Martine Kruijtbosch

209 Summa r y We therefore concluded that the perceived impact of drug shortages on patient outcomes explains community pharmacists’ dominant professional ethics MRP in situations of drug shortages better than their personal characteristics. In Part 4 in Chapter 4 we presented the last study in this thesis on pharmacists’ moral reflection in dialogue. We explored whether moral case deliberation (MCD) fosters the moral reflectivity of community pharmacists. Moral reflectivity is required to make ethical decisions in situations of moral dilemmas. A total of 14 community pharmacists (seven pharmacists per session) and two facilitators participated in two MCD sessions using videoconferencing. In each session, a real life moral dilemma case concerning one of the participants was central to the deliberation. The facilitator led an exploration of the case with the aim of stimulating the participants to understand and discover the facts and values involved for the pharmacist, the perspectives and values of all other parties involved in the dilemma, and the arguments for the best possible action, and to find a resolution to the core moral question. We concluded that MCD has the potential to foster community pharmacists’ moral reflectivity in the context of professionally resolving moral dilemmas. Participants became more aware of their own professional values and the role these values play in recognising the moral dilemma and the values and perspectives of other parties involved. MCD also enabled participants to substantiate their ethical decision-making with professional values in the context of resolving the dilemma. Part 5 presented the final Chapter 5 where we discussed the main outcomes of this thesis. We structured these results along the three cognitive-affective processes involved in professional behaviour: moral sensitivity, moral reasoning and moral intention. We clarified the importance of professional value awareness and moral reflectivity for pharmacists in all ethical decision-making processes to provide appropriate, safe and effective pharmaceutical care in the best interests of patients and society. We emphasised that moral reflectivity is crucial in prioritising the best possible course of action in situations of moral dilemmas. Pharmacists need support from professional bodies, the law and society to realise the best possible care. These parties should recognise pharmacists as health professionals and facilitate their professional autonomy. To develop moral reflectivity in pharmacists we stressed the need for further exploration of the use and applicability of moral case deliberation. We formulated recommendations for education, pharmacy practice and policy, and research. Professional ethics education should be an integral part of all phases of (post)academic education. Moral sensitivity should be taught. Special attention should be given to increasing the knowledge of human behaviour and patient characteristics. Pharmacists should be taught howmoral reasoning complements clinical reasoning in the resolution of moral dilemmas. The implementation of professional ethics education and its effects on students’ and pharmacists’