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  1. Developing an Ethical Evaluation Framework for Coercive Antimicrobial Stewardship Policies.Tess Johnson - 2024 - Public Health Ethics 17 (1-2):11-23.
    Antimicrobial resistance (AMR) has been declared one of the top ten global public health threats facing humanity. To address AMR, coercive antimicrobial stewardship policies are being enacted in some settings. These policies, like all in public health, require ethical justification. Here, I introduce a framework for ethically evaluating coercive antimicrobial stewardship policies on the basis of ethical justifications (and their limitations). I consider arguments from effectiveness; duty of easy rescue; tragedy of the commons; responsibility-tracking; the harm principle; paternalism; justice and (...)
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  • Antimicrobial Resistance, One Health Interventions and the Least Restrictive Alternative Principle.Davide Fumagalli - 2024 - Public Health Ethics 17 (1-2):5-10.
    Antimicrobial resistance (AMR) is increasingly recognised as a threat to human, animal and environmental health. In an effort to counter this threat, several intervention plans have been proposed and implemented by states and organisations such as the WHO. A One Health policy approach, which targets multiple domains (healthcare, animal husbandry and the environment), has been identified as useful for curbing AMR. Johnson and Matlock have recently argued that One Health policies in the AMR context require special ethical justification because of (...)
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  • Distributive justice and value trade-offs in antibiotic use in aged care settings.Jane Williams, Sittichoke Chawraingern & Chris Degeling - forthcoming - Monash Bioethics Review:1-10.
    Residential aged care facilities (RACF) are sites of high antibiotic use in Australia. Misuse of antimicrobial drugs in RACF contributes to antimicrobial resistance (AMR) burdens that accrue to individuals and the wider public, now and in the future. Antimicrobial stewardship (AMS) practices in RACF, e.g. requiring conformation of infection, are designed to minimise inappropriate use of antibiotics. We conducted dialogue groups with 46 participants with a parent receiving aged care to better understand families’ perspectives on antibiotics and care in RACF. (...)
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  • Stewardship and social justice: implications of using the precautionary principle to justify burdensome antimicrobial stewardship measures.Tess Johnson - forthcoming - Monash Bioethics Review:1-15.
    Antimicrobial resistance has been termed a ‘silent pandemic’, a ‘hidden killer.’ This language might indicate a threat of significant future harm to humans, animals, and the environment from resistant microbes. If that harm is uncertain but serious, the precautionary principle might apply to the issue, and might require taking ‘precautionary measures’ to avert the threat of antimicrobial resistance, including stewardship interventions like antibiotic prescription caps, bans on certain uses in farming sectors, and eliminating over-the-counter uses of antibiotics. The precautionary principle (...)
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  • Systemic intervention can be intrusive, too: a reply to Paetkau.Tess Johnson - 2024 - Journal of Medical Ethics 50 (10):692-693.
    In his feature article, Tyler Paetkau1 argues that the Nuffield Council on Bioethics’ (NCOB) infamous intervention ladder2 fails to acknowledge systemic influences towards poor health outcomes and instead places the blame on individuals. The ladder of interventions to change individual health behaviours runs from less intrusive to more intrusive and pays less attention to possible regulatory mechanisms for big businesses that would often avoid such intrusion on individuals and the punitive implications of that intrusion. Paetkau cites smoking bans and food (...)
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  • Is Resource Allocation that is Sensitive to Vaccination Status Coercive? Who Cares?Tess Johnson - 2024 - American Journal of Bioethics 24 (7):106-108.
    Park and Davies (2024) discuss the allocation of scarce resources during a pandemic—primarily ventilators and healthcare staff—and assess the ethical concepts that are used in arguments for and aga...
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  • Coercive public health policies need context-specific ethical justifications.Tess Johnson, Lerato Ndlovu, Omolara O. Baiyegunhi, Wezzie S. Lora & Nicola Desmond - forthcoming - Monash Bioethics Review:1-22.
    Public health policies designed to improve individual and population health may involve coercion. These coercive policies require ethical justification, and yet it is unclear in the public health ethics literature which ethical concepts might justify coercion, and what their limitations are in applying across contexts. In this paper, we analyse a number of concepts from Western bioethics, including the harm principle, paternalism, the public interest, and a duty of easy rescue. We find them plausible justifications for coercion in theory, but (...)
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