Fostering moral reflectivity in community pharmacists through moral case deliberation using the dilemma method

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.