Antimicrobial prescribing matters: the irreconcilability in moral ranking systems

Antimicrobial resistance caused by widespread use of antimicrobials is a defining challenge of our time. This article presents antimicrobial prescribing among physicians as a morally irreconcilable endeavour. Particularly, the physician may have no good option when antimicrobial resistance is seen as both (1) a global threat to be addressed at the population level, and (2) a threat to the individual patient to be addressed in clinical practice. This research demonstrates that in practice, the physician is presented with an irreconcilable dilemma between caring for the population or caring for the individual. The author utilizes an extended ethnographic case study of infectious disease specialists to show that physicians are pressured to use antimicrobials more responsibly for the benefit of society, yet at the same time treat the individual patients with care by administering the most effective and appropriate agents. The author concludes by suggesting that there is no straightforward answer for the practicing physician, since what ultimately matters is unlikely to satisfy either moral ranking system.