Martine Kruijtbosch

83 App l i cab i l i t y o f t he Au s t ra l i an Pro f es s i ona l E t h i c s i n Pha rmacy t es t approach and professional practice aims to ensure the effective and safe use of medicines and includes the responsibility for helping patients to achieve definite health outcomes. 8,38 This pharmaceutical care culture contributed to the development and design of the Dutch Charter of Professionalism. 39 The Charter states the profession’s core values, which guide pharmacists working in all sectors in the Netherlands. Commitment to the patient’s well-being, which includes protecting the patient’s rights, is an important value, but so are societal responsibility, being reliable and caring, pharmaceutical expertise and professional autonomy. 40 One core value is not more important than another. Keeping in mind this Dutch pharmacy practice context, all statements in the post-conventional schema in the PEP-NL test were interpreted as ‘professional ethics’. For example, the statement (M12) ‘whether the professional and clinical judgement of the pharmacist in this case is relevant’ (morphine scenario, Appendix), fits seamlessly with the professional autonomy in moral decision-making, which is expected from Dutch pharmacists. This statement clearly represents the professional responsibility to achieve effective and safe use of medicines in the dilemma concerned. However, the statements can be further refined and adapted to triggers closer to the context. For example, the statement (O12) ‘ Whether you counsel and explain the options to her as per professional guidelines’ would be improved as the text ‘so that the patient can understand and make an informed decision’ was added as trigger for this schema. Upon interpreting all statements in the pre-conventional level of moral reasoning ‘business orientation’ and the conventional level ‘rules and regulations’ in our PEP-NL test, it was agreed these also exist among pharmacists in the Netherlands. Although, further research is needed to find out if the related statements can be improved further in their function as triggers for these schemas for pharmacists practicing in the health system in the Netherlands. Australian and Dutch pharmacists seem to share the pre-conventional and conventional schemas of moral reasoning. The majority of the eligible statements that represented these two schemas in our PEP-NL test were the same as those that represented these schemas in the Australian PEP study. This is in contrast to the post-conventional moral reasoning schema in which none of the eligible statements in the PEP-NL test (‘professional ethics’ schema) were the same as the statements that represented the post-conventional schema in the Australian PEP test (‘patients’ rights’ schema). Apparently, different statements representing the post-conventional moral reasoning schema triggered the pharmacists in both countries, suggesting variation in underlying beliefs and cognitions and pharmacy practice context. This is surprising as in both countries pharmacists have a patient-centred pharmaceutical care practice as their highest goal. 40,41 However, the variation may come from differences in professional guidance (e.g. education, policy) to achieve this patient-centred pharmaceutical care practice and in corresponding professional language. 31