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 theVideo Abstract. (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 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)

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 paper examines diverse perspectives around the concept of responsibility concerning antibiotic use in animal agriculture. Antibiotic use in agriculture has been identified as a source of antimicrobial resistance, one of the largest public health threats today. In the United States, efforts to curb antibiotic use in farming draws on a diverse range of actors—including farmers, veterinarians, consumers, and public health advocates—and relies on a mix of industry standards and federal guidelines around responsible use. The paper selects (...) a similarly diverse range of people and employs Q methodology to query the points of disagreement and consensus around the practices that constitute responsible antibiotic use in animal agriculture, and who is responsible for antimicrobial resistance. We find a diverse mix of actor types across three discourses, but with clear differences between farmers and public health advocates. We also argue that, in some cases, points of disagreement and agreement are often based on different interpretations of ideas, indicating points of common ground where there might appear to be disagreement, and areas of difference where there appears to be agreement. We argue that these flexible interpretations of some of the key issues around antibiotic use are nevertheless grounded in durable differences in views of what agriculture is and what it should be. (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.

Though the vegetarian movement sparked by Peter Singer’s book Animal Liberation has achieved some success, there is more animal suffering caused today due to factory farming than there was when the book was originally written. In this paper, I argue that there may be a technological solution to the problem of animal suffering in intensive factory farming operations. In particular, I suggest that recent research indicates that we may be very close to, if not already at, the point where we (...) can genetically engineer factory-farmed livestock with a reduced or completely eliminated capacity to suffer. In as much as animal suffering is the principal concern that motivates the animal welfare movement, this development should be of central interest to its adherents. Moreover, I will argue that all people concerned with animal welfare should agree that we ought to replace the animals currently used in factory farming with animals whose ability to suffer is diminished if we are able to do so. (shrink)

Antibiotic resistance threatens the capacity to treat life-threatening infections. If it is accepted that it will be many years until the production of new antibiotics overcomes current concerns with antibiotic resistance then ways to conserve the effectiveness of current antibiotics will have to be found. For many bacterial agents of infection levels of antibiotic resistance are directly dependent on the quantity of antibiotic prescribed. Antibiotics are currently underutilised in many parts of the world. If a just (...) distribution of access to antibiotics requires equal access for individuals with equal need irrespective of wealth then responding to this requirement of justice has the potential to shorten the effective life of currently available antibiotics. Increasing the range and numbers of individuals treated with antibiotics would seem to threaten sustainability and also potentially undermine the access of future generations to cost-effective treatments for bacterial infection. The control of antibiotic resistance requires that the determinants of infectious disease transmission are addressed, such as poor housing, education and nutrition as well as the provision of antibiotics. The apparent tension between intragenerational justice and sustainability diminishes when the account of distributive justice extends beyond access to antibiotics and includes plural entitlements. Controlling antibiotic resistance requires more than the redistribution or reduction of antibiotics. (shrink)

Genome editing in livestock could potentially be used in ways that help resolve some of the most urgent and serious global problems pertaining to livestock, including animal suffering, pollution, antimicrobial resistance, and the spread of infectious disease. But despite this potential, some may object to pursuing it, not because genome editing is wrong in and of itself, but because it is the wrong kind of solution to the problems it addresses: it is merely a ‘technological fix’ to a (...) complex societal problem. Yet though this objection might have wide intuitive appeal, it is often not clear what, exactly, the moral problem is supposed to be. The aim of this paper is to formulate and shed some light on the ‘technological fix objection’ to genome editing in livestock. I suggest that three concerns may underlie it, make implicit assumptions underlying the concerns explicit, and cast some doubt on several of these assumptions, at least as they apply to the use of genome editing to produce pigs resistant to the Porcine Reproductive and Respiratory Syndrome and hornless dairy cattle. I then suggest that the third, and most important, concern could be framed as a concern about complicity in factory farming. I suggest ways to evaluate this concern, and to reduce or offset any complicity in factory farming. Thinking of genome editing’s contribution to factory farming in terms of complicity, may, I suggest, tie it more explicitly and strongly to the wider obligations that come with pursuing it, including the cessation of factory farming, thereby addressing the concern that technological fixes focus only on a narrow problem. (shrink)

To combat the OneHealth threat of antimicrobial resistance (AMR), the use of antibiotics in agriculture is subject to significant governance-led initiatives to change food system behaviours, including promoting more responsible use of antibiotics on farms through market-level interventions. To combat knowledge gaps about how consumers perceive risks associated with antibiotic use and AMR in farming, the current study carried out an in-depth qualitative focus group study incorporating a risk information exposure exercise with food consumers on the island of Ireland (...) (_n_ = 36). Using a theoretical lens of social representation theory, a thematic analysis of the collected data identified how participants made sense of, often new, information on agricultural antibiotic use and AMR. Participants displayed high awareness and concern for AMR but low understanding and misconceptions around AMR transmission from the agri-food sector. Social representations about antibiotics and food and farming systems shaped preferences for a movement away from antibiotics in farming, and in particular, prophylactic use. However, participants acknowledged the role of antibiotics to protect animal health and the integrity of the food supply chain. They debated the lack of a simple fix to antibiotics in the agri-food system and revealed preferences for preventive actions at farm level and supporting actions at market level. The study highlights the need to first tackle low levels of public understanding through effective risk communication including strategies such as targeted message framing and proactive, cross-sector OneHealth awareness campaigns, followed by the introduction of a trusted antibiotic use food labelling system. (shrink)

Existing ethical frameworks for public health provide insufficient guidance on how to evaluate the risks of public health programs that compromise the best clinical interests of present patients for the benefit of others. Given the relevant similarity of such programs to clinical research, we suggest that insights from the long‐standing debate about acceptable risk in clinical research can helpfully inform and guide the evaluation of risks posed by public health programs that compromise patients’ best clinical interests. We discuss how lessons (...) learned regarding the ethics of risk in one context can be fruitfully transferred to the other, using the example of a so‐called ‘rational antibiotic use’ guideline that limits antimicrobial prescribing in order to curb antimicrobial resistance. (shrink)

Objectives -/- Surveys in various countries suggest 17% to 80% of doctors prescribe ‘placebos’ in routine practice, but prevalence of placebo use in UK primary care is unknown. Methods -/- We administered a web-based questionnaire to a representative sample of UK general practitioners. Following surveys conducted in other countries we divided placebos into ‘pure’ and ‘impure’. ‘Impure’ placebos are interventions with clear efficacy for certain conditions but are prescribed for ailments where their efficacy is unknown, such as antibiotics for suspected (...) viral infections. ‘Pure’ placebos are interventions such as sugar pills or saline injections without direct pharmacologically active ingredients for the condition being treated. We initiated the survey in April 2012. Two reminders were sent and electronic data collection closed after 4 weeks. Results -/- We surveyed 1715 general practitioners and 783 (46%) completed our questionnaire. Our respondents were similar to those of all registered UK doctors suggesting our results are generalizable. 12% (95% CI 10 to 15) of respondents used pure placebos while 97% (95% CI 96 to 98) used impure placebos at least once in their career. 1% of respondents used pure placebos, and 77% (95% CI 74 to 79) used impure placebos at least once per week. Most (66% for pure, 84% for impure) respondents stated placebos were ethical in some circumstances. Conclusion and implications -/- Placebo use is common in primary care but questions remain about their benefits, harms, costs, and whether they can be delivered ethically. Further research is required to investigate ethically acceptable and cost-effective placebo interventions. (shrink)

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)

In this paper, rather than focusing on genes as an organising concept around which historical considerations of theory and practice in genetics are elucidated, we place genetic markers at the heart of our analysis. This reflects their central role in the subject of our account, livestock genetics concerning the domesticated pig, Sus scrofa. We define a genetic marker as a element existing in different forms in the genome, that can be identified and mapped using a variety of quantitative, classical (...) and molecular genetic techniques. The conjugation of pig genome researchers around the common object of the marker from the early-1990s allowed the distinctive theories and approaches of quantitative and molecular genetics concerning the size and distribution of gene effects to align in projects to populate genome maps. Critical to this was the nature of markers as ontologically inert, internally heterogeneous and relational. Though genes as an organising and categorising principle remained important, the particular concatenation of limitations, opportunities, and intended research goals of the pig genetics community, meant that a progressively stronger focus on the identification and mapping of markers rather than genes per se became a hallmark of the community. We therefore detail a different way of doing genetics to more gene-centred accounts. By doing so, we reveal the presence of practices, concepts and communities that would otherwise be hidden. (shrink)

In this paper, rather than focusing on genes as an organising concept around which historical considerations of theory and practice in genetics are elucidated, we place genetic markers at the heart of our analysis. This reflects their central role in the subject of our account, livestock genetics concerning the domesticated pig, Sus scrofa. We define a genetic marker as a element existing in different forms in the genome, that can be identified and mapped using a variety of quantitative, classical (...) and molecular genetic techniques. The conjugation of pig genome researchers around the common object of the marker from the early-1990s allowed the distinctive theories and approaches of quantitative and molecular genetics concerning the size and distribution of gene effects to align in projects to populate genome maps. Critical to this was the nature of markers as ontologically inert, internally heterogeneous and relational. Though genes as an organising and categorising principle remained important, the particular concatenation of limitations, opportunities, and intended research goals of the pig genetics community, meant that a progressively stronger focus on the identification and mapping of markers rather than genes per se became a hallmark of the community. We therefore detail a different way of doing genetics to more gene-centred accounts. By doing so, we reveal the presence of practices, concepts and communities that would otherwise be hidden. (shrink)

Food security is one of the major concerns in the Philippines. Although livestock and poultry production accounts for a significant proportion of the country’s agricultural output, smallholder households are still vulnerable to food insecurity. The current study aims to examine how livestock production and selling difficulties affect smallholder households’ food-insecure conditions. For this objective, Bayesian Mindsponge Framework (BMF) analytics was employed on a dataset of the Food and Agriculture Organization’s Data in Emergencies Monitoring (DIEM) system. We found that (...) production and selling difficulties significantly adversely affect food insecurity in the Philippines. However, their effects vary according to the severity of food insecurity. In particular, production and selling difficulties affect the households’ likelihood of eating less healthy and nutritious food equally. However, the production difficulties have more negligible impacts on the possibility of skipping meals and even ambiguous impacts on the likelihood of not eating for a whole day compared to the effects of selling difficulties. Moreover, we also found that the market plays a crucial role in facilitating not only livestock trading but also livestock production (e.g., purchase of feed and medicines). Based on these findings, we suggest that the livestock market needs to be expanded and regulated to maintain the balancing prices between livestock products and products and services used for livestock production, and facilitate the product-exchanging mechanism. (shrink)

Antibiotic-resistant bacteria pose a serious threat to our health. Our ability to destroy deadly bacteria by using antibiotics have not only improved our lives by curing infections, it also allows us to undertake otherwise dangerous treatments from chemotherapies to invasive surgeries. The emergence of antibiotic resistance, I argue, is a consequence of various iterations of prisoner’s dilemmas. To wit, each participant (from patients to nations) has rational self-interest to pursue a course of action that is suboptimal for all (...) of us. The standard solutions to prisoner’s dilemma look to realign cost-benefit such that individuals’ interests match those of the collective. However, the lack of a global organization to enforce an effective carrot-and-stick system makes it unlikely that we can solve the antibiotic resistance problem this way. I argue that our best chance might be an attempt to teach altruism and convince individuals to act not out of their self-interests. (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)

Driven by population pressures on natural resources, peri-urban pastoralists in the Far North Province of Cameroon have recently intensified livestock production in their traditional pastoral system by feeding their cattle cottonseed cakes and other agricultural byproducts to cope with the disappearance of rangelands typically available through the dry season. Although the crop–livestock interactions in this altered intensive pastoral system seem similar to alterations recently named in mixed-farming systems in West Africa, they are distinctly different and would require a (...) different type of agricultural development support. I use Bourdieu’s theoretical constructs of “habitus” and “capital” to explain those differences. (shrink)

Intravenous drug abusers may incur bloodstream infections, in particular those involving the heart valves, that often require extended courses of antibiotics, commonly on the order of six weeks.Conventional wisdom has dictated that even when patients are sufficiently well to not need ongoing hospitalization, it is unsafe to complete their antibiotic course in any setting other than in a closely supervised facility, even if this is contrary to their wishes. The assumption has been that such patients would be at risk (...) of using their indwelling intravenous catheter for illicit purposes. Recent advances in the care of patients who suffer from addiction disorders suggest that when patients receive state-of-the-art addiction treatment, many may be able to continue their intravenous antibiotic course unsupervised, at home. This represents a departure from the parentalistic model of care of impaired patients who are prone to self-harm, moving towards a model that respects autonomy and trusts patients who are in recovery to continue their care in a manner that is self-beneficial. (shrink)

Most histories of livestock disease in Britain treat the development of control policy as a government responsibility, to which farmers made little constructive contribution. Similarly, farmers rarely appear in accounts of disease research. This paper uses the example of contagious abortion at the turn of the twentieth century to reveal that state-farming collaboration in research and policy did in fact occur, and that it operated in various ways, with often unexpected outcomes. The collaborative approach to contagious abortion is partly (...) attributed to its clinical and epidemiological features, which made it an unsuitable candidate for the existing, state-led policy of stamping out disease. It is claimed that such collaboration has been overlooked by historians on account of their focus upon diseases that were amenable to stamping out. This focus needs to change if history is to inform present-day disease governance in Britain, which is founded on the concept of ‘partnership’ between farmers and the state. (shrink)

We thank Parker and Wright for engaging in this roundtable debate in such a spirited way. The ‘Pharmacogenetic [test] to Avoid Loss of Hearing’ Trial is the first time a genetic point of care test has been applied in the acute neonatal setting; therefore, it is not surprising that questions have been raised which require debate, discussion and clarification. Parker and Wright misattribute several assumptions to the roundtable authors, which we would like to clarify here. Since they raise wider questions (...) about the PALOH trial itself, several of the roundtable discussants have made a joint response. (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)

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)

Antibiotic use in animal farming is one of the main drivers of antibiotic resistance both in animals and in humans. In this paper we propose that one feasible and fair way to address this problem is to tax animal products obtained with the use of antibiotics. We argue that such tax is supported both by deontological arguments, which are based on the duty individuals have to compensate society for the antibiotic resistance to which they are contributing through (...) consumption of animal products obtained with the use of antibiotics; and a cost-benefit analysis of taxing such animal products and of using revenue from the tax to fund alternatives to use of antibiotics in animal farming. Finally, we argue that such a tax would be fair because individuals who consume animal products obtained with the use of antibiotics can be held morally responsible, i.e. blameworthy, for their contribution to antibiotic resistance, in spite of the fact that each individual contribution is imperceptible. (shrink)

A variety of water-based livelihood activities undertaken by women and men in the villages of North Gujarat are under threat due to the unavailability of adequate water. Excessive groundwater withdrawal and limited recharge have led to shrinking water tables. With shrinking supply and growing sectoral demand, the competition for access to water is growing and women, who command less political and social power in the patriarchal communities of South Asia, often find themselves marginalized. Women are basically considered domestic water users (...) while men are seen as productive water users, despite the fact that women make significant use of water for productive purposes as well. This paper, drawing mainly on fieldwork undertaken in six villages of North Gujarat, India, tries to show how women use water for multiple purposes and help sustain the household economy. The paper argues that recognizing women’s roles as multiple water users will help promote the productive use of water in enhancing rural livelihood and sustaining the household economy. With special reference to women respondents, the paper examines gender roles of both domestic and productive water users and explores how these roles help women to improve their socio-economic status. The paper also analyzes operational income and expenditures associated with water-based home enterprise. Individual interviews, focus group discussions, participant observation, daily routine diagrams, and key informant surveys were administered to collect primary data. Key findings show that access of women to water for productive use not only increases their income earning potential, but also helps strengthen their bargaining positions. (shrink)

Following the introduction of do-not-resuscitate orders in the 1970s, there was widespread misinterpretation of the term among healthcare professionals. In this brief report, we present findings from a survey of healthcare professionals. Our aim was to examine current understanding of the term do-not-attempt-resuscitate, decision-making surrounding DNAR and awareness of current guidelines. The survey was distributed to doctors and nurses in a university teaching hospital and affiliated primary care physicians in Dublin via email and by hard copy at educational meetings from (...) July to December 2014. A total of 519 completed the survey. The response rate in the hospital doctors group was 35.5%, 19.8% in the nurses group but 68.8% in the specialist nurses group and 40% in the primary care physician group.Alarmingly, our results demonstrate that 26.8% of staff nurses and 30% of primary care physicians surveyed believed that a patient with a DNAR order could not receive any/at least one of a list of simple treatments including antibiotics, physiotherapy, intravenous fluids, pain relief, oxygen, nasogastric feeding or airway suctioning, which were higher percentages compared to the other hospital doctors and experienced nurses groups with statistically significant differences. Furthermore, a higher percentage of staff nurses and primary care physicians believed that a patient with a DNAR order could not be referred to hospital from home/a nursing home, when compared with other healthcare groups. Our findings highlight continued misunderstanding and over-interpretation of DNAR orders. Further collaboration and information is required for meaningful Advance Care Plans. (shrink)

It has been argued that livestock farming is necessary to feed a growing population, that it enables efficient use of land and biomass that would otherwise be lost from the food system, that it produces manure that is necessary for crop cultivation, and helps improve the sustainability of cropping systems by inclusion of perennial forage crops in otherwise low-diversity crop rotations. In this paper, we analyze these arguments in favor of livestock farming. Through argumentation analysis based on scientific (...) data, we show that the arguments are either invalid or that their validity is limited to certain circumstances. Without taking into consideration any other potential arguments for livestock farming, or arguments against it, we conclude that the arguments analyzed here cannot in isolation provide justification for more than a small proportion of today’s livestock farming. (shrink)

Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should prescribe antibiotics. It also does not explore the ethical significance of (...) public views or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. Methods: An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. Results: Of the participants, 50.3% thought that doctors should generally prioritize individual patients over society, whereas 32.0% prioritized society over individual patients. When asked in the context of AMR, 39.2% prioritized individuals whereas 45.5% prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p = .001) and in relation to AMR specifically (p = .006). Conclusions: Participants’ attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial “ideal observer,” their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society. (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)

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)

In the context of Ukraine’s membership in the WTO, the functioning of a free trade area with the EU, the opportunity for agricultural producers to obtain a larger share of the value added is primarily linked to the intensification of trade in domestic livestock products and their processing products. However, their production is one of the high-risk areas and requires a set of measures aimed at ensuring proper quality. Without effective solution of the problem of quality of livestock (...) products it is impossible to ensure its competitiveness in the world market, to guarantee the rational nutrition of the population of the country, the availability of the necessary components for the vital activity of the human body. The aim of the research is to determine the socio-economic factors for ensuring the quality of livestock products in Ukraine. The scientific and specific research methods were used to solve the tasks set in the work: the historical method; abstraction method; method of comparative analysis; system-structural method. The main producer of livestock products in Ukraine are households. They do not have the capabilities to implement technologies of keeping, feeding, veterinary services, programs prerequisites for guaranteeing the safety of products, adherence to the HACCP principles. In Ukraine, real technical, economic and organizational-economic prerequisites for ensuring the safety and quality of livestock products are created only in the poultry meat sector. During 2015-2017, the trends in production of almost all types of livestock products except poultry and honey were identified. One of the reasons for this situation was, firstly, decreasing in capital investment in the livestock sector, and secondly, the low profitability of production of livestock products in the context of accelerated growth in prices for resources. It is proved that insignificant market (price) incentives should be supplemented with instruments of state assistance to improve the quality parameters of products on the basis of specialized enterprises. The necessity of state support for the production of livestock products based on small and medium-sized enterprises is substantiated. This will effectively combine the processes of increasing the production of livestock products with the environmental friendliness of production and steady improvement of quality. It is shown that the low quality of certain livestock products in Ukraine is caused by insufficient living standards of the population and low incomes of the majority of households, which cause them to consume low quality products. It is determined that the problem of guaranteeing the quality of livestock products in Ukraine has deep roots cause due to the influence of socio-economic factors. Therefore, a comprehensive approach is needed to solve it, which is not limited to improving the efficiency of the state control system and successfully harmonizing of the Ukrainian technical regulation system with the European one. The problem of low quality and the danger of livestock production requires a systematic approach for its solution, which is not limited, in particular, by measures to improve the system of state control and ensure approximation of the domestic technical regulation system to the European one. In Ukraine, major high-quality animal products are economically inaccessible to a large part of households. The projected increase in safety parameters and a certain improvement in the quality of livestock products as a result of the implementation of regulations adopted in 2014-2017, will necessarily lead to an increase in its value, and therefore may lead to a decrease in market demand and even greater inaccessibility of these products to people. All this can only aggravate the situation with guaranteeing the food security of the country, forming the prerequisites for increasing the intellectual capacity of the nation. (shrink)

Irrigation systems are recognized as common pool resources supplying water for agricultural production, but their role in supplying water for other uses is often overlooked. The importance of non-agricultural uses of irrigation water in livelihood strategies has implications for irrigation management and water rights, especially as increasing scarcity challenges existing water allocation mechanisms. This paper examines the multiple uses of water in the Kirindi Oya irrigation system in Sri Lanka, who the users are, and implications for water rights and management (...) policies. There are important residential, gender, and class differences among the water users. People use irrigation system water not only for field crops, but also for fishing, homestead gardens, and livestock. Even within irrigated farming households, men have more control over paddy crops in the main fields, whereas homestead gardens are women's domain. Because the irrigation system provides water for birds and animals, even wildlife and non-resident environmental groups can be considered stakeholders. Current policies emphasize user involvement in both irrigation and domestic water supply. While government agencies have had primary responsibility, institutions such as Farmers' Organizations are being promoted. These have the potential to serve as user platforms for negotiating water allocation among irrigated farmers. However, the user organizations reflect the sectoral responsibility of the government agencies. Their membership and structure do not take into account the multiple uses or users of water. Developing platforms that accommodate different user groups remains a major challenge for improving the overall productivity, as well as equity, of water use. (shrink)

Precision livestock farming promises to allow modern, large-scale farms to replicate, at scale, caring farmers who know their animals. PLF refers to a suite of technologies, some only speculative. The goal is to use networked devices to continuously monitor individual animals on large farms, to compare this information to expected norms, and to use algorithms to manage individual animals automatically. Supporters say this could not only create an artificial version of the partially mythologized image of the good steward caring (...) for his or her animals, but to also improve on it. As one paper in favor of PLF has said, “We can not only replace the farmer’s ‘eyes and ears’ to each individual animal as in the past, but several other variables will soon be measurable in practice” Livestock production and society, Wageningen Academic Publishers, Wageningen, pp 287–292, 2006). Yet these methods of monitoring and control raise a host of ethical issues, including alienation of laborers, further consolidation of farms, and further cover for meat consumption. In this paper, I will address these ethical issues, and suggest a different, under-examined concern: namely, that though PLF may indeed improve the lives of livestock, and the sustainability of livestock operations, it is possible that it will do so at the cost of a loss of identity and relationships for farmers, as well as for the animals in their charge. (shrink)

Eleven organic and two conventionalSwedish livestock farmers and two initiators(non-farmers who took part in shaping earlyorganic livestock production in Sweden) wereinterviewed, using a semi-structured method.Respondents were selected through purposive andheterogeneous sampling with regard toconversion year, type of production, and sizeof farm. Conversion of the animal husbandrytook place between 1974 and 2000. All but twohad positive attitudes towards organiclivestock production and saw it as a wayforward for Swedish livestock production,although especially the latecomers did notperceive it as the only (...) alternative. There wasa distinct difference in values between thepioneers, who converted their farms early, andthose converting later. Pioneer farmers sharedthe values of the initiators. They expressed amore ecocentric view emphasizing a systemicapproach, and displayed a more holisticapproach to questions, interpreting them inlarger frameworks. They also had a moreecocentric understanding of animal welfare. Thelater the conversion, the more important theeconomic reason for conversion appeared to be.Those converting later also tended to have amore superficial relationship to organicprinciples. However, the farmers also tended tobe more influenced by organic values the longerthey worked with organic farming. (shrink)

In 2005, The International Federation of Organic Agricultural Movements (IFOAM) developed four new ethical principles of organic agriculture to guide its future development: the principles of health, ecology, care, and fairness. The key distinctive concept of animal welfare in organic agriculture combines naturalness and human care, and can be linked meaningfully with these principles. In practice, a number of challenges are connected with making organic livestock systems work. These challenges are particularly dominant in immature agro-ecological systems, for example those (...) that are characterized by industrialization and monoculture. Some of the current challenges are partly created by shortages of land and manure, which encourage zero-grazing and other confined systems. Other challenges are created in part by the conditions for farming and the way in which global food distribution systems are organized, e.g., how live animals are transported, how feed is traded and transported all over the globe, and the development of infrastructure and large herds. We find that the overall organic principles should be included when formulating guidelines for practical organic animal farming. This article explores how the special organic conceptions of animal welfare are related to the overall principles of organic agriculture. The aim is to identify potential routes for future development of organic livestock systems in different contexts and with reference to the specific understanding of animal welfare in organic agriculture. We include two contrasting cases represented by organic livestock systems in northwestern Europe and farming systems in tropical low-income countries; we use these cases to explore the widely different challenges of organic livestock systems in different parts of the world. (shrink)

The gut microbiota is an important component of the human body and its immune‐modulating and metabolic activities are critical to maintain good health. Gut microbes, however, are sensitive to changes in diet, exposure to antibiotics, or infections, all of which cause transient disruptions in the microbial composition, a phenomenon known as dysbiosis. It is now recognized that microbial dysbiosis is at the root of many gastrointestinal disorders. However, the mechanisms through which bacterial dysbiosis initiates disease are not fully understood. Microbially‐derived (...) metabolites and their role in disease have also attracted significant attention. Identification of cancer‐associated bacteria and understanding the contributions of microbial metabolism in health and disease are exciting but challenging areas that will allow defining microbial biomarkers for predicting gastrointestinal disorders. Understanding the complex interactions between gut microbiota, diet, host immune system and host genetics will be critical to developing more personalized therapies and approaches to treat disease. (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)

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)

In recent years, the model of shared decision-making has become increasingly promoted as the preferred standard in doctor-patient communication. As the model considers doctor and patient as coe-qual partners that negotiate their preferred treatment options in order to reach a shared decision, shared de-cision-making notably leaves room for the usage of argumentation in the context of medical consultation. A paradigm example of argumentative conflict in consultation is the discussion that emerges between doctors and their patients concerning antibiotics as a method (...) of treatment for what is presumed to be a viral infec-tion. In this paper, a case of such argumentative conflict is studied, using the extended pragma-dialectical theory to argumentation. It is examined how a patient and her physician manoeuvre strategically in order to maintain a balance between dialectical reasonableness and rhetorical effectiveness, as well as an equilibri-um between patient participation and evidence-based medication, while arguing their case for and against antibiotics respectively. (shrink)

Antibiotic allergies are commonly reported among patients, but most do not experience reactions on rechallenge with the same agents. These reported allergies complicate management of infections in patients labelled as having penicillin allergy, including serious infections where penicillin-based antibiotics are the first-line (most effective and least toxic) treatment option. Allergy labels are rarely questioned in clinical practice, with many clinicians opting for inferior second-line antibiotics to avoid a perceived risk of allergy. Reported allergies thereby can have significant impacts on (...) patients and public health, and present major ethical challenges. Antibiotic allergy testing has been described as a strategy to circumvent this dilemma, but it carries limitations that often make it less feasible in patients with acute infections or in community settings that lack access to allergy testing. This article provides an empirically informed ethical analysis of key considerations in this clinical dilemma, usingStaphylococcus aureusbacteraemia in patients with penicillin allergies as a case study. We argue that prescribing first-line penicillin-based antibiotics to patients with reported allergies may often present a more favourable ratio of benefits to risks, and may therefore be more ethically appropriate than using second-line drugs. We recommend changes to policy-making, clinical research and medical education, in order to promote more ethically acceptable responses to antibiotic allergies than the status quo. (shrink)

Precision livestock farming (PLF) is the management of livestock using the principles and technology of process engineering. Key to PLF is the dense monitoring of variegated parameters, including animal growth, output of produce (e.g. milk, eggs), diseases, animal behaviour, and the physical environment (e.g. thermal micro-environment, ammonia emissions). While its proponents consider PLF a win-win strategy that combines production efficiency with sustainability goals and animal welfare, critics emphasise, inter alia, the potential interruption of human-animal relationships. This paper discusses (...) the notion that the objectification of animals by PLF influences the developmental pathways of conventional industrial farming. We conduct a conceptual analysis of objectification by comparing discussions in feminist ethics and animal ethics. We find that in animal ethics, objectification includes deontological arguments regarding instrumentalisation, de-animalisation, alienation, commodification and quantification of animals. The focus on socio-political context and relationality connects these debates to central ideas in care ethics. We adopt a care ethics perspective to assess the implications of the objectification of animals in livestock farming. The basic claim is that sensory knowledge symbolised by the farmers’ unity of hand, head and heart would make it harder to objectify animals than abstract and instrumental reasoning where the pursuit of knowledge is intertwined with the pursuit of control, as in mainstream PLF. Despite of what can be considered as a good caring relationship between farmers and animals that is mediated by PLF, people involved in conventional industrial farming still seem to become further detached from farmers and animals, because the PLF system itself is objectifying. PLF redefines the notion of care, in terms of data transparency, standardisation of methods for analysis, real-time collection and processing of data, remote control, and the use of digital platforms. This creates new expectations and requires a redistribution of responsibilities within a wider scope of relations in the value chain. (shrink)

In this round table response, we discuss some of the problems inherent in insisting on specific consent for an activity that needs to happen rapidly as part of a package of care. The Human Tissue Authority consider that specific consent is mandatory to assess which antibiotics are appropriate on the neonatal unit, but this insistence may actually limit the autonomy which consent aims to promote. While genetic testing to determine which child will react adversely to particular antibiotics has been available (...) clinically for several years, the research proposed here is to assess whether improving the speed of testing allows decisions to be made before treatment starts. Insisting on specific consent before this activity can take place is likely to delay appropriate care in some cases. On admission to the neonatal unit, the unwell infant is routinely subjected to a range of investigations and treatments. A person with parental responsibility will usually be asked to provide consent to undertake treatments for children who do not have capacity to give consent themselves.1 For the acutely unwell child, consent will usually be sought for a package of care: the urgent nature of neonatal medicine often requires clinicians to make many decisions without explicit consent. Doctors must always act in a child’s best interests: their decisions need to protect the health and well-being of a child and hold the child’s welfare paramount in accordance with the Children Act and General Medical Council guidelines.1 2 Thus, for example, ventilation might be initiated, sedation provided, antibiotics commenced or diagnostic investigations requested without separate consent conversations or …. (shrink)

The use of subtherapeutic doses of antibiotics in food-producing animals has been linked to antibiotic resistant infections in humans. Although this practice has been banned in Europe, the U.S. regulatory authorities have been slow to act. This paper discusses the regulatory hurdles and ethical dilemmas of banning this practice within the context of the risk analysis model (risk assessment, risk management, and risk communication). Specific issues include unethical use of scientific uncertainty during the risk assessment phase, the rejection of (...) the precautionary principle leading to ineffective risk management, and the criticality of risk communication to build consensus and force action. The underlying root cause is a conflict of values (Type I ethical problem) among key stakeholders, which is examined in depth along with an ethical analysis using public health ethical values. (shrink)

This study is focused on unsustainable agri-food systems, especially intensive livestock farming and its resulting environmental harms. Specifically we focus on the development of technologies that seek to mitigate these environmental harms. These technologies are generally developed as incremental innovations in response to government regulation. Critics of these technological solutions allege that these developments legitimate unsustainable food production systems and are incapable of supporting agri-food systems transformation. At the same time, technology developers and other actors seek to present these (...) technologies as the legitimate solution to agri-environmental harms. Our study seeks to explore the perceptions and constructions of legitimacy for technologies that are developed to reduce ammonia emissions in intensive livestock farming in Flanders (Belgium). We use a qualitative case study, employing semi-structured interviews and workshops, with technology developers of ammonia-emission reducing technologies and stakeholders in the intensive livestock farming industry in Flanders. What our study shows is that technologies developed to reduce emissions are dependent on regulative legitimacy. The normative and cognitive legitimacy of these technologies is lacking, both due to ties to the intensive livestock industry and due to uncertainty over the performance of these technologies. With the delegitimation of intensive livestock farming, the legitimacy of these technologies is also under threat. In response, technology developers are looking to (re-)construct this legitimacy through knowledge claims over the performance of their technologies. We show several ways for other actors to deal with this, centred on either re-legitimising technologies to maintain the status quo, or to contest these knowledge claims and use them to disrupt path dependencies. (shrink)

Global discussions are ongoing on how to stimulate antibiotic research and development in order to provide patients with new antibiotics able to address the challenges of antimicrobial resistance. In this supplement, we present nine articles derived from the research performed as part of the Innovative Medicine Initiative-funded DRIVE-AB project and others. These publications provide new evidence and arguments in the debate around economic incentives to stimulate antibiotic innovation, including characteristics, implementation and governance.