Book excerpt: Pharmacists face ethical choices constantly -- sometimes dramatic life-and-death decisions, but more often subtle, less conspicuous choices that are nonetheless important. Among the topics confronted are assisted suicide, conscientious refusal, pain management, equitable distribution of drug resources within institutions and managed care plans, confidentiality, and alternative and non-traditional therapies. Veatch and Haddad's book, first published in 1999, was the first collection of case studies based on the real experiences of practicing pharmacists, for use as a teaching tool for pharmacy students. The second edition accounts for the many changes in pharmacy since 1999, including assisted suicide in Oregon, the purchasing of less expensive drugs from Canada, and the influence of managed care on prescriptions. The presentation of some cases is shortened, most are revised and updated, and two new chapters have been added. The first new chapter presents a new model for analyzing cases, while the second focuses on the ethics of new drug distribution systems, for example hospitals where pharmacists are forced to choose drugs based on cost-effectiveness, and internet based pharmacies.