Williams Jane, Chawraingern Sittichoke, Degeling Chris
Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Health and Society, University of Wollongong, Wollongong, Australia.
Sydney Health Ethics, School of Public Health, The University of Sydney, Sydney, Australia.
Monash Bioeth Rev. 2024 Dec;42(Suppl 1):41-50. doi: 10.1007/s40592-024-00191-5. Epub 2024 Jul 11.
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. Participants grappled with value trade offs in thinking about their own parents' care, juggling imagined population and future harms with known short term comfort of individuals and prioritising the latter. Distributive justice in AMR relies on collective moral responsibility and action for the benefit of future generations and unknown others. In RACF, AMS requires value trade-offs and compromise on antimicrobial use in an environment that is heavily reliant on antimicrobial drugs to perform caring functions. In the context of aged care, AMS is a technical solution to a deeply relational and socio-structural problem and there is a risk that carers (workers, families) are morally burdened by system failures that are not addressed in AMS solutions.
在澳大利亚，老年护理机构（RACF）是抗生素高使用场所。老年护理机构中抗菌药物的滥用导致了抗菌药物耐药性（AMR）负担，这种负担会影响现在和未来的个人及更广泛的公众。老年护理机构中的抗菌药物管理（AMS）措施，例如要求确诊感染，旨在尽量减少抗生素的不当使用。我们与46位有父母在接受老年护理的参与者进行了对话小组讨论，以更好地了解家庭对老年护理机构中抗生素使用和护理的看法。参与者在考虑自己父母的护理时，努力权衡价值取舍，在想象中的群体和未来危害与已知的个人短期舒适之间进行权衡，并优先考虑后者。抗菌药物耐药性方面的分配正义依赖于为子孙后代和不特定他人的利益承担集体道德责任并采取行动。在老年护理机构中，抗菌药物管理要求在严重依赖抗菌药物来履行护理职能的环境中，在抗菌药物使用方面进行价值权衡和妥协。在老年护理的背景下，抗菌药物管理是解决一个深层次的人际关系和社会结构问题的技术方案，存在一种风险，即护理人员（工作人员、家庭）会因抗菌药物管理解决方案未解决的系统故障而承受道德负担。
