Responsible care in times of antimicrobial resistance

Emerging antimicrobial resistance (AMR) in one of the grand challenges for modern medicine and health care. Simple infectious that could be easily treated with antibiotics in the past may turn into dangerous diseases as microbes develop resistance against such treatment. In response to AMR, it is essential to promote prudent use of antibiotics, and to develop antibiotic therapies. Moreover, it is important to prevent spread of potentially dangerous infections. This project focuses on the latter goal.

Dutch healthcare has strict procedures to prevent antimicrobial resistance. Such policies can be harmful to persons who are found to have resistant microbes on their body. Nurses are not allowed to work, patients are refused surgery or other treatment, children are excluded from day-care facilities, and nursing home residents cannot participate in social activities, etc. Moreover, it may be that health professionals and institutions follow different procedures in – some being more, others less strict.

As philosophers and public health specialists we are developing an ethical framework for prevention of antimicrobial resistance in health care. The framework helps professionals to overcome practical dilemmas, enabling successful infection control and respectful treatment of individual patients. The ZonMW-sponsored project is a collaboration between the Netherlands Institute of Public Health and the Environment (RIVM), the Philosophy group of Wageningen U&R, and IQ Health Care (Radboudmc).

At Wageningen University, Morten Byskov (postdoc) and Marcel Verweij (professor of Philosophy) work on the philosophical basis of the project. In a first paper, Morten Byskov applies and specifies Martha Nussbaum’s capability approach to the specific context of care for AMR carriers. In the subsequent stage, we will analyse some of the key ethical principles that are appealed to in ethical discussions about practical moral dilemmas that arise in Dutch health care.