Abstract
Antimicrobial resistance (AMR) is one of the greatest challenges facing humanity in the 21st century. Controlled dispensation of antimicrobial drugs is the most echoed solution among many that have been postulated to counter this problem. However, the life-impacting significance of antimicrobials makes this approach a very complex one, which must be considered under the lens of health and planetary ethics. As the problem of AMR is not peculiar to only a few people, the right to know the risk, as well as decisions as to when and how antimicrobials are used should, not be granted to only a few decision makers, but be used as drivers to advance planetary health knowledge in a way that benefits individuals, society, and future generations. Within an ethical framework, implementing policies that extend the efficacy period of antimicrobials should be considered in a way that balances range, choice, and quality of drugs against stewardship activities. The challenge of AMR cannot be eliminated completely by reduced use of antimicrobials only; understanding how, where and when reduction is necessary, and social structures and patterns (as well as existing health and government systems) are required if any global/national intervention would be successful and equitable. We may well have gone past the stage of adopting precautionary principles as the danger we face presents no iota of uncertainty. The measures to control AMR’s emergence and its spread are well presented. Nevertheless, we must not ere from the path of justice and equity even in the face of certain danger.
Highlights
Ethical behaviour is the aggregation of actions, bound by a systematic code of actions and principles, which benefits both humans and the environment
The final report of the 2014–2016 Review on Antimicrobial Resistance, chaired by Jim O’Neill [1] stated, “Antimicrobial drugs are medicines that are active against a range of infections, such as those caused by bacteria, viruses, fungi and parasites
Considered in the context of the triad of imagination challenges, knowledge challenges and implementation challenges facing the field of planetary health [5], it is safe to say that we need to address antimicrobial resistance (AMR) from a perspective that goes beyond morally obliging individuals to use antimicrobials responsibly: human beings do not always act morally even when the risks of not doing so are known
Summary
Ethical behaviour is the aggregation of actions, bound by a systematic code of actions and principles, which benefits both humans and the environment. A subsequent development of the original code [9] presents five key ethics identified as integral to planetary health: intergenerational responsibility; the right to know [the risks associated with (in)action]; the importance of distributive justice; the need to extend rights to the more-than-human-world; and the precautionary principle. Fleming recognized the moral imperative inherent in antibiotic utilization He acted ethically by making clear the risks, and providing the knowledge needed to act. Considered in the context of the triad of imagination challenges, knowledge challenges and implementation challenges facing the field of planetary health [5], it is safe to say that we need to address AMR from a perspective that goes beyond morally obliging individuals to use antimicrobials responsibly: human beings do not always act morally even when the risks of not doing so are known. How much risk is acceptable? Are the benefits and risks shared by all? What/who are the opportunity costs? Must we conserve the efficacy of antimicrobials for future use if this can only be done at the expense of some of today’s patients? These questions bring us to the second ethic to be considered: that of distributive justice
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