Martine Kruijtbosch

205 Summa r y SUMMARY The introduction of this thesis, Chapter 1 , provides a brief overview of the evolving professional role of the community pharmacist from the 1990s to the present. Central to that evolution is that the work of the pharmacist became more patient oriented instead of primarily product oriented. Although safe compounding and dispensing continue to be important features of their work, pharmaceutical care for patients became more prominent in the thinking and practice of pharmacists. The specific responsibilities and competencies which pharmaceutical care demands of pharmacists were elaborated. Patients, who are vulnerable by their health problems, depend on the pharmacist’s expert knowledge about medicines and the risks associated with their use. In order to optimally provide pharmaceutical care, pharmacists must adequately apply their scientific knowledge of medicines to the context and life of their patient. Pharmacists take responsibility for their patients’ drug-related preferences and needs. Such responsible practice implies that pharmacists work closely together with patients, their carers, and other health professionals involved in patients’ care. Within this collaboration pharmacists need to be aware of their own values and perspectives. The introduction further presents what the professional role of Dutch community pharmacists constitutes in the Netherlands. Professionally, Dutch pharmacists are guided by the Dutch Charter of Professionalism which describes the profession’s core values, i.e. commitment to the patient’s well-being, pharmaceutical expertise, reliability and care, social responsibility, and professional autonomy. Dutch pharmacists are encouraged to employ professional expertise and practical wisdom to fulfil these professional values in situations where the most optimal solution for an individual patient is not always obvious. We noted that so far no empirical research has been conducted into the professional values of Dutch community pharmacists. Health professionals, including community pharmacists, work under challenging conditions with an ageing population that needs more care, rapidly emerging healthcare technologies, market forces in healthcare, the curbing of healthcare budgets, and demanding third party payers and patients. These circumstances threaten their professional autonomy. Furthermore, pharmacists may be held accountable by patients as well as society when patients’ health is negatively affected by suboptimal or inappropriate care. As a consequence, health professionals increasingly experience moral dilemmas. Moral dilemmas are situations where it is not immediately clear what the right course of action is as all options have moral advantages as well as disadvantages. In such situations of moral uncertainty, the values and perspectives of the different parties involved are in conflict, and health professionals cannot