The Capability Approach and Upstream Causes—A Discussion of Johnson’s Ethical Evaluation Framework for Coercive Antimicrobial Stewardship Policies

The rise of antimicrobial resistance (AMR) poses a major global health threat. One of the ways to address this issue is through coercive enforcement of antimicrobial stewardship (AMS) policies. The use of such (state) coercion requires ethical justification. Therefore, Dr. Tess Johnson has recently developed a framework to evaluate the possible ethical justifications for these coercive AMS policies. In this discussion article, we aim to contribute to further developing Johnson's ethical evaluation framework by providing two additional arguments. First, we remark how the high burden of ethical justification is premised on the assumption that coercion restricts freedom. We argue that this only applies to narrow conceptions of freedom, while not necessarily to broader conceptions, such as the capability approach. Second, we advocate for attentiveness to upstream causes of AMR. We argue that ethically justified coercive AMS policy is conditional upon giving sufficient consideration to solving these upstream causes.