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  • Munthe, Christian,1962Gothenburg University,Göteborgs universitet,CARe - Centrum för antibiotikaresistensforskning,Institutionen för filosofi, lingvistik och vetenskapsteori,Centre for antibiotic resistance research, CARe,Department of Philosophy, Linguistics and Theory of Science,University of Gothenburg,Univ Gothenburg, Dept Philosophy Linguist & Theory Sci, Box 200, SE-40530 Gothenburg, Sweden.,University of Gothenburg, Sweden (författare)

The Ethics of Antibiotic Resistance: Towards an Agenda for Feasible and Justified Global Health Policy

  • Artikel/kapitelEngelska2019

Förlag, utgivningsår, omfång ...

  • 2019-08-18
  • Wiley,2019
  • electronicrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:gup.ub.gu.se/282800
  • https://gup.ub.gu.se/publication/282800URI
  • https://doi.org/10.1111/bioe.12655DOI
  • https://research.chalmers.se/publication/512344URI
  • https://research.chalmers.se/publication/512524URI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-259433URI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:ri:diva-39861URI

Kompletterande språkuppgifter

  • Språk:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:vet swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • QC 20190924
  •  Funding details: Kungliga Tekniska Högskolan, KTH; Funding details: Västra Götalandsregionen; Funding details: RISE; Funding details: Göteborgs Universitet; Funding details: Chalmers Tekniska Högskola; Funding details: Royal Swedish Academy of Sciences, KVA; Funding details: F17‐1078:1; Funding text 1: Christian Munthe Christian Munthe , is professor of practical philosophy at the University of Gothenburg, where he is also leader of the interventions theme in the Centre for Antibiotic Resistance Research (CARe). His bioethics research includes work on conscientious objection in healthcare, genetic and reproductive technology, person centered care and shared decision‐making, public health, and environmental and technological risk and uncertainty. christian.munthe@gu.se Niels Nijsingh Niels Nijsingh , is a postdoctoral fellow at the Institute of Ethics, History and Theory of Medicine, Ludwig Maximilian University of Munich, and formerly postdoctoral fellow at the Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, where the present work was partly carried out. He is a public health ethicist with a particular interest in the rights of the individual in an institutional context. His research includes work on antibiotic resistance, informed consent, and the ethics of screening. Karl de Fine Licht Karl de Fine licht , is senior lecturer in ethics and technology at Chalmers University of Technology, and a researcher at the Research Institutes of Sweden (RISE) and the Royal Institute of Technology. His bioethics research includes work on responsibility, trust, and public health. D.G. Joakim Larsson D. G. Joakim Larsson , is professor of environmental pharmacology and director of the Centre for Antibiotic Resistance Research (CARe) at the University of Gothenburg, Sweden. His main research interest is to understand the environmental dimensions of antibiotic resistance. Department of philosophy, linguistics and theory of science and the Centre for antibiotic resistance research, CARe, University of Gothenburg Gothenburg Sweden Institute of Ethics, History and Theory of Medicine Ludwig Maximilians University of Munich, Germany, and the Department of philosophy, linguistics and theory of science, and the Centre for antibiotic resistance research, CARe, University of Gothenburg Gothenburg Sweden Chalmers Institute of Technology, and Research Institutes of Sweden (RISE), Gothenburg, Sweden, and Royal Institute of Technology Stockholm Sweden Institute for Biomedicine Department of infectious diseases and the Centre for antibiotic resistance research, CARe, University of Gothenburg Gothenburg Sweden UGOT Challenges Initiative, University of Gothenburg Riksbankens Jubileumsfond F17-1078:1 Antibiotic resistance (ABR) is a major threat to public health and modern healthcare worldwide, jeopardizing the treatment of bacterial infections, and limiting all types of medical procedures where efficient infection prophylaxis is key. Development of truly new antibiotics has stalled, at the same time as new forms of resistance emerge and spread quickly. The latter is a consequence of a combination of overuse of antibiotics in healthcare and food production systems, insufficient transmission control of resistant bacteria, and a vast reservoir of resistance factors in the environmental microbiota that emerges one by one in pathogens. The stakes are massive both in terms of morbidity, mortality and societal costs. World Health Organization, WHO (2015). Global action plan on antimicrobial resistance . Geneva, Switzerland: WHO. Available at: http://www.who.int/antimicrobial-resistance/publications/global-action-plan/en/ Some regions in the world, including northern Europe, have managed to reduce the pace of this destructive process, See: https://resistancemap.cddep.org/ but translating their solutions to other parts of the world is a daunting, sometimes infeasible, task. While the driving forces of ABR are bacteria’s ability to evolve rapidly under the selection pressure from antibiotics, together with a flow of bacterial genes across species and environments, the global societal challenge of ABR is the result of human and social practices and values. Initiatives to curb these challenges therefore quickly meet with complex societal, behavioural political, economic and – underlying all of these – ethical challenges. Littmann, J. & Viens A.M. (2015). The Ethical Significance of Antimicrobial Resistance. Public Health Ethics 8(3), 209–224. On the one hand, ethical reasons of different kinds can be mustered in support of radical and swift action in the face of ABR. But different and mutually conflicting ethical outlooks may nevertheless result in very different recommendations, and present difficult dilemmas. In addition, as action in the face of ABR is ultimately motivated by ethical reasons, it is imperative to consider potential downsides of proposed actions, in order to identify truly justified ways forward, and to reflect on how such options, despite their attractiveness from an ideal perspective, relate to differing values, stakes and practices across individuals and societies. This calls for a research approach where ethics is closely integrated across disciplines to help bring about effective, justified and implementable changes in policy and practices. With this aim and previous initiatives to this effect See, especially, Hoffmann, S., & Outterson, K. (eds.) (2015). Special Issue: Antibiotic Resistance. Journal of Law, Medicine and Ethics, 43(S3), 6‐78; Littmann, J., & Viens, A.M. (eds.) (2015). Special Symposium: Antimicrobial Resistance. Public Health Ethics, 8(3), 209‐265 ; and the forthcoming volume Jamrozik, E., & Selgelid, M. (eds.), Ethics and antimicrobial resistance: Collective responsibility for global public health . Cham, Switzerland: Springer, in press. in mind, in 2017, the Centre for Antibiotic Resistance Research (CARe) at the University of Gothenburg CARe is a multidisciplinary centre, comprising academic disciplines across six faculties and involving partnership with practitioners, decision makers, and public and private institutions. For more information, see http://care.gu.se . organized the symposium Ethics and Value Challenges in Antibiotic Resistance Management, Policy and Research . The symposium was generously sponsored by Riksbankens Jubileumsfond, the Västra Götaland County Government, the Wallenberg Foundations, and the Royal Swedish Academy of Sciences. The symposium program and videos from the lectures are available here: https://care.gu.se/news-events/n//see-all-ethics-and-value-challenges-in-antibiotic-resistance-management--policy-and-research-talks.cid1537410 The presentations and discussions at that event formed the backbone of the present special issue, to which some additional contributors were invited to make the scope appropriately wide. All contributions have been subjected to double blind peer review, with editorial decisions by the guest editors, except for the contribution by Munthe and Nijsingh, where the editorial decisions were taken by the regular editors of Bioethics . The ethics of ABR stretches across all main areas of bioethics: research ethics, clinical ethics, public health ethics and general health policy. It also includes aspects of agricultural ethics and environmental and food ethics and policy, thereby presenting drastic needs of both comprehensive global and “one health” perspectives that challenge mainstream concentrations of bioethical research on issues mostly fitting well‐functioning health systems in high income settings. We, of course, hope that the contributions to this issue serve to move the ABR ethics landscape ahead along these lines, at the same time recognizing that much, much work remains to be done. An already rather well identified area of the ethics of ABR regards how to design justifiable policies of so‐called antibiotic stewardship within healthcare systems, and how to resolve moral dilemmas occurring due to such policies. Annette Rid, Alena Buyx and Jasper Littmann argue that current public health ethical frameworks offer insufficient guidance in evaluating the trade‐off between the best clinical interests of present patients and the benefit of a given program to others. By way of example, the authors examine the notion of “rational” use of antibiotics, which involves programs that aim to affect antibiotic use and prescription. Some of these programs restrict the use of potentially beneficial antibiotics, thus exposing patients to greater risk. By drawing on the analogy with clinical research, the authors propose a framework for evaluating public health programs’ risks and potential benefits. Two contributions serve to complicate this discussion from a global health and justice standpoint, and to provide further suggestions for how an appropriate ethical theoretical framework for antibiotic stewardship should look like. First, Michael Millar observes that significant and deeply unfair inequalities exist with respect to antibiotics and ABR. He approaches this issue from a Scanlonian, contractualist framework, applied to the particularly difficult problem of the use of antibiotics in the prevention of growth stunting, which is a particular risk to underprivileged children. His analysis takes into account alternative feasible actions, as well as current and future interests and international responsibilities, thereby complicating the structure proposed by Rid and colleagues. Second, Eva Krockow and Carolyn Tarrant describe how socio‐economic, organisational and cultural differences between different parts of the world may significantly influence what kind of antibiotic stewardship policies become justifiable, and how ethical dilemmas can be expected to play out and be perceived by key actors due to this. Using South Africa, Sri Lanka and the United Kingdom as cases in point, they argue in
  • Guest editorial to special issue on the ethics of antibiotic resistance

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Nijsingh, Niels,1977Gothenburg University,Göteborgs universitet,Institutionen för filosofi, lingvistik och vetenskapsteori,Extern,CARe - Centrum för antibiotikaresistensforskning,Department of Philosophy, Linguistics and Theory of Science,External,Centre for antibiotic resistance research, CARe,University of Gothenburg,Ludwig-Maximilians-Universität München,Ludwig Maximilian University of Munich,Univ Gothenburg, Dept Philosophy Linguist & Theory Sci, Box 200, SE-40530 Gothenburg, Sweden.;Univ Gothenburg, Ctr Antibiot Resistance Res, CARe, Gothenburg, Sweden.;Ludwig Maximilians Univ Munchen, Inst Eth Hist & Theory Med, Munich, Germany.,University of Gothenburg, Sweden; Ludwig Maximilian University of Munich, Germany(Swepub:gu)xnijni (författare)
  • de Fine Licht, Karl,1979RISE,KTH,Filosofi,Chalmers Inst Technol, Gothenburg, Sweden.;Res Inst Sweden RISE, Gothenburg, Sweden.,Energi och cirkulär ekonomi,Chalmers Institute of Technology, Sweden; KTH Royal Institute of Technology, Sweden(Swepub:ri)karl.licht@ri.se (författare)
  • Larsson, D. G. Joakim,1969Gothenburg University,Göteborgs universitet,Institutionen för biomedicin, avdelningen för infektionssjukdomar,CARe - Centrum för antibiotikaresistensforskning,Institute of Biomedicine, Department of Infectious Medicine,Centre for antibiotic resistance research, CARe,University of Gothenburg,Univ Gothenburg, Ctr Antibiot Resistance Res, CARe, Gothenburg, Sweden.;Univ Gothenburg, Dept Infect Dis, Inst Biomed, Gothenburg, Sweden.,University of Gothenburg, Sweden(Swepub:gu)xlarjo (författare)
  • Göteborgs universitetCARe - Centrum för antibiotikaresistensforskning (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:Bioethics: Wiley33:7, s. 731-7330269-97021467-8519

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