Martine Kruijtbosch

177 Gene ra l d i s cu s s i on • The study in Chapter 3.3 shows that being a managing pharmacist as compared to being a locum pharmacist was (negatively) associated with having a dominant PE-MRP. Also, being confronted with the Contraceptive drug shortage (a drug shortage with a perceived medium impact on patient outcomes) as compared to being confronted with the Parkinson’s drug shortage (a drug shortage with a perceived high impact on patient outcomes) was (negatively) associated with having a dominant PE-MRP. Within the Parkinson’s scenario pharmacists’ intended action ‘importing the drug concerned in the drug shortage’ was (positively) associated with a dominant PE-MRP. • In the last study in Chapter 4 we show that pharmacists appreciated participating in moral case deliberation (MCD). The MCD increased understanding of the perspectives of all parties involved in the dilemma cases. Furthermore MCD increased participating pharmacists’ awareness of their professional values in the context of potential ethical decision-making within the moral dilemma cases. In this last Chapter 5 we discuss our findings regarding pharmacists’ moral reflectivity in situations of moral dilemmas by structuring these along the processes of ethical decision- making as developed by Rest in his Four Component Model of ethical decision-making. 22,23 Finally, we provide recommendations for education, practice, policy and research. Pharmacists’ moral reflectivity within the ethical decision-making processes Rest’s Four Component Model of ethical decision-making distinguishes four cognitive- affective processes involved in ethical decision-making in situations of moral dilemmas. 22,23 These processes are associated with professional (moral) behaviour: (1) moral sensitivity (the individual’s ability to recognise moral dilemmas), (2) moral reasoning (the individual’s ability to reflect on the moral ideal course of action), (3) moral intention (the motivation that prioritises the moral ideal course of action) and (4) moral character or action (the ability to hold on to the morally ideal intended action). Rest views these four processes not as a linear process of ethical decision-making but as a process wherein these four processes interact backward and forward. 22,24 One can be skilled in one process and not in the other. A person can fail to act morally due to a deficiency in any of the four processes. Moral sensitivity, as an exception, is most likely to precede moral reasoning, intention and character. 25-28 When professionals do not have the ability to recognise (professional) value conflicts, it is unlikely that they will reflect on these values in the decision-making process in real practice. 29-31