Martine Kruijtbosch

60 Chap t e r 2 . 2 DISCUSSION The pharmacy profession’s core values were identified in moral dilemma narratives of pharmacists in community pharmacy. The descriptions of these values were customised for community pharmacy. All four professional core values, i.e. commitment to the patient’s well-being, reliable and caring, pharmaceutical expertise and responsibility to society were recognised in the dilemmas. As no other professional core values were identified, we believe the four core values are concordant with the practice of community pharmacy. The values commitment to the patient’s well-being and reliable and caring were prominent in almost all narratives. This suggests that pharmacists value patient-centredness, and concomitantly have retained their traditional attitude that emerges from Good Manufacturing and Good Clinical Practice. It confirms findings of studies among pharmacists in other countries. 2,29,31 This study also reveals that pharmacists are aware of their responsibility to society as shown in their moral dilemma narratives . Although worldwide pharmacy associations emphasise the importance of responsibility to society 21 , only in a few studies among pharmacists is this value reported. 2,27,31 The strength of this study is that moral dilemmas were used that were actually experienced by pharmacists in community pharmacy practice. This study also has limitations. Firstly, the moral dilemmas were reported by PharmD students and ‘early career’ pharmacists whose recent training stimulates a patient-centred attitude. These pharmacists may be more committed to patients’ well-being because of more advanced training on their care role and the concerns and needs of patients, compared to earlier generations of pharmacists whose training focused more on caring for the product. Moreover, the training provided might have influenced their sensitivity for reflecting on the professional core values. However, it has also been reported that early career pharmacists might be more rule oriented even when this is not in the patient’s best interest. 32 Further research among senior community pharmacists is therefore recommended. Secondly, in the majority of the moral dilemma narratives, the outcomes were not clearly described. The actual weighing of professional core values could therefore not be analysed. As none of the professional core values is superior, it will be relevant to know to what extent the context of a moral dilemma influences the way pharmacists let one of the core values prevail in practice. Thirdly, the findings are confined to a Dutch context. The core value commitment to the patient’s well-being is not limited to ‘what is best for the patient’ from the perspective of the pharmacist. Patients have their own health logic, preferences and values that pharmacists must consider. The ‘other value’ protect life highlights that pharmacists can also be motivated by personal or religious convictions. For example, pharmacists may decline to provide pharmaceuticals for euthanasia. Such convictions may conflict with professional core values and subsequently cause moral distress. 33 To avoid