Code of Ethics

The Code of Ethics is intended to guide pharmacy professionals when addressing ethical issues and dilemmas encountered during pharmacy practice, assisting them in developing sound ethical reasoning. All pharmacy professionals must adhere to both the content and the spirit of the Code of Ethics. The Code of Ethics also sets expectations for pharmacy owners, managers, leaders, and others to support pharmacy professionals in fulfilling their professional duties to patients.

Ethical Principles

Ethical principles are steadfast concepts that pharmacy professionals are obligated to uphold and balance in all aspects of their practice. The Code of Ethics describes seven core principles to which pharmacy professionals are expected to align their practice, and pharmacy owners, managers, leaders, and others are expected to act in a manner that supports them in doing so. For more information on each of the seven core principles, please hover over the icons below.

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Beneficence
Non-Maleficence
Respect for Persons
Justice
Utility
Solidarity
Stewardship

Beneficence

Caring and advocating for patients through applying knowledge, skills, and attitudes to achieve and maintain optimal patient and population health and well-being.

General Obligations

Assess the impact that a decision or action would have on patient outcomes.
Prioritize decisions or actions that benefit or reduce harm to patients.
Examples of Specific Ethical Expectations
Identify, establish, and maintain the conditions, environment, and human and technological systems necessary for quality patient care.
Provide the pharmacy services that are necessary to meet patient and community needs, to the extent possible.
Determine and assign adequate human resources with an appropriate expertise mix to support safe, accurate, and effective patient care and medication use.
Address gaps in competence (e.g., therapeutic knowledge, cultural safety, communication, leadership) to optimize practice in the best interests of the patient, community and society.
Establish and implement processes that promote safe, accurate, and effective patient care and medication use.
Engage in continuous quality improvement, including reporting medication incidents.
Enable optimal health outcomes through inter- and intra-professional collaboration.
Determine and implement procedures for identifying and addressing fitness-to-practice concerns in oneself, professional colleagues, and/or the patient care team.
Identify the anticipated positive outcomes for patients, groups, and populations prior to implementing new technology (e.g., artificial intelligence applications, robotics, electronic prescribing, communication technology, counting and measuring equipment).
Monitor and assess the actual positive outcomes for patients, groups, and populations related to new technology.
Only contribute to health research involving human subjects that adheres to research ethics requirements and has received approval from an appropriate health research ethics board, such as NL’s Health Research Ethics Authority (HREA), the Interdisciplinary Committee on Ethics in Human Research (ICEHR), or another Canadian health research ethics board.

Non-Maleficence

To avoid or reduce harm. Purposefully acting to avoid patient harm when providing direct care, as well as upstream actions that support population safety, align with this principle.

General Obligations

Assess the impact that a decision or action would have on patient outcomes.
Avoid decisions or actions that might cause or contribute to harm.
Examples of Specific Ethical Expectations
Avoid actual and potential conflicts of interest (e.g., financial rewards or programs that affect professional judgement).
Where conflicts of interest exist, declare these interests to any patient who may be affected and prioritize the patient’s best interest above other interests such as:
the professional’s personal benefit (e.g., financial, social, psychological);
the organization’s economic benefit (e.g., time, revenue, expertise); and
the professional’s or organization’s philosophic interests (e.g., values, beliefs).
To maintain objectivity, avoid dual relationships where possible. Treatment of oneself, family, or close personal contacts may be justifiable in emergencies, or when timely access to another appropriate health professional is not available.
When terminating a therapeutic patient relationship, continue service until care has been transferred to another provider or a reasonable notice of termination has elapsed.
Where a pharmacy professional has a conscientious objection to a pharmacy practice activity,
Plan, in advance where possible, how specific instances will be managed, in collaboration with pharmacy management, as appropriate.
Ensure patients receive timely referrals to other appropriate professionals so that the service or medication can be accessed within a timeframe that meets the patient’s needs.
Prevent, and effectively respond to, diversion of controlled drugs and substances.
Challenge, and report as appropriate, unsafe decisions made by inter- and intra-professional colleagues.
Prevent and challenge communications that provide misinformation to patients or the public.
Seek fair and reasonable remuneration for pharmaceuticals and services.
Identify and mitigate real or potential risks to patients prior to implementing new technology (e.g., artificial intelligence applications, robotics, electronic prescribing, communication technology, counting and measuring equipment).
Monitor and respond to unintended negative consequences related to new and existing technology (e.g., negative health outcomes and privacy or safety-related incidents).

Respect for Persons

Conveys the requirement that all patients be treated with dignity. Central to dignity is autonomy or the right of patients to make their own decisions.

General Obligations

Foster patient relationships that convey the inherent worth of persons, regardless of their personal traits (e.g., background, socioeconomic circumstance, capacity, culture, or identity).
Listen and communicate in a way that is sensitive to patient needs, beliefs, values, experiences, preferences, health goals, and capacity.
Promote meaningfully informed health decisions on the part of the patient and discourage paternalistic forms of patient care.
Examples of Specific Ethical Expectations
Maintain patient privacy and ensure confidentiality of patient information.
Provide patients with, and confirm their understanding of, the information required to make meaningfully informed healthcare decisions.
Inform patients about the purpose, use, control, storage, and security of information collected.
Use or disclose patient information only for the purposes it was collected, except pursuant to patient consent, or as otherwise required by law.
Identify and respond to quality risks resulting from personal biases or moral beliefs pertaining to specific clinical services or patient characteristics.
Respect the right of a competent patient to accept or reject any treatment, care, or professional service.
Recognize the role of substitute decision makers and the decision-making capacity of mature minors.
Recognize and act on advance health care directives.
Balance evidenced-based health care with patient needs and expectations around traditional, complimentary, or combined integrative health practices.
Uphold the patient’s free, unpressured choice of pharmacy and service providers by:
Refraining from providing inducements to patients or organizations that are conditional on, or related to, a patient obtaining medications or services from the pharmacy.
Ensuring advertising and promotional communications do not diminish patient trust in specific pharmacy professionals, pharmacies, or the pharmacy profession as a whole.

Justice

Extends ethical responsibility to include not only individual patients, but also the broader community and society. It means committing to equity, diversity, and inclusion (EDI) in terms of health outcomes, world views, access to services, representation, backgrounds, and other social determinants of health.

General Obligations

Support access for patients, groups or populations to healthcare and services in a manner that promotes equitable health outcomes across society.
Foster a culture of safety, transparency, and honesty.
Contribute to quality improvement of the healthcare system.
Avoid and confront discrimination based on prohibited grounds as specified in the NL Human Rights Act.
Examples of Specific Ethical Expectations
Foster practice conditions that support professionals’ autonomous decision-making and priority-setting related to patient care.
Provide practice conditions and environments that support workforce health and wellbeing, cultural and psychological safety, and quality patient care.
Contribute to fulfilling public need for adequate pharmacy workforce and access to pharmacy services by participating in professional training, supervision, and retention programs.
Contribute to equitable distribution of resources (e.g., human, equipment, medications, supplies) to geographic areas or facilities experiencing inequity of access or health outcomes (e.g., due to local workforce shortage, climate-related issues, or localized public health events).
Raise concerns to colleagues or appropriate authorities when policies or processes (including disaster planning), systems, or practice conditions have potential to compromise the health of a patient, group, or community.
Foster effective therapeutic relationships with patients and communities by recognizing and addressing personal biases and prejudices.
Demonstrate cultural humility by seeking to understand patients’ lived experience.
Provide equitable care to patients or groups of patients with high or unique needs.
Identify, and assist with bridging, literacy or technology barriers that may contribute to inequitable health outcomes for patients or groups of patients.
Mitigate the impact of systemic racism and discrimination on patient care, communities, and the health system.
Support research, policy development, public education, and advocacy aimed at health systems improvement.
Engage in respectful and informed interactions (in-person, virtually, and on social media) with colleagues, other health professionals, the public, CPNL, and others to promote positive relationships, psychological safety, and quality care.
Refrain from incentivizing activities or recommendations that reduce professionals’ ability to equitably distribute professional resources (including attention and expertise).
Monitor for signs of abuse of members of the community and report to the correct authorities in an appropriate manner6.

Justice is central to the care pharmacy professionals provide to Indigenous Peoples. Pharmacy professionals upholding this ethical principle in the context of caring for Indigenous Peoples will:

Relate Indigenous peoples’ historical and recent experience of society and the healthcare system to health outcomes and perspectives on pharmacy services.
Foster cultural humility and cultural safety around Indigenous health beliefs, healing practices, and the needs of local communities.
Consider changes to practice in response to the Calls to Action of the Truth and Reconciliation Commission of Canada, Reclaiming Power and Place: The Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls, and emerging guidance related to reconciliation between Indigenous peoples and Canada’s non-Indigenous society and health systems.

Utility

Aims to produce the greatest benefit for the largest number of people. Utility prioritizes population-oriented care over patient-oriented care. Although relevant during typical practice conditions, utility carries less weight than other ethical principles. Its importance increases in extraordinary conditions, such as public health emergencies, when resources are scarce and the risk of systems failure, illness, or death to members of the community or society is high.

General Obligations

During typical practice conditions:

Include preventative public health strategies in patient care.
Prepare for future health crises, climate events, geopolitical conflicts, or other emergencies, and the associated major systems failures.
Provide the best care possible to patients, while recognizing the need to maximize the well-being of the community and society.

In addition, during extraordinary practice conditions:

Maximize efficient use of resources.
Strive to maintain quality patient care while recognizing that minimizing harm to the greatest number of people is the priority.
Employ triage protocols more stringently and more readily than during typical conditions.
Examples of Specific Ethical Expectations
Support vaccination and prophylaxis for patients and others, in accordance with public health recommendations and existing evidence.
Engage in and support harm reduction programming.
Ensure disaster plans consider mechanisms to:
Conserve workforce availability.
Conserve or ration medications to help maintain supply.
Provide for continuity of care as conditions allow.
Establish, rehearse, and if necessary, implement disaster plans.

Solidarity

A bond of unity, support and shared commitment. Solidarity is a sustained cohesion based on shared experience, cause, or need, and evokes connection, empathy, and commitment. Solidarity is different from collaboration, which is focused on individuals working together towards a common goal. Collaboration is task-focused, while solidarity is relationship-focused. Although solidarity applies during typical practice conditions, its priority increases under extraordinary conditions when resources are scarce and there is high risk of systems failure, illness, or death to members of the community or society.

General Obligations

During typical practice conditions:

Cultivate connection and cohesion within the profession to foster mutual support, workforce well-being, and the capacity to provide effective and accessible pharmacy services to the public.
Unite with others to achieve health system-level change for the benefit of patients, communities, and society.

In addition, during extraordinary practice conditions:

Connect, and work, with other groups and communities in the interests of conserving and prioritizing the use of limited healthcare resources.
Establish or strengthen connections to achieve a consistent, united approach in managing the extraordinary circumstances.
Examples of Specific Ethical Expectations
Engage with organizations, opportunities, and initiatives that cultivate meaningful connections within the profession, health system, and community.
Provide and accept support that arises from connection with others that have shared experiences.
Offer assistance, collaborate, coordinate, and share resources across inter- and intra-professional groups.
Support consistent public communication of evidence-based information across groups of individuals, teams and organizations.
Decision-makers and leaders at the individual, team, organization, and system levels seek consensus, particularly when setting direction on issues that threaten public health.
Uphold direction established through consensus of decision-makers and leaders, particularly on issues that threaten public health.

Stewardship

Calls for responsible management of resources with the goal of reducing harm and maintaining function in the present and future society and planet. Stewardship is an ethical obligation to reduce the negative impacts of healthcare, not only on individual patients (refer to principle 2), marginalized populations (see principle 4), and the population as whole, but also on species and habitats.

General Obligations

Consider the impact of resource use (e.g., medications, technology, supplies, energy) on society and the planet.
Conserve resources for the benefit of patients, communities, society, and the planet.
Examples of Specific Ethical Expectations
Integrate evidence on climate change mitigation into patient care decision-making and pharmacy operations (e.g., deprescribing initiatives, social prescribing, selection of medication options with lower carbon footprint where clinically appropriate, waste reduction, and pharmaceutical procurement).
Balance minimization of pharmacy-generated waste with other ethical principles and regulatory obligations and expectations.
Safely dispose of medication waste and associated physical waste.
Engage in antimicrobial stewardship to help mitigate antibiotic resistance.
Reduce negative impacts related to misuse of medications and the related downstream societal issues related to substance use disorders (e.g., controlled substances stewardship).

Subjective influences

Subjective influences – human qualities and values – shape how pharmacy professionals and other relevant individuals carry out their professional and ethical responsibilities. To navigate the complex interplay between subjective influences and the ethical principles of the Code of Ethics, pharmacy professionals must be self-aware of their own subjective influences during ethical reasoning and prioritize upholding the ethical principles. While a pharmacy professional, other individual, or organization may hold their own values, pharmacy professionals must subscribe to the values of the profession and society. Examples of human qualities consistent with the profession’s established values and the ethical principles include:

Accountable
Attentive
Caring
Compassionate (for self, peers, patient and community)
Conscientious
Curious
Honest
Humble
Non-judgemental
Trustworthy
Wise

Ethical Decision-Making Framework

The Ethical Decision-Making Framework (EDMF) is a systematic approach that supports consistent, transparent, and objective thinking. When facing an ethical issue or dilemma, it helps those involved reflect and collaborate. It also provides a common format for discussing ethical issues or dilemmas with other pharmacy professionals, patients, other members of the patient care team, and with ethical advisors.

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Additional Resources

Code of Ethics (PDF)
Code of Ethics Interpretation Guides
Advertising and Promotion Interpretation Guide
Ending the Pharmacist-Patient Relationship Interpretation Guide
Maintaining Professional Boundaries Interpretation Guide
Prohibition on Inducements Interpretation Guide
Use of Social Media Interpretation Guide

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