Impartiality and infectious disease: prioritizing individuals versus the collective in antibiotic prescription

Bernadine Dao, Thomas Douglas, Alberto Giubilini, Julian Savulescu, Michael Selgelid, Nadira S. Faber

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should prescribe antibiotics. It also does not explore the ethical significance of public views or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. Methods: An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. Results: Of the participants, 50.3% thought that doctors should generally prioritize individual patients over society, whereas 32.0% prioritized society over individual patients. When asked in the context of AMR, 39.2% prioritized individuals whereas 45.5% prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p =.001) and in relation to AMR specifically (p =.006). Conclusions: Participants’ attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial “ideal observer,” their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society.

Original languageEnglish
Pages (from-to)63-69
Number of pages7
JournalAJOB Empirical Bioethics
Volume10
Issue number1
DOIs
Publication statusPublished - 2019

Keywords

  • antibacterial agents
  • bacterial
  • Drug resistance
  • drug resistance
  • ethics
  • medical overuse
  • microbial
  • patient preference

Cite this

Dao, Bernadine ; Douglas, Thomas ; Giubilini, Alberto ; Savulescu, Julian ; Selgelid, Michael ; Faber, Nadira S. / Impartiality and infectious disease : prioritizing individuals versus the collective in antibiotic prescription. In: AJOB Empirical Bioethics. 2019 ; Vol. 10, No. 1. pp. 63-69.
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abstract = "Background: Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should prescribe antibiotics. It also does not explore the ethical significance of public views or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. Methods: An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. Results: Of the participants, 50.3{\%} thought that doctors should generally prioritize individual patients over society, whereas 32.0{\%} prioritized society over individual patients. When asked in the context of AMR, 39.2{\%} prioritized individuals whereas 45.5{\%} prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p =.001) and in relation to AMR specifically (p =.006). Conclusions: Participants’ attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial “ideal observer,” their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society.",
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Impartiality and infectious disease : prioritizing individuals versus the collective in antibiotic prescription. / Dao, Bernadine; Douglas, Thomas; Giubilini, Alberto; Savulescu, Julian; Selgelid, Michael; Faber, Nadira S.

In: AJOB Empirical Bioethics, Vol. 10, No. 1, 2019, p. 63-69.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Impartiality and infectious disease

T2 - prioritizing individuals versus the collective in antibiotic prescription

AU - Dao, Bernadine

AU - Douglas, Thomas

AU - Giubilini, Alberto

AU - Savulescu, Julian

AU - Selgelid, Michael

AU - Faber, Nadira S.

PY - 2019

Y1 - 2019

N2 - Background: Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should prescribe antibiotics. It also does not explore the ethical significance of public views or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. Methods: An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. Results: Of the participants, 50.3% thought that doctors should generally prioritize individual patients over society, whereas 32.0% prioritized society over individual patients. When asked in the context of AMR, 39.2% prioritized individuals whereas 45.5% prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p =.001) and in relation to AMR specifically (p =.006). Conclusions: Participants’ attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial “ideal observer,” their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society.

AB - Background: Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should prescribe antibiotics. It also does not explore the ethical significance of public views or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. Methods: An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. Results: Of the participants, 50.3% thought that doctors should generally prioritize individual patients over society, whereas 32.0% prioritized society over individual patients. When asked in the context of AMR, 39.2% prioritized individuals whereas 45.5% prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p =.001) and in relation to AMR specifically (p =.006). Conclusions: Participants’ attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial “ideal observer,” their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society.

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KW - Drug resistance

KW - drug resistance

KW - ethics

KW - medical overuse

KW - microbial

KW - patient preference

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