The expanding role of pharmacists in healthcare, particularly in dispensing Over the Counter (OTC) medications, presents a complex array of ethical challenges. This critical review explores the delicate balance pharmacists must maintain between facilitating patient access to medications and ensuring safe, responsible use of OTC drugs. It delves into the ethical considerations inherent in non-prescription medication dispensation, including patient safety, the risks of self-medication, and the pharmacist's duty to provide comprehensive patient counseling. The review also examines the legal and regulatory frameworks guiding pharmacists' actions and the importance of professional discretion in situations lacking clear guidelines. Through an analysis of best practices, ethical decision-making models, and case studies, this article highlights the importance of ethical vigilance and ongoing professional development in navigating the intricacies of non-prescription medication dispensation. It concludes with a forward-looking perspective on the evolving role of pharmacists in the context of technological advancements and public health initiatives, underscoring the need for a continued ethical discourse within the pharmacy profession.