Applied Bioethical Reasoning and Moral Development in Pharmacy Students: A Cross-Sectional Study

Pharmacists in all work settings routinely face ethical dilemmas. The frequency and complexity of these dilemmas is likely to increase significantly as the profession continues to undergo a shift from product- to patient-centered. This shift, and its consequences, beg several important questions: What are pharmacy schools doing to affect their students’ (our future pharmacists) moral development? Are these efforts effective? The present study seeks to address these two questions as they relate to a single pharmacy school in the northeastern United States. Specifically, a cross-sectional research design was employed to explore differences in the use of professional ethical principles and moral reasoning ability among four cohorts of pharmacy students (freshmen thru seniors) and one group of veteran pharmacists (serving as preceptors). The research hypotheses, based on the cognitive-structuralist theory of moral development, were that participation in an ethic course (during year two) and clinical internships (during years 3 and 4) would 1) affect students application of APhA’s ethical principles and 2) increase their moral reasoning ability (as measured by the DIT). Results showed significant differences between students and pharmacists in both their action choices (deciding whether or not to dispense drugs in various hypothetical dilemmas) and use of bioethical principles to support those action choices. Contrary to the second hypothesis, results showed that students’ principled reasoning scores (P-scores) declined throughout pharmacy education, although no differences among the four cohorts of students, nor among students and pharmacists, reached statistical significance. Finally, results from exploratory analyses suggested that P-scores did not play a role in determining how ethical dilemmas were handled or which bioethical principles were used to justify their action choices. These results and their implications for educators and researchers are discussed as well as the limitations of the present study