A positive case for adjusting fluoride level in water
Major dental health inequalities persist between children from the most affluent and poorest backgrounds - despite the overall improvements attributed to widespread use of fluoride toothpaste over the past 30 years.
However, water fluoridation helps not only to reduce the scale and severity of tooth decay but also to narrow the gap that otherwise separates children from different social groups.
With no credible scientific evidence of harm to health from adjusting fluoride levels in public water supplies, and with a considerable body of evidence confirming the dental benefits, there is a strong ethical case for taking action to introduce water fluoridation schemes where it is feasible to do so.
As the then Bishop of Newcastle said in a House of Lords debate in 2003: “I cannot think of another measure that could produce such a health gain for so many. The cost of not fluoridating is paid for by the continued suffering and poor dental health of some of the vulnerable groups in our society.”
One in a Million
Our One in a Million online database includes a comprehensive section on the ethics of water fluoridation.
The view of a human rights campaigner and defender of liberty
The late Lord Avebury was a tireless campaigner for human rights and liberty. Writing in the British Dental Journal, he staunchly defended the ethics of water fluoridation: “Fluoride is a natural constituent of water supplies, as indeed it is of many foods. The adjustment of the quantity to an optimum level cannot be compared with the addition to water of a substance not found there ordinarily.”
He continued: “No consumer has the right to dictate the chemical composition of water, a recipe for anarchy. What is at stake is not the erosion of liberty but …the erosion of millions of teeth and the resultant suffering and misery of thousands of children which fluoridation would go far to prevent.”
The view of a leading academic philosopher in bioethics
John Harris, Professor of Bioethics and Director of the Institute for Science, Ethics and Innovation at the University of Manchester, has summed up the ethics of water fluoridation in the following terms: “We should ask not are we entitled to impose fluoridation on unwilling people but are the unwilling people entitled to impose the risks,damage and costs of failure to fluoridate on the community at large. When we compare the freedoms at stake, the most crucial is surely the one which involves liberation from pain and disease.”
Reports addressing key ethical issues
Irish Supreme Court judgement: community obligation to make good a deficiency
In a landmark judgement delivered in 1964 against attempts in the courts to stop the fluoridation of water supplies in Ireland, the country’s Supreme Court observed: “If water occurring naturally is deficient in some of its wholesome elements, it is the right if not the obligation of the community to make good the deficiency where this can be done without harm or danger to the public.”
Read more (see page 13)
Irish Forum on Fluoridation:
emphasis placed on children’s health and safety
Giving evidence to the Irish Forum on Fluoridation, which reported its findings in 2002, ethicist Dr Richard Hull argued: “It is all very well to emphasise the value of autonomy, but the desire to effectively safeguard the health and safety of children (who are not yet autonomous) could be said to constitute a strong counter-emphasis.”
Read more (see page 17)
Nuffield Council on Bioethics:
priority given to reducing inequalities
In its 2007 report on ethical issues in public health, the Nuffield Council on Bioethics states: “Reducing health inequalities should be considered central to the goals of public health, and prioritarian programmes that address inequalities can, in principle, be ethically justified. This justification could be used for fluoridation of water, given that it may potentially improve dental health across the population including in lower socio-economic groups.”