Moral dilemmas of community pharmacists: Reflection on professional values

Pharmacists increasingly take responsibility for appropriate use of medicines by prescribers and patients. For this pharmacists work closely with patients, carers, prescribers and other healthcare professionals. However, pharmacists’ professional relationships and autonomy are under pressure because of increasing healthcare needs due to an ageing population, more complex treatments, empowered patients and cost control in healthcare. As a result, pharmacists experience moral dilemmas. Moral dilemmas are situations in which the right course of action is not immediately clear, since all action options have both moral advantages and disadvantages. To deal with moral dilemmas, pharmacists need ethical competencies, such as moral reflection. Our aim was to gain insight into moral reflection of community pharmacists in situations of moral dilemmas and how professional values play a role therein. This thesis shows that Dutch community pharmacists were able to recognise moral dilemmas and the professional values involved to some extent. Pharmacists' professional autonomy and care were hampered mainly by the behaviour of patients or healthcare professionals. Third parties, like health insurers or regulatory authorities, sometimes complicated the pharmacist-patient relationship further during these dilemmas. When dealing with moral dilemmas, pharmacists generally reasoned from professional values. Rules and regulation and a business orientation played a greater role in pharmacists’ reasoning when dilemmas had a lower impact on patient outcomes while concurrently having a strong impact on the pharmacy's sustainability. Moral case deliberation can be a method to further develop the ethical competencies of community pharmacists, enabling them to provide optimal pharmaceutical patient care in moral dilemmas.