Martine Kruijtbosch

180 Chap t e r 5 Dutch pharmacists’ moral reflections in the process of moral sensitivity We investigated Dutch pharmacists’ moral reflectivity in situations of moral dilemmas through written narratives of early career pharmacists’ self-experienced dilemma cases. These pharmacists wrote these narratives as part of their postacademic professional training in which moral reflection is a central activity. The narratives were written down shortly after they were experienced. Written narratives produced in this manner have the advantage that pharmacists have no problems recalling their moral dilemmas and the emotions when they experienced these dilemmas. This enabled them to clearly describe their feelings about the potential negative consequences of certain potential decisions or actions for both patients and other parties involved. This enabled us, as researchers, to check whether the narratives actually reflected moral dilemmas. Subsequently we could easily identify themes in these dilemmas (Chapter 2.1) and identify the moral arguments that kept pharmacists from realising their (professional) values (Chapter 2.2). These findings add to the literature that professional ethics education may benefit from experiential learning methods such as reflection on self-experienced moral dilemmas. The narratives show that community pharmacists recognise moral dilemmas and the professional values that played a role therein. This novel method of individual moral reflection in written narratives may help community pharmacists to explore the values involved in their gut feelings when being confronted with situations of moral dilemmas. 50,51,52 Thereby, narratives may foster the process of moral sensitivity needed to make ethical decision-making a regular aspect of pharmaceutical care decisions. Our results highlight the need to teach pharmacy ethics. Pharmacists in our studies were not always able to distinguish moral dilemmas from other complex situations (Chapter 2.1; excluded narratives). Some pharmacists wrote a narrative about a complex problem they had experienced, but which could not be described in terms of a value conflict of different parties. Although we had to exclude the narratives which were not a moral dilemma, the content showed which competencies pharmacists need. Pharmacists, for example, described their difficulties in dealing with claiming or aggressive behaviour of patients due to psychic, cognitive or physical problems these patients were suffering from. Pharmacists felt compassion for these patients, but missed that there was no moral conflict. Similarly, moral conflict was missed in dilemmas where the uncertainty was actually about clinical risk- benefit assessments (clinical dilemmas) or who pays for the medicines (financial dilemmas). The pharmacists in these clinical dilemma narratives seemed to have deficiencies in their clinical reasoning skills. Further, in some narratives pharmacists described conflicts with their employer or employees. Even though these difficulties may have moral elements these