Understanding pharmacists' values: a qualitative study of ideals and dilemmas in UK pharmacy practice

Pharmacy, like other health care professions, is both a knowledge-based and a value-based profession. However, the values that inform practice activities are rarely made explicit. We sought to identify the values drawn on by UK pharmacists through qualitative interviews on day-to-day practice activities focused around practitioners' conceptions of 'the good pharmacist', good practice and their experiences of ethical issues and dilemmas. The study was based upon loosely structured, one-to-one interviews of 38 selected practitioners reflecting a range of practice roles and settings. The interviews were recorded, transcribed and analysed following the principles of grounded theory. The accounts of practice (of self and colleagues) in the data showed pharmacists to be very dedicated and conscientious. Practice was predominantly discussed and presented by practitioners drawing upon a scientific mode of rationality. Value and ethical judgements were typically presented within this mode, with more open-ended and complex discussion of values and ethics appearing quite rarely. Two core values generally drawn on in reported practice emerged from the analysis--these were, 'the patient's best interests' and a value we labelled 'respect for medicines'. Common dilemmas arose from conflicting values, for example competing obligations to different parties, sometimes brought to a head by the conflicting demands of 'rules' of various sorts. Reported dilemmas related to rule breaking, resource allocation, patient communication and teamwork. There was a tendency for practitioners to 'fall back', often unreflectively, on their own personal value judgements when addressing these dilemmas. However, in the main, the values and dilemmas reported clearly show the socially embedded nature of professional ethics and, thereby, contribute to the social science re-theorisations of professional ethics needed if work on ethics development is to be realistic.