STAGES OF MORAL DEVELOPMENT
Scenario
Mark Talis comes to the Liyema private hospital pharmacy to collect his medication. The pharmacist, just recently
assigned to mark patient care,finds out that he has a long history of being non-compliant with his medication due to its
side effects. According to the mark, the haloperidol made him have repetitive involuntary body movements such as
swaying from side to side, flapping arms, tapping feet, and involuntary sticking out his tongue. He believes that it has
decreased his overall quality of life, such as when he lost his girlfriend and job; therefore, he has discontinued his
haloperidol several weeks ago, and he does not feel comfortable with continuing his medication any further. He says that
his life was fine after stopping his medication. The doctor involved in the patient's care was unaware that the patient had
stopped taking his maintenance medication, so he prescribed haloperidol again. Mark mentioned that he did not feel the
need to raise his concerns about his abrupt discontinuation of the medication with anyone, and that he comes to collect
medication regularly because he does not want to raise any suspicions that he is not adhering to his medication.
Mark lives alone, but his sister visits him every month. He occasionally does yoga to improve his mental health, but he
also indulges in dagga. Mark had previously experienced mania episodes several times in a month but refused to be
admitted to the hospital.
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, Level 1:Preconventional:
At this level, an individual accepts the authority of others because they do not want to get into trouble or receive a reward.
For instance, if an action results in punishment, it must be wrong; if it results in a reward, it must be right.
Stage 1- Avoiding Punishment
Communication: Dialogue ( Telephone communication)
(Lauren, a pharmacist assistant, who just started at Hospital about 3 months ago, while in the consultation, makes the
call to the doctor about Mark's prescription.)
Lauren: Good Day! Is this Dr. David, from the department of psychiatry?
Doctor: Yes, this is Dr. David. How can I help you today?
Lauren: This lauren. I am calling from the pharmacy. I called you regarding the prescription of one of your patients, Mr .
Talis Mark. I can see here that you have prescribed him Haloperidol, which is antipsychotic that is known to have severe
extrapyramidal side effects.
Doctor: (nods). That's correct.
Lauren: Well, Mr. Talis, has a long history of non adherence to his medication due to its side effects. Is it possible for you
to change his medication to one that has fewer side effects?
Doctor: Unfortunately, that won't be possible. I don't think it is necessary to change the medication, and I don't
understand what you are saying about Mr. Talis being non- adherent. He seems to be doing better, according to me
Lauren: (after failed attempts to convince the doctor.). That would be all. Dr. David, thank you for your time. (hangs up the
call).
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