Table 1.
Childress and Beauchamp Biomedical Ethical Framework Applied to 3 Common Antimicrobial Stewardship Scenarios
| Brief Definition | Autonomy | Justice | Nonmaleficence | Beneficence |
|---|---|---|---|---|
| The right for a patient or prescriber to make healthcare decisions for themselves | Balancing benefits to patients and society with equity and impartiality | “Do no harm” or avoiding or minimizing harm whenever possible | Preventing harm by doing good; acting to promote the welfare of the patient | |
| Scenario #1 Antimicrobial prescribing pressure (prescribers, patients) |
-Is the intervention encroaching upon the prescriber or patient’s right to initiate, change, discontinue, or refuse antimicrobials? -Are the patient and prescriber making an informed decision about antimicrobial usage? |
-Does the intervention favor a specific patient or patient population? -Does the intervention unfairly limit antimicrobial access to stakeholders who may need them? |
-How does the intervention reduce patient or prescriber harm? -How does the intervention potentially expose a patient or prescriber to harm? |
-Does the intervention increase the prescriber’s ability to help the patient? -Does the intervention help the patient make a better decision? -Does the intervention provide other benefits? |
| Scenario #2 Preauthorization/prospective audit and feedback |
-To what extent is preauthorization limiting prescriber choice? -To what extent can or should AS programs manage “outlier” prescribers’ behavior? |
-Does the intervention favor or discriminate against certain stakeholders? -How does the intervention impact the institution or society? -Do our metrics accurately measure appropriate use? |
-How does the intervention of interest harm different stakeholders? -What harms do we risk if we defer the implementation of an intervention? -Are interventions reducing truth telling by incentivizing prescribers to lie or misrepresent their case? |
-Do preauthorization and prospective audit and feedback benefit the prescriber? The patient? The AS program? -Does the intervention benefit the patient–prescriber or prescriber–AS program relationship? |
| Scenario #3 The individual versus the group or society |
-To what extent can or should an intervention restrict a prescriber or patient who is acting against the interest of the group? -To what extent can an individual prescriber or patient limit the interests of the group? |
-Does the intervention favor a particular stakeholder? -How do we measure and define acceptable risk or benefit to the individual and the group in the intervention? -What is the “opportunity cost” if resources are used for this intervention instead of others? |
-What are the immediate and potential risks of this intervention to the patient, prescriber, or society at large? -Are certain stakeholders being placed at a higher risk than others? -Who is harmed to a greater extent if an intervention is not implemented? |
-What immediate or future benefits could this intervention have for an individual patient? -What immediate or future benefits could this intervention have for a hospital or society at large? |
Note. AS, antimicrobial stewardship.