Environmental dimensions of the ethics of antimicrobial resistance

Abstract

Antimicrobial resistance (AMR) is a massive systemic, global threat to public health and the effectiveness of healthcare. The ethics of AMR comprises of ethical aspects of the phenomenon itself, understanding its significance for fundamental values, and of proposed actions to manage AMR, often linked to the concept of "one health". Most of this discussion has focused on rationalizing the use of antibiotics in human healthcare and farming. However, AMR has a sizeable environmental dimension that so far has mostly flown under the bioethical radar. This dimension encaptures the role of the environment as source for evolution of resistance as well as a transmission route, both spawned by the pollution of antibiotics and fecal matter from various sources. A bioethical analysis of AMR needs to take these dimensions into account, and doing so may potentially upset fundamental assumptions in both practical bioethics, health policy and their environmental counterparts. This chapter outlines the environmental dimensions of AMR, their bioethical significance, and some of the most obvious new ethical complexities and challenges for bioethical research made visible by such a broadening of the scope of the ethics of AMR