ANTIBIOTIC RESISTANCE
An ethical analysis
Maastricht University
GZW2224 (Phia 2.4)
The Moral Compass of Contemporary Health
Date: 08-02-2019
, The miracle of the 20th century, the invention of antibiotics that teared up life-threatening
infectious diseases. Whenever bacteria developed resistance to the antibiotics, new antibiotics
variants were discovered. The medicine was consumed on a large scale and even used
preventively by farmers to protect their cattle from diseases (Goossens, 2005). Nowadays
bacteria are resistant to nearly all antibiotics that were earlier active against them,
antimicrobial resistance is a slowly emerging disaster and a health issue on a global level
(Giubilini, 2017). A major cause of antibiotic resistance is antibiotic use. For decades, we
have created an environment where bacteria, that can survive antimicrobial treatment, have a
strong selective advantage. This fits in with the ‘survival of the fittest’ theory (Foster &
Grundmann, 2006). Antibiotic resistance is an perfect example of a ‘tragedy of the commons’.
The long-term value of antimicrobials is reduced when it is consumed a lot or used
incorrectly. Individualistic choices are giving rise to collective problems (Foster &
Grundmann, 2006).
So if we are not careful with antibiotic consumption and prescriptions, simple infections can
become fatal in the near future (Goossens, 2005). According to the European Centre for
Disease Prevention and Control (EDCD) every year 400.000 people suffer from infections
with resistant bacteria in Europe and 25.000 eventually die because of this (RIVM, 2018).
This costs approximately 1.5 billion euros each year (RIVM, 2018). Experts predict that by
2050, 10 million people worldwide will die each year as a result of antibiotic resistance. This
is more than the deaths of cancer and diabetes added up together (O'Neill, 2016).
International traffic appears to be a major cause for the rapid spread of resistant bacteria, this
is evident from several studies (van der Bij & Pitout, 2012) (von Wintersdorff et al., 2014).
Because of this, countries have developed national guidelines on the prevention of antibiotic
resistance. The Netherlands, for example, introduced a ‘search and destroy’ policy for
antibiotic resistance that involves screening of all hospitalized patients and isolation if the
patients possibly belong to risk groups (Kluytmans et al., 2005). Recent research points out
that refugees carry relatively often resistant bacteria (Reinheimer et al., 2016). In the article of
Kamenshchikova et al. (2018) is mentioned that ideas about obligated antibiotic resistance
screenings of refugees are upcoming. The screening of refugees will surely ensure the emerge
of moral discussions.
The Infectious Diseases Society of America (IDSA) recommends antimicrobial stewardship
programmes (ASPs). ASPs focus on narrowing the spectrum of antibiotics, reducing the dose
and shortening the duration of antimicrobials used in clinical practice (Giubilini, 2017).
However, ASPs have also caused the emergence of several moral dilemmas.
All in all, it is clear that there are many moral dilemmas when it comes to this topic. As a
future health professional I want to focus on the moral dilemma that ASPs bring. Is it, as a
doctor, morally correct to make choices about antibiotic treatments that may affect the health
of the patient itself but benefits the global future? What are the consequences for the
autonomy of the patient?
In this article the moral dilemma will be analysed from two philosophical perspectives. The
perspective of Taylor and the care-ethics perspective.
An ethical analysis
Maastricht University
GZW2224 (Phia 2.4)
The Moral Compass of Contemporary Health
Date: 08-02-2019
, The miracle of the 20th century, the invention of antibiotics that teared up life-threatening
infectious diseases. Whenever bacteria developed resistance to the antibiotics, new antibiotics
variants were discovered. The medicine was consumed on a large scale and even used
preventively by farmers to protect their cattle from diseases (Goossens, 2005). Nowadays
bacteria are resistant to nearly all antibiotics that were earlier active against them,
antimicrobial resistance is a slowly emerging disaster and a health issue on a global level
(Giubilini, 2017). A major cause of antibiotic resistance is antibiotic use. For decades, we
have created an environment where bacteria, that can survive antimicrobial treatment, have a
strong selective advantage. This fits in with the ‘survival of the fittest’ theory (Foster &
Grundmann, 2006). Antibiotic resistance is an perfect example of a ‘tragedy of the commons’.
The long-term value of antimicrobials is reduced when it is consumed a lot or used
incorrectly. Individualistic choices are giving rise to collective problems (Foster &
Grundmann, 2006).
So if we are not careful with antibiotic consumption and prescriptions, simple infections can
become fatal in the near future (Goossens, 2005). According to the European Centre for
Disease Prevention and Control (EDCD) every year 400.000 people suffer from infections
with resistant bacteria in Europe and 25.000 eventually die because of this (RIVM, 2018).
This costs approximately 1.5 billion euros each year (RIVM, 2018). Experts predict that by
2050, 10 million people worldwide will die each year as a result of antibiotic resistance. This
is more than the deaths of cancer and diabetes added up together (O'Neill, 2016).
International traffic appears to be a major cause for the rapid spread of resistant bacteria, this
is evident from several studies (van der Bij & Pitout, 2012) (von Wintersdorff et al., 2014).
Because of this, countries have developed national guidelines on the prevention of antibiotic
resistance. The Netherlands, for example, introduced a ‘search and destroy’ policy for
antibiotic resistance that involves screening of all hospitalized patients and isolation if the
patients possibly belong to risk groups (Kluytmans et al., 2005). Recent research points out
that refugees carry relatively often resistant bacteria (Reinheimer et al., 2016). In the article of
Kamenshchikova et al. (2018) is mentioned that ideas about obligated antibiotic resistance
screenings of refugees are upcoming. The screening of refugees will surely ensure the emerge
of moral discussions.
The Infectious Diseases Society of America (IDSA) recommends antimicrobial stewardship
programmes (ASPs). ASPs focus on narrowing the spectrum of antibiotics, reducing the dose
and shortening the duration of antimicrobials used in clinical practice (Giubilini, 2017).
However, ASPs have also caused the emergence of several moral dilemmas.
All in all, it is clear that there are many moral dilemmas when it comes to this topic. As a
future health professional I want to focus on the moral dilemma that ASPs bring. Is it, as a
doctor, morally correct to make choices about antibiotic treatments that may affect the health
of the patient itself but benefits the global future? What are the consequences for the
autonomy of the patient?
In this article the moral dilemma will be analysed from two philosophical perspectives. The
perspective of Taylor and the care-ethics perspective.
