Martine Kruijtbosch

58 Chap t e r 2 . 2 TABLE 3: Moral dilemmas 3 and 4 Moral dilemma 3 (PHARM-79) Before closing time on Friday afternoon, a 12-year-old patient requested extra methylphenidate for the weekend. The prescriber could not be reached at that time. The boy needs the medication for chronic attention deficit hyperactivity disorder (ADHD). He revealed that his mother had used his medication. When the pharmacist contacted the mother, she confirmed that she was going through a rough time and had used her child’s medication. Customised professional core values: ‘ As there was no prescription and the boy’s physician could not be reached, I had a dilemma: keeping with the law that forbids to dispense without a prescription…’ Reliable and caring ( acting meticulously and carefully ) ‘…my concerns about the possible harm to the mother using such a drug without having consulted a physician, and my responsibility for the child’s health over the weekend.’ Commitment to the patient’s well-being Moral dilemma 4 (PHARM-263) A patient had used paroxetine for five weeks. She asked the pharmacist for advice on how to discontinue the medicine as soon as possible because she suffered heavily from side effects. Customised professional core values: ‘ She persisted in her request to discontinue ‘these chemicals’. She had tried to contact her physician, but he was on summer holidays and told me that she was not willing to consult another physician to discuss her problem.’ Commitment to the patient’s well-being ( respecting the patient’s preferences and values; respecting the patient’s right to self-determination ) ‘ Motivating this patient to continue treatment seemed useless. However, making a scheme to discontinue the paroxetine without consulting her physician did not feel right either. We had previously agreed with the local physicians to closely monitor and counsel patients, starting with antidepressants to prevent them from stopping.’ Reliable and caring ( acting reliably within the collaboration with other health professionals ) Pharmaceutical expertise ‘ On the other hand, if I did not provide her with such a scheme, she might have stopped abruptly and experienced withdrawal symptoms.’ Commitment to the patient’s well-being Reliable and caring ( acting meticulously and carefully ) Pharmaceutical expertise