How Should We Think About Clinicians' Individual Antibiotic Stewardship Duties?

Area of Science:

• Medical Ethics
• Public Health
• Infectious Disease

Background:

• Antibiotic resistance is a major global health threat requiring multifaceted solutions.
• The concept of antibiotic stewardship is frequently framed around the moral obligations of individual prescribers.
• Ethical frameworks for collective action problems, such as those in environmental ethics, inform stewardship discussions.

Purpose of the Study:

• To critically examine the ethical implications of the term "antibiotic stewardship."
• To explore how a hyper-focus on individual stewardship may misrepresent prescribers' decision-making processes.
• To highlight alternative perspectives on antibiotic use limitation.

Main Methods:

• Conceptual analysis of ethical terminology.
• Literature review of environmental ethics and collective action problems.
• Discussion of prescriber motivations in limiting antibiotic use.

Main Results:

• The concept of "stewardship" originates from collective action problems, implying that individual actions alone are insufficient for solutions.
• An overemphasis on individual prescriber stewardship may inadvertently overlook systemic factors and diverse prescriber rationales.
• This focus risks a moralistic framing that may not accurately reflect clinical realities or encourage effective change.

Conclusions:

• Rethinking the dominant narrative of antibiotic stewardship is necessary.
• Understanding the varied reasons prescribers limit antibiotic use requires moving beyond a narrow focus on individual moral duty.
• A more nuanced ethical approach is needed to effectively combat antibiotic resistance.