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Ethics and antibiotic resistance.

Euzebiusz Jamrozik1,2,3, George S Heriot3

  • 1The Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford. Old Road Campus, Oxford OX3 7LF, UK.

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|February 9, 2022
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Summary

Antibiotic resistance poses ethical challenges. Current analyses are limited, necessitating more complex approaches to address harms and improve antibiotic stewardship for better global health outcomes.

Keywords:
antimicrobial resistancebioethicsdrug resistancejusticestewardshiptragedy of the commons

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Area of Science:

  • Bioethics
  • Public Health
  • Microbiology

Background:

  • Antibiotic resistance presents significant ethical dilemmas due to its severe and unevenly distributed consequences.
  • Individual actions and policies contribute to the rise of antibiotic resistance, creating complex moral considerations.

Purpose of the Study:

  • To critically evaluate existing ethical analyses of antibiotic resistance.
  • To identify limitations in current approaches and explore more comprehensive ethical frameworks.
  • To highlight neglected areas for future research in antibiotic stewardship and ethics.

Main Methods:

  • A synthesis of ethical, scientific, and clinical literature was performed.
  • Analysis of existing ethical frameworks concerning patient responsibility, tragedy of the commons, and antibiotic stewardship.
  • Exploration of more complex ethical considerations including asymptomatic carriage and global health disparities.

Main Results:

  • Traditional ethical analyses of antibiotic resistance, focusing on patient compliance and limited use, have significant shortcomings.
  • These narrow perspectives can lead to ineffective or counterproductive policy implications.
  • More advanced analyses are needed to address the ethical dimensions of asymptomatic carriage, non-linear health outcomes, and global variations in resistance burdens.

Conclusions:

  • Existing ethical frameworks for antibiotic resistance are insufficient and can be self-defeating.
  • A more nuanced ethical approach is required, considering the harms of antibiotic use and the lack of evidence for many prescriptions.
  • Future research should focus on these neglected areas to develop more effective and equitable policies for combating antibiotic resistance.