By Zeynep Sude Yeşildağ and Şəfiqə Süleymanova
Antibiotics are among the most significant advances in modern medicine, transforming once-fatal infections into easily treatable conditions. Yet this success has a fragile side. When antibiotics are used casually, without proper indication or supervision, the very tools designed to save lives begin to lose their effectiveness. What was once a medical triumph becomes an emerging ethical and public health concern.
Antimicrobial resistance (AMR) now stands as one of the most alarming global health challenges. If current patterns continue, AMR threatens to undermine routine medical care by making infections harder, slower, and more costly to treat. It also increases risks during procedures where antibiotics are used prophylactically. According to the World Health Organization, AMR directly caused 1.27 million deaths in 2019 and contributed to nearly 5 million deaths overall. A major driver of this crisis is antibiotic misuse, particularly self-medication without medical guidance.
Why AMR Is an Ethical Problem?
Antimicrobial resistance challenges more than clinical practice — it strains the core principles of biomedical ethics. When individuals self-medicate without adequate knowledge, autonomy becomes distorted rather than supported. Misuse that leads to ineffective treatment or worsening infection conflicts with nonmaleficence, while beneficence is undermined when an intended therapy ultimately causes harm. Justice is also jeopardized: resistant infections limit future therapeutic options, placing an unfair burden on generations who were not responsible for the misuse.
Ethical Responsibility and Shared Accountability
The ethical responsibility for antibiotic misuse cannot be placed solely on the individual who chooses self-medication. Instead, AMR reflects a wider, shared moral burden.
Physicians play a critical role through responsible prescribing and clear patient communication. Overprescribing — or failing to explain when antibiotics are unnecessary — compromises beneficence by enabling avoidable harm.
Pharmacists act as the final barrier before antibiotics reach the public. Dispensing them without a prescription not only violates legal requirements but also breaches nonmaleficence by enabling misuse.
Governments and healthcare systems carry structural responsibility. Awareness campaigns, regulatory enforcement, and accessible healthcare pathways are essential to protect autonomy and justice at the population level. When these systems fail, individuals are left without the guidance needed to make informed decisions.
Patients, too, possess moral agency. Even without medical training, there is an ethical obligation to seek professional advice rather than rely on convenience. Choosing quick self-treatment over proper consultation ultimately affects not only the individual but also broader society, further eroding justice.
In many countries, including Azerbaijan, antibiotics are legally restricted to prescription use. This regulation signals an important recognition of the problem, but law alone cannot address the deeper ethical dimensions. Sustained awareness — among both healthcare professionals and the public — remains essential.
Each year, from 18–24 November, the World Antimicrobial Awareness Week highlights exactly this point. Led by the World Health Organization, the initiative promotes responsible antibiotic use under the 2025 theme: “Act Now: Protect Our Present, Secure Our Future.” The message is straightforward: AMR is a shared challenge, and it demands shared responsibility.
In conclusion antibiotic misuse is not the result of a single failure. It emerges from interconnected actions across patients, clinicians, pharmacists, and health systems. Addressing AMR therefore requires a collective ethical commitment — one that extends beyond the clinic and into the wider community.
Author: Zeynep Sude Yeşildağ & Şəfiqə Süleymanova
Affiliation: Naxçıvan State University, Medicine Faculty, Azerbaijan
Conflicts of Interest: None to declare