McKnight Ulla, Farsides Bobbie, Soni Suneeta, Will Catherine
The Sociology and Criminology Department, University of Sussex, Freeman Building G30, Falmer Brighton, BN1 9QE, UK.
Brighton and Sussex Medical School, Falmer, UK.
Monash Bioeth Rev. 2024 Dec;42(Suppl 1):89-104. doi: 10.1007/s40592-024-00200-7. Epub 2024 Jul 11.
Antimicrobial Resistance is a threat to individual and to population health and to future generations, requiring "collective sacrifices" in order to preserve antibiotic efficacy. 'Who should make the sacrifices?' and 'Who will most likely make them?' are ethical concerns posited as potentially manageable through Antimicrobial Stewardship. Antimicrobial stewardship almost inevitably involves a form of clinical cost-benefit analysis that assesses the possible effects of antibiotics to treat a diagnosed infection in a particular patient. However, this process rarely accounts properly for patients - above and beyond assessments of potential (non)compliance or adherence to care regimes. Drawing on a vignette of a pregnant woman of colour and migrant diagnosed with Mycoplasma genitalium, a sexually transmissible bacterium, this article draws out some of the ethical, speculative, and practical tensions and complexities involved in Antimicrobial Stewardship. We argue that patients also engage in a form of cost-benefit analysis influenced by experiences of reproductive and social (in)justice and comprising speculative variables - to anticipate future possibilities. These processes have the potential to have effects above and beyond the specific infection antimicrobial stewardship was activated to address. We contend that efforts to practice and research antimicrobial stewardship should accommodate and incorporate these variables and acknowledge the structures they emerge with(in), even if their components remain unknown. This would involve recognising that antimicrobial stewardship is intricately connected to other social justice issues such as immigration policy, economic justice, access to appropriate medical care, racism, etc.
抗生素耐药性对个人、群体健康以及子孙后代构成威胁，这需要做出“集体牺牲”以维持抗生素的疗效。“谁应该做出牺牲？”以及“谁最有可能做出牺牲？”是伦理问题，被认为通过抗生素管理有可能得到解决。抗生素管理几乎不可避免地涉及一种临床成本效益分析形式，该分析评估抗生素对治疗特定患者已确诊感染的可能效果。然而，这个过程很少充分考虑患者因素——除了对潜在的（不）依从或遵守护理方案的评估之外。本文以一名被诊断感染生殖支原体（一种性传播细菌）的有色人种孕妇和移民为例，阐述了抗生素管理中涉及的一些伦理、推测性和实际的紧张关系与复杂性。我们认为，患者也会进行一种受生殖和社会（不）公正经历影响且包含推测性变量的成本效益分析，以预测未来可能性。这些过程可能产生超出抗生素管理旨在解决的特定感染之外的影响。我们主张，抗生素管理的实践和研究应适应并纳入这些变量，并承认它们所产生的结构，即使其组成部分尚不清楚。这将涉及认识到抗生素管理与其他社会公正问题紧密相连，如移民政策、经济公正、获得适当医疗护理、种族主义等。
