Martine Kruijtbosch

185 Gene ra l d i s cu s s i on for a remuneration model that rewards pharmaceutical care rather than logistics. Besides, a strategy could be to include the Dutch Charter in the procedure for development of the professional guidelines for community pharmacists. 80 Overall the strategy should be that policymakers and leaders in pharmacy promote the social role and underpinning values of pharmacists. Especially, they should more clearly emphasise the trust-based relationship between pharmacist and patient. 81 Moral intention Once a health professional has judged what morally would be the best care for the patient, this does not automatically lead to professional behaviour. 82 Moral intention, also referred as moral motivation, is the cognitive-affective reflection process needed between moral judgement and moral character to perform professional behaviour. 83,84 Moral intention is the motivation that prioritises the moral ideal course of action. 23,85 It not only implies that a health professional is committed to the professional values that underpin the moral best action, but also means that a health professional is motivated to overcome, for example, self-interest or concerns about rules and regulations. 23,62 Health professionals who have internalised their professional values may be more consistent in prioritising the moral ideal course of action. 86-88 Such professionals have internalised their professional ethics. 62 Moral intention among pharmacists Like for any health professionals, moral intention is essential for pharmacists to act professionally. Unfortunately, research on moral intention among pharmacists is scarce. A qualitative study among seven community pharmacists in the United States showed that pharmacists, who suspected an opioid use disorder, carefully balanced the risk of abuse and the genuine need for analgesic treatment when patients presented potentially falsified prescriptions. Their moral intentions were clear. However, the pharmacists also considered that their license or reputation of their pharmacy could be compromised when they dispensed the falsified prescription. Therefore, this concern sometimes overruled their moral intention. 84 Another study among 23 community pharmacists in the United Kingdom showed that pharmacists frequently prioritised other values, such as keeping with the law, above the professional values. Some pharmacists, however, did feel uncomfortable with legal obligations, for example when a genuine mistake of a physician could imply that a patient would be deprived of necessary medication. The ethical passivity of pharmacists was considered as potentially deleterious for patients’ well-being. 46 In our studies Dutch pharmacists showed that their moral intentions were more consistent with the professional value commitment to the patient’s well-being. For example, the reflections of pharmacists in the moral dilemma narratives under the theme ‘Dispensing