Abstract
Community water fluoridation (CWF), a long-established public health intervention, has been studied for scientific evidence from both of yea and nay standpoints. To justify CWF with scientific evidence inevitably leads to ethical justification, which raises the question of whether oral health is of individual concern or social responsibility. As dental caries is a public health problem, public health ethics should be applied to the topic instead of generic clinical ethics. From both pro- and anti-fluoridationists’ perspectives, CWF is a public health policy requiring a significant level of intervention. Thus, there needs to take further considerations for justifying CWF beyond the simple aspect of utility. For further ethical considerations on CWF, three caveats were suggested: procedural justice, social contexts, and maintenance of trust. The process to justify CWF should also be justified, not simply by majority rule but participatory decision-making with transparency and pluralistic democracy. Social contexts are to be part of the process of resolving conflicting values in public health interventions. Public trust in the dental profession and the oral healthcare system should be maintained over the considerations. This article suggests accountability for reasonableness as a framework to consider infringement by CWF for public justification of its implementation.
Highlights
IntroductionCommunity water fluoridation (CWF) is a long-established [1] but still ethically contentious [2] public health scheme
We present three caveats to justify the infringement of public health policy: procedural justice, social context, and maintenance of trust
We have found that Community water fluoridation (CWF) needs to be justified in ethical considerations, and public health ethics is an adequate framework for the discussion
Summary
Community water fluoridation (CWF) is a long-established [1] but still ethically contentious [2] public health scheme. For a scientific background on CWF, a large portion of empirical findings support its benefit of preventing dental caries, including systematic reviews [3,4,5]. Considering the importance of evidence-based healthcare, consistent/continuous accumulation of robust scientific evidence by refuting each other [9,10] for the justification of CWF seems required. If the frame of reference is set on philosophical and ethical considerations, the rationale for CWF is no longer empirically testable. There remains a pragmatic issue of “acceptability” [11] to the various stakeholders of CWF
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