Martine Kruijtbosch

29 Mo ra l d i l emmas o f commun i t y pha rmac i s t s INTRODUCTION Worldwide, the primary focus of pharmacists is shifting from products to patients. 1-7 This patient-centred approach means that pharmacists have to identify patients’ concerns and needs, and collaborate closely with other health professionals in order to ensure effective and safe use of medicines. 8 Lastly, pharmacists are responsible for helping patients to achieve definite health outcomes. Nowadays, health professionals such as pharmacists are faced with ever more regulations, financial pressure, and increased competition. At the same time, the demand for health services is growing as a result of population ageing, more chronic illnesses, and increased healthcare consumerism. 9,10 Economic and legal constraints and demanding patients challenge health professionals’ autonomy to act in the best interests of society and the individual patient. 9,11-19 In this complex setting, pharmacists are frequently confronted with moral dilemmas 20-30 arising from conflicting personal, professional, institutional or societal values of the different parties involved. 28, 31-33 These moral dilemmas need to be studied in order to address the challenges pharmacists face in their professional role. 24, 29, 30, 34-39 There have been few international studies of the moral dilemmas experienced by community pharmacists, and existing studies vary widely in aim, method and presentation of results. 24,25,26,27,29,30,40 In most existing studies, pharmacists were presented with scenarios of moral dilemmas and their moral reasoning was assessed. Pharmacists found it difficult to recall moral dilemmas and most studies interviewed a limited number of pharmacists. 20-23, 30, 41 Hence the themes of moral dilemmas experienced in clinical practice may still be incomplete. Aim of the study We aimed to make a thematic overview of moral dilemmas community pharmacists actually experienced in clinical practice. Ethics approval The Medical Ethics Review Committee of the University Medical Centre Leiden concluded that the Dutch Medical Research Involving Human Subjects Act (WMO) was not applicable. All participants consented that their narratives could be used for the purpose of the study. Data that could give clues about the origin of dilemmas (e.g. names of patients, cities, pharmacies, pharmacists or physicians) were removed.