The role of moral reasoning in the processes of decision making and professional ethics in the Quality Use of Medicines (QUM) and pharmacy
Background: Pharmacists encounter a broad range of issues, both clinical and non-clinical, in practice and they play a critical role in achieving QUM. Pharmacists are often faced with ethical dilemmas in practice. Ethical decision making often involves having to weigh complex, controversial issues in balance with the patient’s best interests, which might include avoiding harm and ensuring continuity of drug supply.
Decision making, in this context of professional ethics, is strongly related to moral reasoning. Moral reasoning can be measured using the validated Defining Issues Test P-score, based on the Cognitive Moral Development theory by Kohlberg ¹.
Aim: To determine moral reasoning of practicing pharmacists in NSW,Australia, and to examine predictors in decision making processes within the framework of professional ethics in pharmacy.
Method: The DIT was administered to a random sample of 1500 pharmacists. Data were entered in a database in SPSS and statistical computation of descriptives, correlations, and regressions were conducted.
Results: The response rate was 27% (N=399). The mean DIT P-score was 32.98 (SD=14.36), similar to DIT P-scores of pharmacists in the USA, but significantly lower than those of other health care professionals. The DIT P-score of females was significantly higher than males(particularly >55 years of age). The most statistically significant variable predicting the P-score was workplace. Hospital pharmacists scored higher P-scores than their counterparts in community pharmacies. This observation may be due to reasons other than stages of moral development.
Conclusion: The main predictors of moral reasoning in the profession of pharmacy were found to be age, gender and most significantly, the workplace. Further research is needed to explore these predictors to ascertain their impact on QUM and the profession of pharmacy.
¹ Rest, J. R. (1979). Development in judging moral issues. Minneapolis, University of Minnesota Press