Introduction 
The need for greater ethical and value literacy in community pharmacy¹ together with changes to the contract and the need for pharmacists to justify their actions in an increasingly litigious and consumer-driven society mean that an understanding of practitioners’ ethical awareness is both timely and necessary. Prior research has been predominantly US-based and has not explored ways in which UK pharmacists resolved ethical dilemmas. This study set out to explore this area in more depth to identify ethical ability and dilemmas encountered.

Method 
The study reported on here adopted a qualitative approach using depth interviews with community pharmacists to explore a potential range of ethical abilities and dilemmas. It continues the trend of empirical health care ethics research² and analysed interviews with reference to several ethical theories and an ethical decision-making model³ to understand how community pharmacists both identify ethical problems, use ethical reasoning and finally act upon ethical decisions. Eleven community pharmacists were interviewed, purposively selected to reflect the diversity of the profession and the transcribed interviews analysed qualitatively with reference to the ethical decision-making model to assess ethical ability and to identify emergent ethical themes.

Discussion 
Pharmacists identified many ethical problems but their ability to resolve them varied, with some displaying considerable sensitivity and reflection whilst others less so. Analysis of interviews identified reasoning that reflected ethical theories such as consequentialism, rights and narratives but was often inconsistent or incomplete. Pharmacists also admitted using intuition and common sense to resolve ethical problems and occasionally made ethical decisions based upon facts rather than values. Several pharmacists failed to recognise an issue as ethical when, for example, acting paternalistically in recording sales of medicines without the customers’ knowledge or withholding information. At times, pharmacist showed awareness of an ethical problem but either failed to make a decision (for example, regarding selling confectionery) or did not act upon an ethical decision or waited for someone else to intervene. Common ethical dilemmas had legal implications including emergency supplies and whether to dispense incorrect controlled drug prescriptions. The code of ethics was not considered useful in providing ethical help by the pharmacists interviewed, nor was its ethical content thought memorable. Pharmacists identified several commercial concerns including charging for monitored dosage systems, brand substitution, link-selling and relative customer poverty. Professional isolation was often identified as a barrier to being able to seek help on ethical problems. 

Conclusion 
Community pharmacists varied considerably in their ability to resolve ethical problems. Legal controls, the commercial environment and professional isolation precipitated many dilemmas. The identification of professional isolation, the limited benefit of the code of ethics and ethical value illiteracy may contribute to the lack of ethical ability and which may, ultimately, be detrimental to patient and customer welfare in community pharmacies.

References

1. Cribb, Alan and Barber, Nick Developing Pharmacy Values: Stimulating the Debate London, Royal Pharmaceutical Society of Great Britain 2000

2. Hoffmaster, Barry ‘The Forms and Limits of Medical Ethics’ Soc Sci Med. Vol. 39 No. 9 1994 p1156

3. Jones, Thomas M. ‘Ethical Decision Making by Individuals in Organisations: An Issue-Contingent Model’ Academy of Management Review Vol. 16 No.2 1991 pp. 366-295