Littmann, JR; (2014) Antimicrobial resistance and distributive justice. Doctoral thesis , UCL (University College London).

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Abstract

The rapid emergence of Antimicrobial Resistance (AMR) over the past decades together with a lack of research into new drugs presents health care systems with serious challenges and threatens their ability to effectively treat serious bacterial infections. As a result, it is realistic to expect that effective treatment options for some infections will run out in the future. The thesis begins by outlining the mechanisms and consequences of AMR and argues that AMR differs from other distributive problems, due to the specific characteristics of antibiotics. It is suggested that for considerations of distributive justice, antibiotic effectiveness should be treated as a resource, which can be depleted and which must be fairly distributed between people and generations. The thesis then goes on to examine the distinctive moral challenge posed by AMR. It begins by considering a consequentialist account, which suggests that AMR is a moral problem due to the bad health outcomes it entails. However, this approach is subsequently dismissed because it struggles to account for some of the particular features of AMR. An alternative is to consider AMR as a morally wrongful harm to individuals, which requires not only that AMR has adverse effects, but also violates the victim’s rights. It is shown that the harm caused by AMR is morally wrongful and that people have a right to be protected from adverse health outcomes, which AMR violates. However, it is difficult to specify correlative duties that result from such a rights claim. As an alternative, the thesis suggests and defends a form of Scanlonian contractualism, which offers the best model to represent and address issues of distributive justice in the case of AMR. It is shown that a principle of antibiotic use, which rules out the use of antibiotics for infections that do not pose a serious risk of irreversible harm, offers a convincing contractualist argument. The thesis examines the concerns for intergenerational justice that arise as a consequence of AMR and shows that contractualism is capable of addressing them. The thesis concludes by suggesting a new way of framing AMR as a specific type of policy challenge, which better captures its complexity and advocates a reduction of future dependency on antibiotics.

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