Ethical lessons for Australian pharmacists from overseas

Australia is one of many countries pursuing evolution in pharmacist scope of practice through prescribing. 

While pharmacists have long prescribed Pharmacy Medicines and Pharmacist Only Medicines, prescribing higher-risk medicines is relatively new.

On Monday (1 September), a panel of experts at the FIP World Congress explored the ethical issues which arise from this shift, and those which Australian pharmacists and governance systems will need to navigate.

UK: Put in place structures to navigate undue pressure

The UK has had a head start on pharmacist prescribing, with a third of registered pharmacists now endorsed as pharmacist prescribers – a number set to grow rapidly following its incorporation into undergraduate training.

Claire May, Senior Lecturer in Pharmacy Practice at the University of Brighton, highlighted that number of UK pharmacists feel pressured to prescribe outside of their accountability and scope – and that this will probably be one of the greatest ethical challenges.

‘The future of pharmacists prescribing, I believe, is shaped by three powerful forces: digitalisation, workforce pressures and regulatory reform,’ she said. ‘How do we make sure every prescribing decision is made with confidence, competence and care?’

In exploring the answers to this, Mrs May identified commitment to lifelong learning, professional culture and getting the regulations right.

The panel cautioned other countries following a proliferation of independent pharmacists supporting protocol-based online prescribing clinics. They also reflected on situations where pharmacist prescribers in general practice were pressured to sign (authorise) prescriptions outside their individual scope of practice to facilitate ongoing patient care.

Basic ethical principles ‘more important’ when prescribing

So what are the key messages for Australia? Associate Professor Betty Chaar from the University of Sydney highlighted the key ethical issues related to prescribing in her address:

• beneficence
• non-maleficence (not causing harm)
• respect for autonomy, including informed consent
• accountability
• professional integrity, including conflicts of interest
• collaborative care.

‘These are basic principles. But they are even more important when we are prescribing,’ A/Prof Chaar said.

‘Our accountability isn’t just to our patients, but also to the profession. One mistake and it’s all over social media. This means taking responsibility for competence, documentation, consulting, making judicious decisions, and being transparent about our scope of practice and our limitations.’

Overall though, Prof Chaar encouraged the profession to lean into these ethical principles to enable more prescribing, rather than hold the profession back.

‘It is phenomenal that we are prescribing, and that so many countries are adopting and legalising [it],’ she said. ‘All pharmacy profession leaders have led us into this wonderful new era. We must rise to the occasion and deliver.’

A/Prof Betty Chaar is a member of the Project Advisory Group for the review of PSA’s Code of Ethics, which recently commenced.