Kruijtbosch M, Floor-Schreudering A, van Leeuwen E, Bouvy M L
SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, The Netherlands.
Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands.
Int J Clin Pharm. 2025 Jan 4. doi: 10.1007/s11096-024-01854-3.
Moral case deliberation has been successfully implemented in multidisciplinary groups of secondary care professionals to support ethical decision making. It has not yet been reported for community pharmacists.
This study investigated whether moral case deliberation fosters moral reflectivity in community pharmacists.
Two moral case deliberations with 14 community pharmacists were guided by two facilitators. One session was described and illustrated with participants' quotes, detailing each reflection step of the method. An adapted version of the Maastricht evaluation questionnaire was used to understand the effects of the moral case deliberation on participants' moral reflectivity skills both quantitatively and qualitatively.
In a 2-h session, pharmacists reflected on a moral dilemma concerning double anticoagulant therapy of one presenter pharmacist. Participants discussed the pros and cons of two potential actions: dispensing the medication as prescribed without contacting the patient or contacting the patient first. Deliberation highlighted the importance of understanding the patient's perspective, leading the presenter and two others to shift towards the latter action. The evaluation questionnaire revealed that all 14 participants felt supported by the deliberation and the facilitator in recognising the dilemma's moral dimension and understanding their own and others' values behind arguments and how these influenced different perspectives. They all felt encouraged to critically reflect, to ask open questions and to delay judgements. The method helped all to morally justify their final decision, with six participants arriving at a decision different from their initial perspective towards the dilemma's resolution.
This study demonstrates that moral case deliberation enables pharmacists to critically examine their reasoning and reach morally sound resolutions, supporting pharmacists' professionalism and ethical decision-making.
道德案例审议已在二级医疗保健专业人员的多学科团队中成功实施，以支持道德决策。但尚未有针对社区药剂师的相关报道。
本研究调查了道德案例审议是否能促进社区药剂师的道德反思。
由两名主持人引导14名社区药剂师进行了两次道德案例审议。其中一次会议通过参与者的引述进行了描述和说明，详细阐述了该方法的每一个反思步骤。使用改编后的马斯特里赫特评估问卷从定量和定性两方面了解道德案例审议对参与者道德反思技能的影响。
在一个两小时的会议中，药剂师们针对一位药剂师提出的双重抗凝治疗的道德困境进行了反思。参与者讨论了两种潜在行动的利弊：按处方配药而不联系患者或先联系患者。审议突出了理解患者观点的重要性，促使提出问题的药剂师以及另外两人转向后一种行动。评估问卷显示，所有14名参与者都感到审议和主持人支持他们认识到困境的道德层面，并理解论点背后自己和他人的价值观，以及这些价值观如何影响不同观点。他们都感到受到鼓励去进行批判性反思、提出开放性问题并推迟判断。该方法帮助所有人从道德上为自己的最终决定辩护，六名参与者做出的决定与他们最初对困境解决方案的看法不同。
本研究表明，道德案例审议使药剂师能够批判性地审视自己的推理并达成道德合理的解决方案，支持药剂师的专业精神和道德决策。
