Martine Kruijtbosch

193 Gene ra l d i s cu s s i on Regarding the first type of research, it should firstly focus on structurally measuring, monitoring and evaluating students’ and (early career) pharmacists’ moral sensitivity (qualitatively as well as quantitatively) and their progression towards reflection on and commitment to professional values. Hence, this automatically implies that the second focus of research - developing and testing of (experiential) learning methods or interventions - is in place. For example, in order to be able to measure moral development quantitatively and monitor that development regularly, the test we developed in this thesis to measure moral reasoning perspective levels (Chapter 3.2) can be adjusted for situations of moral dilemmas other than drug shortages. It should be emphasised once more, moral reasoning tests that aim tomeasure moral reasoning perspective levels among pharmacists should be designed on the basis of professional values, practice (role and guidance) and language of the responding pharmacists who are tested. Hence each country should design such tests in alignment with local professional circumstances. Future research could evaluate the effects on moral sensitivity and moral reflectivity of interventions such as written narratives and MCD in the processes of moral reasoning and intention. When such interventions also include teaching the difference between clinical and moral reasoning, such research could as well investigate the dynamics between these two types of reasoning in order to optimize the patient-centred decision-making in pharmacy practice. In order to evaluate MCD more substantially, future studies could identify the aims that pharmacists want to achieve with MCD and evaluate whether these aims are actually reached. 100 Moreover, the effect of these learning methods on professionally and ethically handling moral dilemmas in practice should be investigated. Finally the effect of ethically handling of pharmacists on patient outcomes could be studied, e.g. by qualitative studies among patients who were involved in these dilemma cases. The third type of studies focuses on the cause of the moral intention-professional behaviour gap. It is essential to identify which (contextual) factors influence community pharmacists’ moral intentions when they act or not act in line with these intentions. Anthropological research methods could be used where the researcher observes pharmacists in practice. More simple, less time-consuming and less expensive methods could be to interview pharmacists directly after they experienced a moral dilemma and ask these pharmacists to reflect on their considerations and actions. Lastly, as has been mentioned several times in this thesis, pharmacists and many other health professionals experience moral distress in the context of moral dilemmas. Moral distress can