Martine Kruijtbosch

82 Chap t e r 3.1 Professional ethics The five statements that loaded on this component (O9, O12, M12, R9, R11) were considered to reflect a moral schema labelled as professional ethics (Table 4). These statements are as follows: (O9) ‘whether a recent article in a reputable journal queried the benefit of that particular OTC’, (O12) ‘whether you counsel and explain the options to her as per professional guidelines’, (M12) ‘whether the professional and clinical judgement of the pharmacist in this case is relevant’, (R9) ‘whether concerns for safety override need for medication’, and (R11) ‘whether it is a pharmacist's duty to exercise professional judgment in dispensing’. In the Australian version of the PEP test, statements O9, O12 and R11 loaded as the rules and regulations moral reasoning schema . Further, statement R9 loaded in the Australian PEP study on the business orientation moral schema component. Statement M12 loaded < 0.3 in that study. DISCUSSION This study shows that the Dutch version of the Professional Ethics in Pharmacy test (PEP test) resulted in two identical moral reasoning schemas compared to the Australian version, and in one different schema, namely the post-conventional moral reasoning schema. However, the PEP-NL test statements need to be adapted to make the test more sensitive to the Dutch community pharmacy context. Such an adapted test would have to be validated once more before it can be applied. This suggests that a similar adaptation and validation process may be needed when applying the PEP test in other countries. As in the Australian PEP test, our results fit quite well with the three moral reasoning schemas of the DIT. We found the pre-conventional level of moral reasoning ‘business orientation’, the conventional level ‘rules and regulations’, and the post-conventional level ‘professional ethics’ (Table 1, fifth column). As described in the method section, schemas are tacit beliefs and cognitions in the long-term memory of a person. The schemas originate from the specific context wherein that person has lived, worked and still lives and works. The statements of the PEP test are designed to trigger these underlying tacit beliefs and cognitions related to the context of pharmacy practice. For an interpretation of the post-conventional moral reasoning statements of the PEP-NL test and their underlying schema (‘professional ethics’) the context of pharmacy practice in the Netherlands therefore has to be considered. Pharmaceutical patient care - as a foundational philosophy - was introduced in the 1990s by Hepler 8 and embraced by the Dutch Pharmaceutical Association. 37 This patient-centred