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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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  • More Carrots, Less Sticks: Encouraging Good Stewardship in the Global Antimicrobial Commons.Cristian Timmermann - 2023 - Health Care Analysis 31 (1):53-57.
    Time-tested commons characterize by having instituted sanctioning mechanisms that are sensitive to the circumstances and motivations of non-compliers. As a proposed Global Antimicrobial Commons cannot cost-effectively develop sanctioning mechanisms that are consistently sensitive to the circumstances of the global poor, I suggest concentrating on establishing a wider set of incentives that encourages both compliance and participation.
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  • Property Claims on Antibiotic Effectiveness.Cristian Timmermann - 2021 - Public Health Ethics 14 (3):256–267.
    The scope and type of property rights recognized over the effectiveness of antibiotics have a direct effect on how those claiming ownership engage in the exploitation and stewardship of this scarce resource. We examine the different property claims and rights the four major interest groups are asserting on antibiotics: (i) the inventors, (ii) those demanding that the resource be treated like any other transferable commodity, (iii) those advocating usage restrictions based on good stewardship principles and (iv) those considering the resource (...)
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  • Governing Antibiotic Risks in Australian Agriculture: Sustaining Conflicting Common Goods Through Competing Compliance Mechanisms.Chris Degeling & Julie Hall - 2023 - Public Health Ethics 16 (1):9-21.
    The One Health approach to antimicrobial resistance (AMR) requires stakeholders to contribute to cross-sectoral efforts to improve antimicrobial stewardship (AMS). One Health AMR policy implementation is challenging in livestock farming because of the infrastructural role of antibiotics in production systems. Mitigating AMR may require the development of more stringent stewardship obligations and the future limitation of established entitlements. Drawing on Amatai Etzioni’s compliance theory, regulatory analyses and qualitative studies with stakeholder groups we examine the structural and socio-cultural dimension of antibiotic (...)
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  • Taxing Meat: Taking Responsibility for One’s Contribution to Antibiotic Resistance.Hannah Maslen, Julian Savulescu, Thomas Douglas, Patrick Birkl & Alberto Giubilini - 2017 - Journal of Agricultural and Environmental Ethics 30 (2):179-198.
    Antibiotic use in animal farming is one of the main drivers of antibiotic resistance both in animals and in humans. In this paper we propose that one feasible and fair way to address this problem is to tax animal products obtained with the use of antibiotics. We argue that such tax is supported both by deontological arguments, which are based on the duty individuals have to compensate society for the antibiotic resistance to which they are contributing through consumption of animal (...)
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  • Antimicrobial Footprints, Fairness, and Collective Harm.Anne Schwenkenbecher - 2020 - In Euzebiusz Jamrozik & Michael Selgelid (eds.), Ethics and Drug Resistance: Collective Responsibility for Global Public Health. Springer. pp. 379-389.
    This chapter explores the question of whether or not individual agents are under a moral obligation to reduce their ‘antimicrobial footprint’. An agent’s antimicrobial footprint measures the extent to which her actions are causally linked to the use of antibiotics. As such, it is not necessarily a measure of her contribution to antimicrobial resistance. Talking about people’s antimicrobial footprint in a way we talk about our carbon footprint may be helpful for drawing attention to the global effects of individual behaviour (...)
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  • A Principled Account of AMR Global Governance Solidarity, Subsidiarity, and Stewardship.Thana C. de Campos-Rudinsky - 2023 - Health Care Analysis 31 (1):58-63.
    This commentary defines what shared yet differentiated ethical responsibilities to tackle antimicrobial resistance (AMR) mean, by introducing a threefold principled account of AMR global governance. It argues that the principles of solidarity, subsidiarity, and stewardship can be especially helpful for further justifying some of the universal, differentiated, and individual responsibilities that Van Katwyk et al propose. The upshot of my threefold principled account of AMR global governance is a less ambitious AMR treaty, one that can only justify (i) universal duties (...)
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  • Justifying the More Restrictive Alternative: Ethical Justifications for One Health AMR Policies Rely on Empirical Evidence.Tess Johnson & William Matlock - 2023 - Public Health Ethics 16 (1):22-34.
    Global consumption of antibiotics has accelerated the evolution of bacterial antimicrobial resistance. Yet, the risks from increasing bacterial antimicrobial resistance are not restricted to human populations: transmission of antimicrobial resistant bacteria occurs between humans, farms, the environment and other reservoirs. Policies that take a ‘One Health’ approach deal with this cross-reservoir spread, but are often more restrictive concerning human actions than policies that focus on a single reservoir. As such, the burden of justification lies with these more restrictive policies. We (...)
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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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  • Is the Cure Worse than the Disease? The Ethics of Imposing Risk in Public Health.Diego S. Silva & Maxwell J. Smith - 2023 - Asian Bioethics Review 15 (1):19-35.
    Efforts to improve public health, both in the context of infectious diseases and non-communicable diseases, will often consist of measures that confer risk on some persons to bring about benefits to those same people or others. Still, it is unclear what exactly justifies implementing such measures that impose risk on some people and not others in the context of public health. Herein, we build on existing autonomy-based accounts of ethical risk imposition by arguing that considerations of imposing risk in public (...)
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  • Articulations of antimicrobial resistance in trade union financed journals for nurses in Scandinavia – A Foucauldian perspective.Stinne Glasdam, Henrik Loodin & Jonas Wrigstad - 2021 - Nursing Inquiry 28 (3):e12396.
    Antimicrobial resistance (AMR) in bacterial infections is a growing threat to humanity and a challenge to healthcare systems worldwide. Healthcare professionals have an important role in preventing AMR and the spreading of infections. This article focuses on trade union financed journals for nurses in Scandinavia studying how the journals articulate AMR to its readership. A systematic literature search over an eleven‐year period was conducted, using web‐based national trade union financed journals, searching for ‘bacteria’ and ‘resistance’. A thematic analysis, inspired by (...)
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  • Global Health Solidarity.Peter G. N. West-Oram & Alena Buyx - 2017 - Public Health Ethics 10 (2).
    For much of the 20th century, vulnerability to deprivations of health has often been defined by geographical and economic factors. Those in wealthy, usually ‘Northern’ and ‘Western’, parts of the world have benefited from infrastructures, and accidents of geography and climate, which insulate them from many serious threats to health. Conversely, poorer people are typically exposed to more threats to health, and have lesser access to the infrastructures needed to safeguard them against the worst consequences of such exposure. However, in (...)
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  • Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable?Christina Åhrén, Anna Lindblom, Christian Munthe & Niels Nijsingh - 2020 - Monash Bioethics Review 38 (Suppl 1):72-90.
    Effectiveness is a key criterion in assessing the justification of antibiotic resistance interventions. Depending on an intervention’s effectiveness, burdens and costs will be more or less justified, which is especially important for large scale population-level interventions with high running costs and pronounced risks to individuals in terms of wellbeing, integrity and autonomy. In this paper, we assess the case of routine hospital screening for multi-drug-resistant Gram-negative bacteria (MDRGN) from this perspective. Utilizing a comparison to screening programs for Methicillin-Resistant Staphylococcus aureus (...)
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  • What High-Income States Should Do to Address Industrial Antibiotic Pollution.Erik Malmqvist & Christian Munthe - 2020 - Public Health Ethics 13 (3):275-287.
    Antibiotic resistance is widely recognized as a major threat to public health and healthcare systems worldwide. Recent research suggests that pollution from antibiotics manufacturing is an important driver of resistance development. Using Sweden as an example, this article considers how industrial antibiotic pollution might be addressed by public actors who are in a position to influence the distribution and use of antibiotics in high-income countries with publicly funded health systems. We identify a number of opportunities for these actors to incentivize (...)
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  • Environmental risk and market approval for human pharmaceuticals.Davide Fumagalli - forthcoming - Monash Bioethics Review:1-20.
    This paper contributes to the growing discussion about how to mitigate pharmaceutical pollution, which is a threat to human, animal, and environmental health as well as a potential driver of antimicrobial resistance. It identifies market approval of pharmaceuticals as one of the most powerful ways to shape producer behavior and highlights that applying this tool raises ethical issues given that it might impact patients’ access to medicines. The paper identifies seven different policy options that progressively give environmental considerations increased priority (...)
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  • The international dimensions of antimicrobial resistance: Contextual factors shape distinct ethical challenges in South Africa, Sri Lanka and the United Kingdom.Eva M. Krockow & Carolyn Tarrant - 2019 - Bioethics 33 (7):756-765.
    Antimicrobial resistance (AMR) describes the evolution of treatment‐resistant pathogens, with potentially catastrophic consequences for human medicine. AMR is driven by the over‐prescription of antibiotics, and could be reduced through consideration of the ethical dimensions of the dilemma faced by doctors. This dilemma involves balancing apparently opposed interests of current and future patients, and unique contextual factors in different countries, which may modify the core dilemma. We describe three example countries with different economic backgrounds and cultures—South Africa, Sri Lanka and the (...)
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  • Treating Mycoplasma genitalium (in pregnancy): a social and reproductive justice concern.Ulla McKnight, Bobbie Farsides, Suneeta Soni & Catherine Will - forthcoming - Monash Bioethics Review:1-16.
    Antimicrobial Resistance is a threat to individual and to population health and to future generations, requiring “collective sacrifices” in order to preserve antibiotic efficacy. ‘Who should make the sacrifices?’ and ‘Who will most likely make them?’ are ethical concerns posited as potentially manageable through Antimicrobial Stewardship. Antimicrobial stewardship almost inevitably involves a form of clinical cost-benefit analysis that assesses the possible effects of antibiotics to treat a diagnosed infection in a particular patient. However, this process rarely accounts properly for patients (...)
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  • Effort Worth Making: A Qualitative Study of How Swedes Respond to Antibiotic Resistance.Mirko Ancillotti, Stefan Eriksson, Tove Godskesen, Dan I. Andersson & Jessica Nihlén Fahlquist - 2021 - Public Health Ethics 14 (1):1-11.
    Due to the alarming rise of antibiotic resistance, medically unwarranted use of antibiotics has assumed new moral significance. In this paper, a thematic content analysis of focus group discussions was conducted to explore lay people’s views on the moral challenges posed by antibiotic resistance. The most important finding is that lay people are morally sensitive to the problems entailed by antibiotic resistance. Participants saw the decreasing availability of effective antibiotics as a problem of justice. This involves individual as well as (...)
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