Who is responsible for anti-microbial resistance?

13 July 2017

Portrait of Dr Anne Schwenkenbecher

by Dr Anne Schwenkenbecher

Anne is a Lecturer in Philosophy in the School of Arts and Academic Chair of the Philosophy Program at Murdoch University in Western Australia. Before joining Murdoch in June 2013, she held appointments at The University of Melbourne, the Centre for ...

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Antibiotics provide great benefits in medicine and food production, but at the same time our extensive (and ever increasing) collective usage reduces their overall efficacy and undermines these benefits. Anti-microbial resistance and a decline in anti-microbial efficacy are urgent collective action problems.

Who is responsible for this problem? When we ask such a question we need to be aware that there are several ways in which it can be understood. We might be enquiring about causal responsibility. We would then be asking how the problem came about, or which agent(s) caused it. We could also be asking about retrospective moral responsibility: which agent(s) – if any – are appropriate objects of blame for the occurrence of this problem? Finally, we could be asking about prospective (moral) responsibility: who should fix the problem?

As is typical for collective action problems, responsibility for anti-microbial resistance on all these levels is diffused. This is one of the aspects, which make collective action problems difficult to resolve. There is no single cause and no single agent or group of agents who can be held responsible.

We need the empirical sciences for understanding the complex causal relations between our use of antibiotics and increasing resistance. Social scientists are able to develop political and regulatory strategies, which can help us slow down this process. But what can philosophy, and, more specifically, philosophical ethics contribute to this debate? Philosophy’s core business is in conceptual analysis and theory development. As such, ethical enquiry into collective responsibility is concerned with understanding existing ethical concepts and developing new ones where we lack the appropriate conceptual resources. For collective action problems such as anti-microbial resistance, it is not only the empirical facts and causal relationships that are difficult to understand. It is also difficult to establish how the different agents involved – farmers, doctors, patients, governments and regulators – should understand their own role vis-à-vis the problem and corresponding obligations. Often, the notion of ‘collective responsibility’ is invoked to express the diffused and distributed responsibilities arising in the context of collective action problems.

Take the example of anti-microbial resistance. It is true that no particular agent has caused this problem. Further, no agent exists that could solve the problem single-handedly. It is tempting for each of those agents to think that they need not contribute to its solution since they did not cause the problem. To make such an argument assumes (at least) the following two principles to be true: that we only need to fix what we ‘broke’. Or, in other words, that we only need to solve problems that we are retrospectively responsible for. Further, it assumes that such causal responsibility must be direct in that our individual actions must have made a difference to the outcome. But note that it is not clear that we should endorse such principles. Many philosophers do indeed think that we should not.

Our moral code – the rules by which we live and the way in which we understand ourselves as ethical agents in the world – has evolved over a long period of time. Many of our moral concepts are thought to have developed when people lived in small communities and our individual actions impacted only those few people directly connected to us. But today, small and individually inconsequential actions can have real and morally significant impacts in the world on people far removed from us. And note that we are now in a position to know about these impacts in a way that we never could have a hundred years ago.

Philosophers concerned with ‘collective ethics’ think that our traditional moral code is no longer suitable for the kind of world we live in. Take the notion of ‘harm’: it is obviously wrong to act in ways that make a concrete person worse off than they could and should have been. But it is harder for us to think of harms we cause in aggregation, harms that only come about because millions of others do the same thing we do, as wrongful on our part. After all, when it comes to large-scale collective action problems, what I do individually has little consequence and neither does my refraining from doing it.

The philosopher Derek Parfit thought that we need to re-think our ‘moral mathematics’: we need to find ways of understanding our role as contributors to large-scale collective action problems where our individual actions only play a role insofar as they cause problems together with countless actions of others. Apart from anti-microbial resistance, climate change is such a problem. Whether any of us reduces their individual carbon footprint or in fact whether any particular individual even exists will have no influence on climate change (except for very powerful individuals).

So thinking in terms of individual actions, their consequences and individual responsibility does not suffice when we reflect on our role in these collective action problems. This is why many scholars think that we should couch our moral role in terms of collective responsibility: we are collectively or jointly responsible for having brought about the problem as well as for fixing it.

But what does that mean for each of us? How can I together with others be collectively responsible for some harm or problem? Again, we need to think about our different types of responsibility – causal and moral – with the latter dividing into retrospective and prospective. That harms such as environmental pollution, anti-microbial overuse and resulting resistance, or an unsafe level of greenhouse gas concentration in the atmosphere are collectively caused is evident.

But what about moral responsibility? What does it mean that people can be collectively blamed for having brought about harm in the past? And what does it mean to say that we have prospective collective responsibility to fix a problem? We might think that it should be states and state agents that need to fix the problem. But what about ‘ordinary citizens’ do they have such obligations? The idea of collective moral responsibility is usually meant to express that we share such obligations with other people. For many collective action problems we can only make a difference if all of us (or a sufficiently large number of us) do the right thing, for instance to reduce our individual carbon or antibiotic footprints in the right way.

The question for the moral philosopher is not how we get people to do the right thing, but what the right thing to do is for each of us. In thinking that moral responsibility for a problem can be collective we can make sense of our obligations to contribute to collective endeavours even where our individual actions or deliberate omissions make no difference in isolation. That is, I may not outright deny responsibility for fixing problems that I alone cannot fix. It is possible that I share responsibility for collective action problems with others provided I can fix (or at least improve) the problem together with others. My individual obligations can be grounded in this collective responsibility and what I should be doing is to contribute to the collective pattern that is morally optimal.

Whether or not anti-microbial resistance is a problem that can be fixed or improved through the aggregate effect of individual antibiotic footprint reductions by patients and doctors, customers and producers is an empirical question. Whether this fact could ground a collective obligation for patients, doctors, consumers and producers to reduce our antibiotic footprint is a philosophical question. Philosophical arguments defending such ascriptions of collective responsibility are contributions to a public debate that seeks to adjust our moral categories to the challenges of the 21st century.

Parfit, D. (1984). Five mistakes in moral mathematics. Reasons and Persons. Oxford, Clarendon Press. 1: 55-83.

This opinion piece reflects the views of the author, and does not necessarily reflect the position of the Oxford Martin School or the University of Oxford. Any errors or omissions are those of the author.