Impartiality and infectious disease: prioritizing individuals versus the collective in antibiotic prescription

Background Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human healthcare. 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 US 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 50.3% of participants thought that doctors should generally prioritise individual patients over society, whereas 32.0% prioritised 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 prioritise 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-personal rather than first-personal 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.