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Pharmacists have often faced “situations in which there is a choice between at least two courses of action, neither of which is obviously morally preferable”. With the increased patient-centeredness in pharmacy practice nowadays, they are now expected to provide solutions for such ‘dilemmas’, relying on ethical judgment, principles of professional ethics, standards of practice and moral reasoning capabilities. Pharmacists necessarily need to be competent in ethical decision-making, which will enable them to act in a morally preferable and justifiable manner. Literature has shown that moral reasoning skills are teachable competencies in healthcare. This domain remains relatively unexplored in developing countries, and there is a paucity of research conducted in the area of pharmacy ethics particularly in Jordan. The overarching aim of this thesis was to investigate ethical decision-making in pharmacy practice in developing countries such as Jordan. This thesis also investigates the manner in which ethical dilemmas are handled by Jordanian pharmacists, the resources used to address such dilemmas, and their attitudes towards them. The secondary objective was the development of an educational component about ethical decision-making in pharmacy practice for the undergraduate curriculum for pharmacy students in Jordan. The scoping review (Chapter 2 of this thesis) highlighted a gap in pharmacy ethics literacy in developing countries and variances in pharmacists’ ethical attitudes in handling ethical dilemmas. It also illuminated the lack of familiarity with ethical principles and codes of ethics., and pharmacists being prone to financial pressure were found to have a significant impact on pharmacy practice in most developing countries. Chapter 3 explored ethical decision-making in pharmacy practice in Jordan. elucidating that it was influenced by pharmacists’ personal moral values, legal requirements and managed by exercising common sense and experience. Giving emphasis to the need for professional ethics training, and incorporating pharmacy ethics courses in pharmacy undergraduate curricula, as well as to professional development courses. Chapter 4 then explored the impact of Vertically Integrating Teaching in Ethical Decision-Making (VIT-EDM), as a pedagogical approach influencing moral reasoning capabilities of pharmacy students whilst progressing in pharmacy studies, using a validated instrument as a surrogate measure of moral reasoning capabilities. This underlined the positive impact of this relatively novel mixed-method pedagogy in teaching pharmacy ethics, which highlighted students’ enhanced confidence levels in deciding morally preferable choices when facing ethical dilemmas. The seminal part of this thesis was the development, implementation, and evaluation of the utility of a tailored ethics education component in the pharmacy curriculum for students enrolled at a well-ranked Jordanian University (Chapter 5). This chapter highlighted the importance of implementing an ethics course in pharmacy undergraduate curricula. It also emphasized the positive impact this course made on the students’ learning experiences and provided a strong environment for discussion and group learning. In conclusion, the investigations carried out in this thesis emphasized the importance and significance of ethical pharmacy practice. Hopefully, this body of work is the beginning of further research and intervention-testing intended for teaching pharmacy ethics in developing countries. This paves the way for developing countries to adopt principles/rights-guided professional practice in pharmacy, to protect and provide patient-centered care in reality. |
