Pharmacists face moral dilemmas everyday in their practice. Role conflicts arise from pleasing management, pleasing individual customers, service to the larger patient base and society as a whole, as well as peers, other health professionals, regulators, and professional organizations. Pharmacists must develop professional behavior and a common professional identity that goes beyond their personal values and self-interests. The professional values of pharmacists are critical to effective practice. Moral dilemmas arise when the wants and/or needs of two or more of the aforementioned parties are in contrast.

Kruitjtosch et al examined the professional core values in the moral dilemmas of pharmacists in community pharmacy and to customize the descriptions of these values for practice.¹ During an ethics training course, students and pharmacists wrote about a moral dilemma they had experienced in practice and described their own ethical stances and values explicit in adjudication of those dilemmas. Examples of dilemmas included a patient presenting too early for a refill of pain medication and another with a patient overusing a laxative with the pharmacist refusing to sell her additional doses and the patient presenting with a legitimate written prescription for additional usage in spite of the drug doing her harm and masking more serious disease. The researchers coded the responses into 4 broad categories: (1) Commitment to the patient’s well-being, but inclusive of the patient’s right to self-determination; (2)  Pharmaceutical expertise, emanating from basic pharmaceutical sciences, therapeutics, and health psychology; (3) Reliability and care, thus developing trust and respecting the patient’s confidentiality; and (4) Social responsibility, where the pharmacist is responsible for the societal implications of their actions and for guaranteeing access to and continuity for pharmaceutical care.

Previous studies have shown pharmacists to be caring but not necessarily operating on the same cognitive moral development plane as other health professionals. The management in MTM says much about doing the right thing in myriad situations even while holding consistently to a set of principle, core values. Every decision has consequences, and many decisions have negative consequences that might be outweighed by the greater good. Pharmacy managers cannot be a part of each decision made by every employee; however, effective managers have carefully weighed the various mandates, policies, and societal influences to create an environment for and even encourage self-development and ethical decision-making training among all pharmacy personnel.

Additional information about Ethical Decision-Making and The “Management” in Medication Therapy Management can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

¹Kruijtbosch M, Gottgens-Jansen W, Floor-Schreudering A. Moral dilemmas reflect professional core values of pharmacists in community pharmacy. Int J Pharm Pract. 2019;27(2):140-148.