Introduction
Community pharmacists work in a commercial environment that must respond to profit imperatives and consumer pressure. Few are owner-proprietors 1 and are therefore operating within organisational cultures set by others. These cultures may be small and informal or of national proportions and complexity. When individual pharmacists deal with ethical dilemmas at pharmacy level, their options may be influenced by policies and procedures that reflect values and priorities in company policy rather than needs of the patient. This study, a final year pharmacy student project, sets out to describe the nature of these dilemmas.

Methodology
A literature review revealed few studies that looked specifically at organisational and commercial influences on ethical decision-making in community pharmacy. To research this area, a focus group of five community pharmacists was first established to allow understanding and comparison of participant's beliefs and experiences in this area 2. Using material gained from this, 11 semi-structured interviews were carried out with a sample of local community pharmacists. Key questions included "How does the owner's or company policy affect how you deal with ethical issues?" and clarification of how often these arise, what action is taken and how policy is amended.

Findings
The focus group identified ethical issues arising under 5 themes: management of inventory, controlling costs or preserving profit, responding to consumer pressure, marketing and promotion methods and role clarification. Examples of such ethical dilemmas included stocking of "borderline" slimming products, reuse of patient's returned medicines, interruptions and time pressure to serve more customers, "3 for 2" offers on medicines and accountabilities of locums, employee pharmacists, line and non-pharmacist managers. Subsequent interviews provided more examples of activities within these themes and identified situations where company policy was of considerable assistance to "front-line" pharmacists in guiding their thinking in difficult areas such as supply of emergency hormonal contraception.

Discussion
This was a very small study in a largely unexplored aspect of community pharmacy practice. Further research is planned to more comprehensively describe and conceptualise the influence of commercial and corporate environment on the professional autonomy of community pharmacists. For pharmacy services, this research suggests that company policy may provide opportunities to foster a more supportive, service based culture and relieve some of the immediate burden of ethical decision-making at the "front line", although arguably this may compromise professional autonomy of the individual pharmacist. The current community pharmacy contract rewards prescription volume causing ethical anxieties over time available for patient counselling and for safe practice. The purchase of medicines has become a transaction in commodities responding to ordinary commercial incentives and creating ethical dilemmas for those pharmacists who do not see medicines as "ordinary articles of commerce".

References
1. Harania V, (1998) "Independents Day", Chemist and Druggist, 250 (14 Nov), 42-44
2. David L Morgan (1998) The Focus Group Handbook, Focus group kit1, Sage publication, Chapters 1,2,7,8, p1-33, 55-71