient’s well- being, reliable and caring, pharmaceutical expertise and responsibility to society) played a role in the moral dilemmas that pharmacists experienced, with social responsibility being the least present. The descriptions of these professional values as given in the Charter were customised for community pharmacists in order to better reflect community pharmacy practice. • In Chapter 3.1 we show that the Australian Professional Ethics in Pharmacy moral reasoning test (PEP test) could be adapted for Dutch pharmacists taking into account the professional values and healthcare context of Dutch community pharmacy practice. The test measures three moral reasoning perspectives: a business orientation perspective (pre-conventional), a rules and regulation perspective (conventional) and a professional ethics perspective (post-conventional). Especially the statements which represented the post-conventional moral reasoning perspective in Dutch pharmacists differed from the statements which represented that level in Australian pharmacists. These differences were perceived to be rooted in differences in professional ethical guidance in both countries. • In Chapter 3.2 we developed a new moral reasoning test on the basis of the Charter’s professional values and focused on drug shortages. The pharmacists predominantly reasoned with a professional ethics moral reasoning perspective (PE-MRP), although the business orientation (BO-MRP) and the rules and regulation (RR-MRP) perspectives played a role as well. When the pharmacist perceived the drug shortage to have a lower impact on patient outcomes and the costs of alternative drugs or therapy are expensive, the BO-MRP became more important.