title: The stigmatization dilemma in public health policy--the case of MRSA in Denmark.
abstract: BACKGROUND
  Multi-resistant bacteria pose an increasing and significant public health risk. As awareness of the severity of the problem grows, it is likely that it will become the target for a range of public health interventions. Some of these can intentionally or unintentionally lead to stigmatization of groups of citizens.
  
  
  CONCLUSIONS
  The article describes the phenomenon of stigmatization within the health care area by discussing the concept in relation to AIDS and psychiatric diagnosis. It unfolds the ethical aspects of using stigmatization as a public health instrument to affect unwanted behaviours e.g. smoking. Moreover it discusses stigmatization as an unintended albeit expected side effect of public health instruments potentially used to counter the challenge of multi-resistant bacteria with particular reference to the Danish case of the growing problems with Methicillin-resistant Staphylococcus aureus (MRSA) within pig production. We argue that using stigmatization as a direct means to achieve public health outcomes is almost always ethically illegitimate. Autonomy and dignity considerations count against it, and the cost-benefit analysis that might by some be taken to outweigh these considerations will be fundamentally uncertain. We further argue that interventions where stigmatization is a side-effect need to fulfil requirements of proportionality, and that they may fall prey to 'the stigmatization dilemma', i.e. the dilemma that arises when all policy options are potentially stigmatizing but stigmatize different groups. When this dilemma obtains the decision-maker should choose the intervention that does not lead to permanent stigmatization and that stigmatizes as few as possible, as briefly as possible, and as little as possible.
authors.affiliation: Centre for Applied Ethics and Philosophy of Science, Department of Communication, Aalborg University Copenhagen, A C Meyers Vænge 15, 2450, Kbh SV, Denmark. ploug@hum.aau.dk.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ploug
authors.affiliation: Centre for Social Ethics and Policy, School of Law, University of Manchester, Manchester, M13 9PL, UK. soren.holm@manchester.ac.uk.|Center for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway. soren.holm@manchester.ac.uk.
authors.forename: Søren
authors.initials: S
authors.lastname: Holm
authors.affiliation: Section for Consumption, Bioethics and Governance, Department of Food and Resource Economics, University of Copenhagen, Rolighedsvej 25, DK-1958, Frederiksberg C, Denmark. mgj@ifro.ku.dk.
authors.forename: Mickey
authors.initials: M
authors.lastname: Gjerris
mesh_terms: D000822:Animal Husbandry; D000818:Animals; D000900:Anti-Bacterial Agents; D001294:Attitude to Health; D001364:Awareness; D003362:Cost-Benefit Analysis; D003718:Denmark; D006291:Health Policy; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D011634:Public Health; D013203:Staphylococcal Infections / Q000523:psychology*; D013240:Stereotyping; D013552:Swine
chemical_list: D000900:Anti-Bacterial Agents