Ethical dilemmas in antibiotic prescribing: analysis of everyday practice

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Abstract
Objective: To explore general practitioners' (GP's) views on their obligations with respect to diagnosing infections and prescribing antibiotics. Methods: The GP's reflections and prioritization were studied by means of interviews and observations. We analysed how their prioritization complied with an ethical guidance that ranked patient autonomy and welfare highest, then competence obligations and obligations to society, followed by fraternal obligations. Results: Balancing of pros and cons was prominent in our informants' decision making but often resulted in decisions that deviated from the ethical guidance. The ranking varied much between the GPs. The highest priorities in the GPs' practice were related to the patient's everyday life (sometimes autonomy, sometimes beneficence in a broad sense), doctor–patient relationship (communication competence), the patient's perceived importance on the job market (society) and relationship with colleagues (fraternal). Perceived lack of resources and uncertainty with respect to both diagnostic and treatment decisions frequently influenced decision making.