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- Page navigation anchor for The role of financial incentives in stewardshipThe role of financial incentives in stewardshipAntimicrobial resistance pushes policy-makers to influence public and professionals to reduce antimicrobial consumption. In their welcome ethical discussion, Li et al. claimed that a policy could be considered ‘ethical’ if it respected Beauchamp and Childress’ four Principles of Biomedical Ethics (autonomy, justice, beneficence and non-maleficence).1,2 However, this framework poses interpretive challenges. How do we weigh the externalities associated with antibiotic use (the risk of future harm to others by promoting resistance)? Non-maleficence (at least as primum non nocere) poses a problem since any clinical or policy decision is associated with risk of harm, leaving us to choose either inaction or turn to utilitarian comparison of the relative harms of different strategies. The authors claimed that financial incentives could “encourage physicians to err on the side of refusal.”1 Though, as the authors note, these incentives are aimed at encouraging organisations to improve systems, not to reward prescribers for their individual clinical decisions (though some may benefit directly). Reductions are sought in ‘inappropriate’ antibiotic prescribing, which should result in a net gain for patients who might otherwise be exposed to risk of harm that outweighs chance of benefit.3 An imperative to ration ‘appropriate’ antibiotic prescribing would pose a more serious challenge....Show MoreCompeting Interests: None declared.