Martine Kruijtbosch

74 Chap t e r 3.1 METHODS The PEP test 33 was developed in analogy to the Defining Issues Test (DIT). The Defining Issues Test (DIT) The DIT is based on Kohlberg’s cognitive moral development theory 15,34 Its short form uses three scenarios that contain different hypothetical moral dilemmas. Each moral dilemma scenario is accompanied by 12 statements that include - to the dilemma related - sentence fragments that can trigger moral reasoning schemas. Such schemas are a person’s beliefs and cognitions in his or her long-term memory of which he or she is not explicitly aware. 35 The sentence fragments - theorised representations of these moral reasoning schemas - function as stimuli of these schemas in a person’s mind. When there are stimuli that resemble previous stimuli and experiences in that person, these can trigger that person’s tacitly preferred moral reasoning schema. Hence, respondents rate and rank the importance of each of the statements to the extent these match their tacitly preferred schema. 23,35 Three overall moral reasoning schemas have been postulated 15,34 : the pre-conventional (personal interest) schema, the conventional (maintaining norms) schema, and the post-conventional (principled thinking) schema (Table 1, second column). A person who reasons from a pre-conventional schema is mainly occupied with his or her own interests. A person who reasons from a conventional schema values social norms, laws and regulations. Finally, a person who reasons from a post- conventional schema bases his or her moral reasoning on universal principles such as justice, equality and societal benefit. The PEP test The PEP test 33 is derived from the short-form DIT. Like the DIT, it contains three moral dilemma scenarios. These were developed from the context of Australian community pharmacy practice. The first scenario in the PEP test describes a pharmacist who wants to recommend an expensive over-the-counter (OTC) product of uncertain benefit, against a background of mounting financial pressure for the pharmacy (OTC scenario in Appendix). The second scenario (morphine scenario in Appendix) depicts a client’s request for morphine for her mother, who does not have a prescription. Due to breakthrough pain, this client’s mother currently uses more opiates than prescribed. The request comes at a moment when a doctor is not present to provide the prescription. In the third scenario (repeat prescription scenario in Appendix), a pharmacist is asked to approve an early refill of antidepressants for a patient who is going on a holiday. The scenarios are as well accompanied by 12 statements that have to be rated and ranked (Appendix). These statements are theorised 33 to trigger three moral reasoning schemas similar to those theorised in the DIT, now adapted to the context of community pharmacists in Australia (Table 1, third column). The theorised pre-conventional,