This paper investigates the challenges of implementing antibiotic stewardship – reducing and optimizing the use of antibiotics – in agricultural settings of Low- and Middle-Income Countries (LMICs) as a strategic part of addressing the global problem of antimicrobial resistance (AMR). It does so through analysis of the rapidly transforming yet diverse Kenyan poultry sector, characterized by growing commercial operations alongside traditional smallholder farming. Our research involves interviews with farmers, processors, policymakers, and agro-veterinary stores in these settings. We blend (...) Chandler’s (2019, p. 8) notion of “antibiotics as infrastructure” with value chain frameworks to understand how the structural role of antibiotics in agriculture plays out through contrasting value chains, with different implications for stewardship. Weak regulation and intense market-based pressures are shown to drive widespread antibiotic use in poultry value chains involving small- and medium-sized farms supplying open markets. Antibiotic stewardship through adherence to agricultural and food safety standards is more evident, though unevenly observed, in value chains involving large commercial farms and processors supplying corporate buyers. Our findings reveal the complex structural roles of antibiotics in maintaining producer livelihoods in an intensely competitive and heterogeneous Kenyan poultry sector. This highlights challenges with applying global AMR policy to transforming food systems in LMICs without appropriate translation. We argue that attempts to reduce and optimize the use of antibiotics in agriculture must be informed by nuanced understandings of the roles of antibiotics in food systems in specific places including where very different scales and models of farming and value chain co-exist. (shrink)

The One Health approach to antimicrobial resistance (AMR) requires stakeholders to contribute to cross-sectoral efforts to improve antimicrobial stewardship (AMS). One Health AMR policy implementation is challenging in livestock farming because of the infrastructural role of antibiotics in production systems. Mitigating AMR may require the development of more stringent stewardship obligations and the future limitation of established entitlements. Drawing on Amatai Etzioni’s compliance theory, regulatory analyses and qualitative studies with stakeholder groups we examine the structural and socio-cultural dimension (...) of antibiotic use and AMS compliance in Australian beef and dairy production. We found a disconnect between how antibiotic use is conceptualised by farmers and the way in which AMS policies construe agricultural AMR risks. Under the umbrella of food safety standards and national-level prescribing restrictions, farmers and veterinarians interact around antibiotic use with different operating logics and compliance mechanisms. These parallel regimes service distinct and sometimes competing common goods of food security and antibiotic preservation. Further reforms to mitigate AMR need to account for the value orientations of different groups and the embeddedness of the constraints imposed by existing systems. Advocacy for greater AMR precaution in agriculture should acknowledge and compensate for erosions in competing common goods and the cost of proposed interventions. (shrink)

Antimicrobial resistance (AMR) is an urgent, global threat to public health. The development and implementation of effective measures to address AMR is vitally important but presents important ethical questions. This is a policy area requiring further sustained attention to ensure that policies proposed in National Action Plans on AMR are ethically acceptable and preferable to alternatives that might be fairer or more effective, for instance. By ethically analysing case studies of coercive actions to address AMR across countries, we can better (...) inform policy in a context-specific manner. In this article, I consider an example of coercive antimicrobial stewardship policy in Canada, namely restrictions on livestock farmers' access to certain antibiotics for animal use without a vet's prescription. I introduce and analyse two ethical arguments that might plausibly justify coercive action in this case: the harm principle and a duty of collective easy rescue. In addition, I consider the factors that might generally limit the application of those ethical concepts, such as challenges in establishing causation or evidencing the scale of the harm to be averted. I also consider specifics of the Canadian context in contrast to the UK and Botswana as example settings, to demonstrate how context-specific factors might mean a coercive policy that is ethically justified in one country is not so in another. (shrink)

Antibiotic resistance has become a problem of global scale. Resistance arises through mutation or through the acquisition of resistance gene(s) from other bacteria in a process called horizontal gene transfer (HGT). While HGT is recognized as an important factor in the dissemination of resistance genes in clinical pathogens, its role in the environment has been called into question by a recent study published in Nature. The authors found little evidence of HGT in soil using a culture‐independent functional metagenomics approach, (...) which is in contrast to previous work from the same lab showing HGT between the environment and human microbiome. While surprising at face value, these results may be explained by the lack of selective pressure in the environment studied. Importantly, this work suggests the need for careful monitoring of environmental antibiotic pollution and stringent antibiotic stewardship in the fight against resistance. (shrink)

This study aimed to identify the antibiotic-relevant lessons from the controlled drug regimen for narcotics. Whereas several elements of the United Nations Single Convention on Narcotic Drugs could be advantageous for antibiotics, we doubt that an international legally binding agreement for controlling antibiotic consumption would be any more effective than implementing stewardship measures through national AMR plans.

Antimicrobial therapy is a cornerstone of therapy in critically ill patients; however, the wide use of antibiotics has resulted in increased antimicrobial resistance and outbreaks of resistant disease. To counter this, many hospitals have instituted antimicrobial stewardship programmes as a way to reduce the inappropriate use of antibiotics. However, uptake of antimicrobial stewardship programmes has been variable, as many clinicians fear that they may put individual patients at risk of treatment failure. In this paper, I argue that antimicrobial (...) stewardship programmes are indeed a form of bedside rationing, and explore the risks and benefits of such programmes for individual patients in the intensive care unit, and the critically ill population in general. Using Norman Daniels’ Accountability for Reasonableness as a framework for evaluating resource allocation policies, I conclude that antimicrobial stewardship programmes are an ethically sound form of bedside rationing. (shrink)

Worldwide, antibiotic use is increasing, but many infections against which antibiotics are applied are not even caused by bacteria. Over‐the‐counter and internet sales preclude physician oversight. Regional differences, between and within countries highlight many potential factors influencing antibiotic use. Taking a systems perspective that considers pharmaceutical commodity chains, we examine antibiotic overuse from the vantage point of both sides of the therapeutic relationship. We examine patterns and expectations of practitioners and patients, institutional policies and pressures, the business (...) strategies of pharmaceutical companies and distributors, and cultural drivers of variation. Solutions to improve antibiotic stewardship include practitioners taking greater responsibility for their antibiotic prescribing, increasing the role of caregivers as diagnosticians rather than medicine providers, improving their communication to patients about antibiotic treatment consequences, lessening the economic influences on prescribing, and identifying antibiotic alternatives. (shrink)

The scope and type of property rights recognized over the effectiveness of antibiotics have a direct effect on how those claiming ownership engage in the exploitation and stewardship of this scarce resource. We examine the different property claims and rights the four major interest groups are asserting on antibiotics: (i) the inventors, (ii) those demanding that the resource be treated like any other transferable commodity, (iii) those advocating usage restrictions based on good stewardship principles and (iv) those considering (...) the resource as common heritage of humankind. (shrink)

Antibiotic use triggers evolutionary and ecological responses from bacteria, leading to antibiotic resistance and harmful patient outcomes. Two complementary strategies support long-term antibiotic effectiveness: conservation of existing therapies and production of novel antibiotics. Conservation encompasses infection control, antibiotic stewardship, and other public health interventions to prevent infection, which reduce antibiotic demand. Production of new antibiotics allows physicians to replace existing drugs rendered less effective by resistance.In recent years, physicians and policymakers have raised concerns about (...) the pipeline for new antibiotics, pointing to a decline in the number of antibiotics approved since the 1980s. This trend has been attributed to high research and development costs, low reimbursement for antibiotics, and regulatory standards for review and approval. Professional societies and researchers around the world have called for renewed emphasis on antimicrobial stewardship, while also supporting antibiotic research and development through grants, changes to intellectual property laws to extend market exclusivity periods, and modification of premarket testing regulations to reduce antibiotic development time and expenses. (shrink)

Antimicrobial resistance kills people. According to a recent estimate, ‘7 00 000 people die of resistant infections every year’, and ‘by 2050 10 million lives a year are at risk due to drug resistant infections, as are 100 trillion USD of economic output’.1 Today, ‘bacteria are resistant to nearly all antibiotics that were earlier active against them’.2 For all these reasons, antimicrobial resistance is considered a ‘slowly emerging disaster’3 and a ‘global health security issue’.4 The prospect we are facing is (...) that of a ‘post antibiotic era’,5 in which we risk losing the availability of effective antibiotics and, with them, of medical interventions that require effective antibiotics, such as chemotherapy, transplantation and major surgery. One of the causes of antimicrobial resistance is antimicrobial consumption. As put by the Centers for Disease Control and Prevention, ‘the use of antibiotics is the single most important factor leading to antibiotic resistance around the world: simply using antibiotics creates resistance’.6 According to the 2016 Review on Antimicrobial Resistance commissioned by the UK Government, ‘more consumption of antibiotics directly leads to more resistance’.1 This is because microbes that are not killed by antimicrobials are more likely to reproduce and proliferate and to pass their resistance genes on to other microbes. Thus, exactly like the consumption of many other finite resources, antibiotic and antimicrobial consumption gives rise to the collective action problem known as ‘tragedy of the commons’: consuming a certain resource, such as antimicrobials, is in an individual’s best short-term interest, but many instances of individual consumption erode the resource and therefore conflict with the collective interest in preserving the good. How to solve a tragedy of the commons? As is the case with the consumption of other finite resources, the answer is quite simple: by rationing the resource. Simon Oczkowski’s article …. (shrink)

Multidrug resistant organisms are a public health threat that have reduced the effectiveness of many available antibiotics. Antimicrobial stewardship programs have been tasked with reducing antibiotic use and therefore the emergence of MDROs. While fecal microbiota transplant has been proposed as therapy to reduce patient colonization of MDROs, this will require additional evidence to support an expansion of the current clinical indication for FMT. This article discusses the evidence and ethics of the expanded utilization of FMT by ASPs (...) for reasons other than severe recurrent or refractory Clostridioides difficile infection. (shrink)

Antimicrobial resistance (AMR) has been declared one of the top ten global public health threats facing humanity. To address AMR, coercive antimicrobial stewardship policies are being enacted in some settings. These policies, like all in public health, require ethical justification. Here, I introduce a framework for ethically evaluating coercive antimicrobial stewardship policies on the basis of ethical justifications (and their limitations). I consider arguments from effectiveness; duty of easy rescue; tragedy of the commons; responsibility-tracking; the harm principle; paternalism; (...) justice and development; a precautionary approach; and professional duties. I consider how these justifications might form the basis for developing a comprehensive ethical framework, and the need for this to be context-specific and aligned with the priorities, evidence and needs of the particular jurisdictions in which a policy is to be enacted. I demonstrate how the ethical justifications might be used by reference to an example policy of the EU ban on the use of certain human-critical antibiotics for livestock, before concluding with challenges for further development of the framework. (shrink)

Time-tested commons characterize by having instituted sanctioning mechanisms that are sensitive to the circumstances and motivations of non-compliers. As a proposed Global Antimicrobial Commons cannot cost-effectively develop sanctioning mechanisms that are consistently sensitive to the circumstances of the global poor, I suggest concentrating on establishing a wider set of incentives that encourages both compliance and participation.

Antimicrobial resistance (AMR) describes the evolution of treatment‐resistant pathogens, with potentially catastrophic consequences for human medicine. AMR is driven by the over‐prescription of antibiotics, and could be reduced through consideration of the ethical dimensions of the dilemma faced by doctors. This dilemma involves balancing apparently opposed interests of current and future patients, and unique contextual factors in different countries, which may modify the core dilemma. We describe three example countries with different economic backgrounds and cultures—South Africa, Sri Lanka and the (...) United Kingdom. Then we discuss how country‐specific factors impact on the prominence of various ethical dimensions of the dilemma (visibility and moral equality of future generations; Rule of Rescue; prescribing autonomy and conflicts of interest; consensus on collective action). We conclude that a nuanced understanding of national prescribing dilemmas is critical to inform the design of effective stewardship approaches. (shrink)

We show how metagenomic analysis of the human gut antibiotic resistome, compared across large populations and against environmental or agricultural resistomes, suggests a strong anthropogenic cause behind increasing antibiotic resistance in bacteria. This area has been the subject of intense and polarized debate driven by economic and political concerns; therefore such recently available insights address an important need. We derive and compare antibiotic resistomes of human gut microbes from 832 individuals from ten different countries. We observe and (...) describe significant differences between samples from these countries in the gut resistance potential, in line with expectations from antibiotic usage and exposure in medical and food production contexts. Our results imply roles for both of these sources in increased resistance among pathogens in recent history. In contrast, other available metadata such as age, body mass index, sex, or health status have little effect on the antibiotic resistance potential of human gut microbes.Also watch the Video Abstract. (shrink)

Effectiveness is a key criterion in assessing the justification of antibiotic resistance interventions. Depending on an intervention’s effectiveness, burdens and costs will be more or less justified, which is especially important for large scale population-level interventions with high running costs and pronounced risks to individuals in terms of wellbeing, integrity and autonomy. In this paper, we assess the case of routine hospital screening for multi-drug-resistant Gram-negative bacteria (MDRGN) from this perspective. Utilizing a comparison to screening programs for Methicillin-Resistant Staphylococcus (...) aureus (MRSA) we argue that current screening programmes for MDRGN in low endemic settings should be reconsidered, as its effectiveness is in doubt, while general downsides to screening programs remain. To accomplish justifiable antibiotic stewardship, MDRGN screening should not be viewed as a separate measure, but rather as part of a comprehensive approach. The program should be redesigned to focus on those at risk of developing symptomatic infections with MDRGN rather than merely detecting those colonised. (shrink)

“Antibiotic resistance is usually associated with a fitness cost” is frequently accepted as common knowledge in the field of infectious diseases. However, with the advances in high‐throughput DNA sequencing that allows for a comprehensive analysis of bacterial pathogenesis at the genome scale, including antibiotic resistance genes, it appears that this paradigm might not be as solid as previously thought. Recent studies indicate that antibiotic resistance is able to enhance bacterial fitness in vivo with a concomitant increase in (...) virulence during infections. As a consequence, strategies to minimize antibiotic resistance turn out to be not as simple as initially believed. Indeed, decreased antibiotic use may not be sufficient to let susceptible strains outcompete the resistant ones. Here, we put in perspective these findings and review alternative approaches, such as preventive and therapeutic anti‐bacterial immunotherapies that have the potential to by‐pass the classic antibiotics. (shrink)

To the extent that antibiotic resistance (ABR) is accelerated by antibiotic consumption and that it represents a serious public health emergency, it is imperative to drastically reduce antibiotic consumption, particularly in high‐income countries. I present the problem of ABR as an instance of the collective action problem known as ‘tragedy of the commons’. I propose that there is a strong ethical justification for taxing certain uses of antibiotics, namely when antibiotics are required to treat minor and self‐limiting (...) infections, such as respiratory tract infections, in otherwise healthy individuals. Taxation would allow a reduction in consumption (given certain behavioural economics assumptions) and/or ensure that individuals internalize or compensate for their contribution to the erosion of the common good of antibiotic effectiveness. I suggest that revenue from the tax could be used to fund conservation and innovation strategies. Taxation might be a coercive policy, especially for certain individuals, but the ethical case for coercive policies is very strong when the good to be preserved is important enough and when they force individuals to do something they have a moral obligation to do anyway. I argue that, in the case of mild and self‐limiting infections, individuals have a moral duty of easy rescue and a moral duty of fairness to make their contribution to the preservation of the common good of antibiotic effectiveness by foregoing antibiotics. I also suggest that taxing antibiotics in such cases is an all things considered ethically justified policy even if it would introduce inequalities in access to healthcare. (shrink)

This article explores the relational and motivational leadership behaviors that may promote stewardship in organizations. I conceptualize stewardship as an outcome of leadership behaviors that promote a sense of personal responsibility in followers for the long-term wellbeing of the organization and society. Building upon the themes presented in the stewardship literature, such as identification and intrinsic motivation, and drawing from other research streams to include factors such as interpersonal and institutional trust and moral courage, I posit that (...) leaders foster stewardship in their followers through various relational, motivational, and contextually supportive leadership behaviors. (shrink)

Antibiotic resistance poses an urgent public health risk. High rates of ABR have been noted in all regions of the globe by the World Health Organization. ABR develops when bacteria are exposed to antibiotics either during treatments in humans or animals or through environmental sources contaminated with antibiotic residues. Spread beyond those administered antibiotics occurs through direct contact with the infected or colonized person or animal, through contact or ingestion of retail meat or agricultural products contaminated with ABR (...) organisms, or through the environment. ABR bacteria spread from individuals to populations and across countries. (shrink)

Antibiotic resistance presents a classic example of the “tragedy of the commons.” In this eponymous tragedy, the commons — shared, public access lands — are overgrazed because farmers can send their livestock onto the land at a zero price. The “tragedy” occurs because overgrazing destroys the land and reduces its ability to provide fodder. The application to antibiotics is obvious: the use of antibiotics creates selection pressure leading to increased proportions of resistant bacteria in the patient and the environment. (...) The increase in frequency of resistant organisms diminishes the effectiveness of antibiotics in treating future infections; thus, the long-term value of the antimicrobial resource is reduced. (shrink)

Great leaders are ethical stewards who generate high levels of commitment from followers. In this paper, we propose that perceptions about the trustworthiness of leader behaviors enable those leaders to be perceived as ethical stewards. We define ethical stewardship as the honoring of duties owed to employees, stakeholders, and society in the pursuit of long-term wealth creation. Our model of relationship between leadership behaviors, perceptions of trustworthiness, and the nature of ethical stewardship reinforces the importance of ethical governance (...) in dealing with employees and in creating organizational systems that are congruent with espoused organizational values. (shrink)

Recently, several studies have demonstrated that tetracyclines, the antibiotics most intensively used in livestock and that are also widely applied in biomedical research, interrupt mitochondrial proteostasis and physiology in animals ranging from round worms, fruit flies, and mice to human cell lines. Importantly, plant chloroplasts, like their mitochondria, are also under certain conditions vulnerable to these and other antibiotics that are leached into our environment. Together these endosymbiotic organelles are not only essential for cellular and organismal homeostasis stricto sensu, but (...) also have an important role to play in the sustainability of our ecosystem as they maintain the delicate balance between autotrophs and heterotrophs, which fix and utilize energy, respectively. Therefore, stricter policies on antibiotic usage are absolutely required as their use in research confounds experimental outcomes, and their uncontrolled applications in medicine and agriculture pose a significant threat to a balanced ecosystem and the well‐being of these endosymbionts that are essential to sustain health.Also watch the Video Abstract. (shrink)

Beginning in the 1940s, mass production of antibiotics involved the industrial-scale growth of microorganisms to harvest their metabolic products. Unfortunately, the use of antibiotics selects for resistance at answering scale. The turn to the study of antibiotic resistance in microbiology and medicine is examined, focusing on the realization that individual therapies targeted at single pathogens in individual bodies are environmental events affecting bacterial evolution far beyond bodies. In turning to biological manifestations of antibiotic use, sciences fathom material outcomes (...) of their own previous concepts. Archival work with stored soil and clinical samples produces a record described here as ‘the biology of history’: the physical registration of human history in bacterial life. This account thus foregrounds the importance of understanding both the materiality of history and the historicity of matter in theories and concepts of life today. (shrink)

The World Health Organization has published a global priority list of antibiotic-resistant bacteria to guide research and development of new antibiotics. Every pathogen on this list requires R&D activity, but some are more attractive for private sector investments, as evidenced by the current antibacterial pipeline. A “pipeline coordinator” is a governmental/non-profit organization that closely tracks the antibacterial pipeline and actively supports R&D across all priority pathogens employing new financing tools.

Vast and pervasive environmental problems such as climate change and biodiversity loss call every individual to active stewardship. Their magnitude and causal and strategic structures, however, pose powerful challenges to our moral psychology. Stewardship may feel overburdening, and appear hopeless. This may lead to widespread moral and political disengagement. This article proposes a resolve to garden practices as a way out of that danger, and describes the ways in which it will motivate individuals to so act as to (...) coordinate on behavioural patterns that will significantly alleviate grave, but seemingly distant and intractable environmental quandaries. (shrink)

Most proposals for new international agreements aim to address important global challenges. If the goal is to solve problems, then the value of these agreements depends on their ability to influence the world — to shape norms, constrain behavior, facilitate cooperation, and mobilize action. A recent review of empirical studies has suggested that many international agreements fail to achieve their aspirations. The review indicates that the form in which states make commitments to each other — through an international legal agreement (...) or through other means — may not be as important as commonly thought. It is the content of the commitments and how these are supported by mechanisms to encourage implementation that matter the most. When developing proposals for new international agreements, like the one that has recently been proposed to address antibiotic resistance, attention to implementation mechanisms should therefore be equal to if not greater than the attention paid to its form. (shrink)

Nuffield Council on Bioethics, London * Corresponding author: Nuffield Council on Bioethics, 28 Bedford Square, London WC1B 3JS, UK. Email: hschmidt{at}nuffieldbioethics.org ' + u + '@' + d + ' '//--> Abstract In November 2007, the Nuffield Council on Bioethics published the report Public Health: Ethical Issues . While the report has been welcomed by a wide range of stakeholders, there has also been some criticism. First, it has been suggested that it is not clear why, in developing its ‘ (...) class='Hi'>stewardship model’, the Council felt the need to go beyond the liberal position developed by John Stuart Mill—what is it that the stewardship model adds? Second, it is suggested that the Report is confused about the concept of paternalism. Third, it is argued that the discussion of the concept of stewardship is lacking in detail and substance. We clarify the Working Party's thinking regarding these three areas, which demonstrates the robustness of the framework set out in the report. CiteULike Connotea Del.icio.us What's this? (shrink)

Numerous ethical issues have emerged from the industrialization of animal agriculture. Those issues ultimately rest in large measure upon overuse of antibiotics. How this has occurred is discussed in detail in this paper.

Numerous ethical issues have emerged from the industrialization of animal agriculture. Those issues ultimately rest in large measure upon overuse of antibiotics. How this has occurred is discussed in detail in this paper.

1. This paper investigates the viability of the harm principle (HP) to justify restricting consumer freedom regarding the purchase of products, such as meat, that require intense use of antibiotics...

This paper explores and discusses the various meanings of the stewardship concept in the field of sustainability science. We highlight the increasing differences between alternative approaches to stewardship and propose a typology to enable scientists and practitioners to more precisely identify the basis and objectives of the concept of stewardship. We first present the two dimensions we used to map the diversity of stances concerning stewardship. Second, we analyse these positions in relation to the limits of (...) the systemic approach, ideological manipulation, responsibility, and solidarity. In the final section we explain how the concept of ecological solidarity, a core principal in recent French law on biodiversity conservation and national park governance can contribute to the underpinning of a specific form of social-ecological stewardship. (shrink)

There are over 2,500 Landcare groups with 65,000 members operating across Australia. With considerable evidence of program impact, Landcare is an important example of state sponsored community participation in natural resource management. However, the authors suggest excessive emphasis has been placed upon attitudinal change - the development of landholder stewardship, as the lever for effecting major changes in land management. Analysis of data from a landholder survey failed to establish predicted stewardship differences between Landcare and nonLandcare respondents or (...) between those who joined early/late, or participated more/less in group activities. And there was no relationship between stewardship and adoption for most of the sustainable agriculture practices surveyed. Further analysis clearly linked Landcare participation and concern about the environmental and economic impacts of land degradation. Whilst respondents were significantly more concerned about economic impacts, research findings were consistent with earlier work indicating that most land managers have a strong stewardship ethic. The authors also suggest that concerns that Landcare is not addressing biodiversity conservation are largely unjustified and reflect urealistic expectations of these voluntary groups. (shrink)

The principle of stewardship has come to play a significant role in the consciousness of Catholic health care. This is a recent development correlative with changes in the economic configurations of Catholic health care in the latter two decades of the twentieth century, as well as with the striking ascendance of the principle within US Catholic culture during the same period. Yet while the concept of stewardship seems to be an unobjectionable given central to Catholic practice, I argue (...) that in its contemporary configuration, it embodies a deeply problematic set of theological assumptions drawn from a particular historical trajectory that is—from a Catholic perspective—quite troubling. This history is concurrent with an equally problematic deformation of the concept of charity. Taken together, these malformed concepts often shackle and misdirect the ability of those who work within Catholic health care to creatively discern transformative solutions and faithful modes of practice. (shrink)

This timely book examines the interaction of health research and regulation with law through empirical analysis and the application of key anthropological concepts to reveal the inner workings of human health research. Through ground-breaking empirical inquiry, Regulatory Stewardship of Health Research explores how research ethics committees (RECs) work in practice to both protect research participants and promote ethical research.This thought-provoking book provides new perspectives on the regulation of health research by demonstrating how RECs and other regulatory actors seek to (...) fulfil these two functions by performing a role of 'regulatory stewardship'. This involves guiding researchers through stages of research approval, as well as seeking to maximise benefits for participants and society while minimising risks. Arguing that participant protection and research promotion should rightly be treated as twin objectives for health research regulators, this book asserts that there is a need for more overt recognition of the importance and function of the deliberative space in which RECs can negotiate the risks relevant to a research application.This book is a key resource for academics and students interested in health research and regulation, and the dynamic interaction of ethics and the law. Regulators and policy-makers will also find it to be an insightful and illuminating text for the practical insights that it reveals about research governance in action. (shrink)

Antibiotic resistance (AR) is a major threat to public health and healthcare worldwide. In this article, we analyse and discuss the claim that taking actions to minimize AR is everyone's responsibility, focusing on individual moral responsibility. This should not be merely interpreted as a function of knowledge of AR and the proper use of antibiotics. Instead, we suggest a circumstantial account of individual responsibility for AR, where individuals do or do not engage in judicious antibiotic behaviour with different (...) degrees of voluntariness. Furthermore, we suggest a notion of responsibility as a virtue, in which individuals have the opportunity to develop a sensitivity towards the AR theme and, consequently, are capable of engaging, actively and voluntarily, in judicious antibiotic behaviour. The development of such sensitivity depends on the creation of adequate circumstances, that is individual capacities and availability of resources. (shrink)

As a field spanning interests among researchers and business professionals, business ethics aims to provide guidance on what can be considered morally right, socially acceptable and legally transparent dealings in the human activity of providing goods or services for trade. Yet, cohesive theory of the ethics of business is lacking, and current ethical practices often fall victim to fluctuating business conditions and circumstances. Thus, stewardship theory is proposed as a more enduring and empowering orientation to more mindful business ethics (...) that is borne out of organizational character, and knowledge stewardship is introduced as a set of practices that can support improved ethical behavior in organizations from an ethos-driven perspective. A definition of knowledge stewardship is provided in this article, and its associated outcomes of authenticity, authority and advocacy are highlighted. Practical recommendations are put forward to assist organizations in their development of stronger stewardship behavior, and exploratory research questions that heighten attentiveness to knowledge stewardship are presented. (shrink)

The concept of stewardship as resource development and conservation, a shallow environmental ethic, arises out of a domination framework. Stewardship as earthkeeping arises out of a keeping framework and falls somewhere between an intermediate and deep environmental ethic. A notion of agricultural stewardship, based on earthkeeping principles, can be used as a normative standard by whichto judge a range of agricultural economies and practices.

Stewardship is potentially a usefulconcept in modernizing management philosophies. Use ofthe term has increased markedly in recent years, yetthe term is used loosely and rarely defined in landmanagement literature. The connections between thispractical usage and the ethical basis of stewardshipare currently poorly developed. The followingdefinition is proposed: ``Stewardship is theresponsible use (including conservation) of naturalresources in a way that takes full and balancedaccount of the interests of society, futuregenerations, and other species, as well as of privateneeds, and accepts (...) significant answerability tosociety.'''' A religious interpretation would require thephrase ``and ultimately to God'''' to be added.Stewardship has both secular and religiousinterpretations and it will be desirable to developboth of these aspects in parallel. A task forphilosophers is to establish whether the ethical basisof stewardship is sufficient to address environmentalconcerns or whether it is necessary to embrace widerethical approaches. Stewardship occupies similarground to several other concepts of use and managementof resources, particularly sustainability. It canbuild on sustainability by encouraging a broader viewof who and what should benefit from managementactivity. In particular, it focuses attention on therole of managers in providing public benefit and onenvisaging other species as a form of ``stakeholder'''' inmanagement decisions. Stewardship is applicable acrossthe widest range of fields of resource use and alsohas relevance to aspects of land tenure and propertyrights. Application of stewardship will require someadjustments in the roles of private managers/ownersvis-à-vis government. It might providemanagers with an expanded role and, importantly, amore positive image, both of themselves and in theeyes of the public. Stewardship could alsobe developed in a way that has relevance to citizensin general (as opposed to managers and owners ofresources), through their interactions with naturalresources as consumers. (shrink)

My goal in this brief essay is not so much to defend White's controversial thesis, but to use it as a context for appreciating the significance of Pope Francis's new encyclical Laudato Si’. Considering it in the context of White’s thesis, will bring certain salient features into relief.

Medical ethics is a footnote to the larger problem of directing our technology to good human ends. Written large, then, medical ethics must ask five basic questions.

ABSTRACTEntrepreneurs should act as stewards of entrepreneurial rent. Entrepreneurial rent is the difference between the ex post value of a venture and its ex ante costs. It is the result of competition among buyers and sellers within the market process rather than the sole efforts of the entrepreneur. As a result, entrepreneurs should allocate entrepreneurial rent for the benefit of other market participants rather than consuming it for themselves. The moral obligation to steward entrepreneurial rent is consistent with traditional bases (...) of property rights and the norm of social welfare maximization, and it applies to corporations and their shareholders, as well as individual entrepreneurs. (shrink)

Decisions to use antibiotics require that patient interests are balanced against the public good, that is, control of antibiotic resistance. Patients carry the risks of suboptimal antibiotic treatment and many physicians are reluctant to impose even small avoidable risks on patients. At the same time, antibiotics are overused and antibiotic-resistant microbes are contributing an increasing burden of adverse patient outcomes. It is the criteria that we can use to reject the use of antibiotics that is the focus (...) of this paper. Scanlon's contractualism explains why antibiotics should not be used to gain small benefits, even when the direct costs of antibiotics are low. We know that some individuals now (and probably more in the future will) carry a burden of irretrievable harm as a consequence of treatment- (antibiotic-) resistant infection. If we accept that the dominant justification for use of antibiotics is to prevent irretrievable harm to an individual or contact, then the use of antibiotics for self-limiting conditions, or for the treatment of individuals with conditions for which antibiotics do not substantially impact on outcomes (eg, in the latter stages of terminal illness), or for access based on preference or willingness to pay (internet or over-the-counter access), or the use of antibiotics as animal growth promoters can be rejected. Scanlon's approach also suggests that, with few new antibiotics in the pipeline and an increasing burden of disease attributable to resistant microbes, control of the spread of antibiotic-resistant microbes should be given increasing priority. (shrink)