With pharmacists taking on more advanced roles than ever, PSA’s revised Code of Ethics for Pharmacists sets out exactly who’s accountable, and when.
Accountability has always been central to pharmacy practice. But today’s broadening and deepening scope of practice means pharmacists are accountable for more decisions, in more settings, than ever before. The PSA’s revised Code of Ethics for Pharmacists reflects this evolution, recognising that as pharmacists’ scope of practice expands, so too does their accountability.
The new iteration of the Code makes it clear that pharmacists are responsible for their professional and clinical decisions – along with the outcomes of those decisions – across every role and setting. This includes when using digital and AI-assisted technologies. Accountability is also not something that can be delegated. While pharmacists can transfer responsibility for a task to colleagues or support staff such as pharmacy assistants, they remain accountable for the outcome.
More responsibility, greater accountability
The pharmacy profession has changed significantly since the last Code was published in 2017. Over the past decade, appropriately trained pharmacists have gained new prescribing rights to treat additional acute and chronic conditions, and are administering more vaccines and medicines by injection to a broader range of patients. At the same time, AI-assisted clinical tools and scribes are becoming part of everyday practice, supporting ambient note-taking and, in some cases, informing clinical decision-making during consultations.
Many pharmacists now perform more functions within the medicine management cycle in more episodes of care. For example, a pharmacist prescribing, dispensing and administering a medicine for the same patient in a single consultation – while also providing follow-up advice – is now well-established practice.
The 2026 Code frames this expanded scope not just as professional progress, but as a widening of accountability.
Integrity Principle 2 of the revised Code states pharmacists are responsible for their professional decisions, and must demonstrate honesty, transparency and accountability in all aspects of practice. This obligation applies across all areas of practice – whether a pharmacist works in a community pharmacy, general practice, hospital, a regulatory body or academia. It also applies across all aspects of practice, including prescribing and dispensing, clinical decision-making, management and the use of technology.
Taking accountability
So what does accountability look like in practice? The following scenarios highlight where pharmacists must stop, reflect and take ownership of their professional decisions.
These cases demonstrate application of PSA’s GUIDE Framework for ethical decision-making, taking contextual detail into account. They should be interpreted as examples only and not as comprehensive guidance or resolutions of the ethical issues involved.
To dispense, or not dispense, medicinal cannabis?
When a patient presents to Anjali’s pharmacy with a prescription for medicinal cannabis, nothing immediately stands out as problematic. The script is legitimate, provided by a telehealth prescriber based in a different city but within the same state.
The prescription was posted to the patient, who tells Anjali it is for his mental health – but provides no further information when prompted.
But just because the script is legally valid, that doesn’t necessarily mean it’s clinically sound. The evidence supporting medicinal cannabis for mental health conditions remains limited, and THC-containing products may be contraindicated in patients with certain diagnoses, including psychosis.
In this situation Anjali could:
a. Dispense the prescription without further investigation: While this approach may ensure timely access to treatment, it carries a risk of patient harm if the prescribed medicine is not clinically appropriate. It may also have professional implications if the decision does not align with safe and evidence-based practice.
b. Investigate further to determine whether to dispense the prescription: This allows for a proper evaluation of risks and benefits, including consideration of potential withdrawal effects if the medicine has been used long term and she refuses to dispense it. While collaborative in approach, the final decision to dispense or not remains Anjali’s professional responsibility.
c. Do not dispense the prescription: Anjali could decide not to dispense the prescription if she believes it is inappropriate without speaking to the prescriber. This may reduce the risk of harm from inappropriate treatment but could also result in negative consequences for the patient, particularly if therapy is interrupted. There may also be professional implications if the decision is not clearly justified and communicated.
Option b is preferred. Anjali should not dispense the medication until she has confirmed the clinical indication, relevant patient history, and that the potential benefits outweigh the risks. As the dispensing pharmacist, she is individually accountable for the decision to supply.
This approach is consistent with her ethical and professional obligations to prioritise patient wellbeing, promote the safe and quality use of medicines, and ensure that treatment decisions are supported by the best available evidence.
When no other prescriber is available
Wei is a prescribing pharmacist based in a rural town in central Queensland, where he is the sole pharmacist serving the community. Wei’s wife, Xiaoyu, develops symptoms of a urinary tract infection (UTI) requiring treatment with antibiotics on a Saturday afternoon. But the nearest alternative prescriber, a 3-hour drive away, is currently closed.
The only feasible option for Xiaoyu to receive timely and effective treatment appears to be through a prescription from her husband.
Yet prescribing to a family member can compromise clinical objectivity and the quality of care provided. Inappropriate antibiotic prescribing can also contribute to antimicrobial resistance, which can impact public health.
Weighing up the risks and benefits, Wei decides to prescribe an antibiotic for Xiaoyu to prioritise her health, support appropriate and safe use of medicines and prevent harm from delayed treatment.
He ensures the consultation is thoroughly documented to demonstrate that the prescribing decision was clinically appropriate, objective, and made in Xiaoyu’s best interests – despite their personal relationship. Wei records the clinical indication, relevant assessment, rationale for treatment, consideration of alternatives and confirmation that the decision aligns with guidelines. He also documents the exceptional circumstances that justified prescribing for a family member, and the measures taken to maintain clinical objectivity, including following established protocols for diagnosing and treating uncomplicated UTI. This supports transparency and professional accountability.
Practising accountability under the revised Code
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