Martine Kruijtbosch

84 Chap t e r 3.1 Our results suggest that Dutch pharmacists, when reasoning with the post-conventional moral reasoning schema, are guided by professional ethics as elaborated upon earlier: pharmacists are professionally autonomous in their pharmaceutical responsibility and are socially expected to use their expertise and judgement to provide the best care for the patient. Whereas Australian pharmacists may be educated and guided (professionally) by a more juridical (rights) perspective and thereto related language. The pharmacists may therefore be more focused on performing their legal duties as being the best care for patients and - simultaneously - on avoiding legal consequences. 41 These possible differences in professional guidance and thereto related language may explain why some statements (e.g. R3, R4 and R5) correlated as the post-conventional schema ‘patients’ rights’ in the Australian PEP test, and did not correlate with the statements that appeared in the post-conventional schema in the PEP-NL test. Similarly, such differences may also explain why the majority of the statements that correlated as the moral reasoning schema ‘professional ethics’ among Dutch pharmacists triggered the ‘rules and regulations’ schema among pharmacists in the Australian PEP test. For example, the statement (O12) ‘whether you counsel and explain the options to her as per professional guidelines’ may have been interpreted by Dutch pharmacists as a professional behaviour because they have internalised the content of the guidelines as ‘good pharmacy practice’, whereas for Australian pharmacists, practising on the basis of guidelines (or laws and regulations) may mean fulfilling one’s (legal) duty. 41 Besides these possible differences in professional guidance and language the variation in underlying beliefs and cognitions may be caused by cross-cultural differences not directly related to the profession. Such cross-cultural differences include the larger context of national socio-economic and healthcare systems, national laws and regulations, religion, family social structures 42-44 , and personal values. 1,41 Therefore, a professional ethics test for a specific professional setting and country should be developed by experts who share the same professional values, practice and language as the respondents. 32 Strengths and limitations A strength of this study is the number of respondents which allowed us to test applicability with a PCA, because A PCA generally needs at least 300 respondents. 36 A limitation of the study is that the majority of participating pharmacists were early in their careers and therefore not representative of the Dutch pharmacist population in general. Future research should include a more representative cohort-mix of younger and more experienced pharmacists to