The Ethical Quandary of Water Fluoridation

Water fluoridation is a population –level public health intervention widely endorsed by health authorities; it’s ethical justification remains contested. Water fluoridation is considered scientifically safe and effective by the proponents of water fluoridation. However, the opponents of water fluoridation regularly raise concerns about efficacy and ethics of water fluoridation which culminates in a debate. This paper is an attempt to elucidate on the key issues of the ethical considerations of water fluoridation, based on the principles of bioethics. In particular, it raises questions about which of the competing values of the health authorities, the community, and the individual values; one must uphold in the consideration of fluoridation of the water. This paper provides a perspective on the key principles of bioethics regarding the pros and cons of water fluoridation, highlighting the considerations of non-maleficence, beneficence, autonomy and justice. The justificatory and the stewardship model are two types of ethical frameworks used to evaluate public health interventions. The application of ethical frameworks in the evaluation of water fluoridation in a particular place, are discussed in this paper. An intervention such as water fluoridation explicates the benefits of equity and justice as it ensures that the opportunity to be free from caries and dental morbidity is distributed equally among all members of society. This paper concludes that continuing the practice of water fluoridation for the prevention of caries and dental morbidity, can be ethically justifiable, and provided a balanced and progressive approach is applied, underpinned by strong scientific evidence.