Forced Medication: The Ethics of Tap Water Fluoridation

Elena Rowan calls for a change to North America’s water fluoridation practices


Fluoride is a naturally-occurring chemical ion of the element fluorine. It can be found naturally in some water sources, based on geographical location and natural sediments. Fluoride is purported to help prevent cavities by reducing the prevalence of tooth decay in the population that consumes it. It is thought that fluoride protects teeth from demineralization caused by acid produced when sugar is ingested, as well as to remineralize any damage that may have already occurred. Scientists inferred these outcomes from the lower incidences of cavities in individuals who grew up in areas with a higher concentration of naturally-occurring fluoride in their water.

Because of the perceived benefits of fluoride, governments in the United States and Canada began adding a synthetic version of fluoride—sodium fluoride—to national water supplies decades ago. Many have argued that water fluoridation represents a great achievement in public health. However, 97% of European countries, including Belgium, Denmark, France, Germany, Italy, Luxembourg, Norway, Netherlands, Scotland, Sweden, and Switzerland have banned water fluoridation for health reasons as well as ethical reasons.

Rowan pic

The most common disease caused by ingestion of fluoride is fluorosis, which has causational links to dental and skeletal erosion. Moderate amounts of ingested fluoride are known to cause staining and pitting in teeth, leading to irreversible enamel damage. In higher amounts skeletal fluorosis can occur, with symptoms ranging from stiffness and pain in the joints to calcified bones and ligaments, which can lead to impairment in muscle functioning. In acute cases, fluorosis can be deadly, causing muscle spasms and seizures. Many advocacy sites in support of banning water fluoridation report correlations found between fluoride and countless other diseases and disorders, including neurological disorders, cancer, thyroid disorders, bone damage, and infertility. Although the majority of these disorders promoted by advocacy sites have not been proven causational, there is, I think, reason for some level of public concern.

In addition to concerns about the safety of water fluoridation, there are ethical concerns. The effect of water fluoridation’s mass medication on a society can be viewed as an experiment that has participants, in a way similar to research participants. The Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans explicitly states its core principles as: respect for persons, concern for welfare, and justice. The administration of any controlled substance should ethically abide by these three principles. Sodium fluoride is a chemical, controlled by governments. While water fluoridation may arguably show concern for welfare and justice, it fails to show respect for persons by violating their autonomy.

When the national population is being used as research participants, there is no explicit or implicit form of consent being given. No opportunity is provided to exclude oneself from the research study. This violation of respect for persons directly contravenes the guidelines outlined in the Tri-Council Policy. Unfortunately, the Tri-Council Policy Statement is not a legal document, and thus cannot dictate the actions of researchers or governments. Rather, it is a general guideline that ethical researchers and scientists follow to ensure they maintain integrity in their work.

Some argue that the harms to autonomy are outweighed by the benefits of water fluoridation. However, tooth decay rates in many European countries have declined at the same rate as those in North American countries. This indicates that other factors may be responsible for decreasing dental cavities rather than water fluoridation, and that the benefits of fluoride (if any) may be overstated.

All this suggests a need for change in the fluoridation process of tap water in North America. It has been demonstrated in European nations that dental fluorosis has decreased without water fluoridation, supposedly rendering the process medically unnecessary. Moreover, it is unethical to force medication upon a population through one of the most viable means of survival: tap water. Following the ethical guidelines outlined in Tri-Council Policy, research participants must consent to medications they are ingesting, something that is not provided through national water fluoridation.


Elena Rowan is in her second year studying Psychology at Dalhousie University. @ElenaRowan

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