An Analysis of Ethical and Legal Issues Concerning Water Fluoridation

This essay delves into the ethical and legal issues surrounding water fluoridation, examining its imposition and benefits within the healthcare context. It explores the process of water fluoridation, its impact on dental health, and the associated ethical and legal concerns. The essay discusses the perspectives of various stakeholders, including healthcare professionals, social workers, and environmentalists, and analyzes the application of ethical theories such as deontology and utilitarianism. It highlights the debate around autonomy, human rights, and the potential negative health implications of fluoridation, including neurotoxic effects and the violation of individual rights. The essay also examines the roles of regulatory bodies and the need for public awareness, concluding with a critical assessment of the overall ethical and legal standards related to water fluoridation.

ETHICAL AND LEGAL ISSUES IN
HEALTHCARE

TABLE OF CONTENTS
Topic chosen: Do the benefits of water fluoridation justify its
imposition?.......................................................................................................................................3
REFERENCES................................................................................................................................9

Topic chosen: Do the benefits of water fluoridation justify its
imposition?
Water fluoridation is the process of supply of fluoridated water for drinking purposes
through common supply chains. It is useful in preventing the targeted population from any tooth
decay or any enamel/pulp related issue (Morabia, 2016). However, there are more negative
implications that has put questions on this process and its relevance in the recent times at the
worldwide levels. Many social workers, environmentalists and other authorities are trying to
regulate this process on minimal levels and promoting programs to generate awareness among
public (Iheozor‐Ejiofor et al., 2015). This assignment is based on understanding the ethical and
legal issues in the healthcare, especially the bioethical aspects to know the contributing
perspectives about water fluoridation. It will include ethical theories including deontology and
utilitarianism and its connection with understanding the components for this process. Along with,
there is also emphasis on the role of healthcare professionals and their outlooks regarding the
preventive measures of this process and mitigate its effects.
It is important to understand that water fluoridation has its pros and cons, however there
is need to differentiate between its relevance and imposition. The overall impact here is on the
basis of ethical and legal standards and must be considered to understand its imposition. This
process has been undertaken of adding fluoride in the supply of drinking water via public water
supply to minimise the decaying of teeth (Peckham, S., & Awofeso, N. (2014). Water fluoridation: a critical
review of the physiological effects of ingested fluoride as a public health intervention. The Scientific World Journal, 2014.).
More so, it has been proved useful for both children and adults. From several studies it has been
found out that tooth decay is one of the concerns of the health and social care sector. For e.g.
efficacy in adults has been reduced to around 30 percent and in children and kids, approximately
37 percent cavities has been minimised (Lippert and Juthani, 2015). However, it is well
documented that fluoridation has mild negative effects in terms of alternations in the appearance
or rise of fluorine levels in the body (Rugg-Gunn et al., 2016). This totally depends upon the
water intake, especially from the drinking water supply for public.
Consequently, the water fluoridation is one of the mass level preventive measures and has
impacted the community in the most effectual ways. It has substantially managed the risks and
has been referred as the culturally viable option for few vulnerable groups. According to Laudon
(2016) it must be understandable that human rights and health are inter connected due to the

presence of ethical code of conduct which ensures an overlapping of principles and welfare
objective. This paves the path of measuring the biophysical and psychological status of people
by giving treatment for existing conditions. Here the water fluoridation occurs in the name of
public health measure but there is no accountability from the regulatory bodies or health
institutions regarding the aftermath of it (Schneider, 2016). The public is consuming this water
without realising the overall impact on their bodies and the environment as well. Laudon (2016)
also supported saying that with continuous consumption of this water, the levels of fluorine in
the human body gets extended from the desirable range and impact the well being of humans.
Although it is found that it helps in dental caries prevention and has assisted in improving the
oral hygiene. There is also no concrete evidence that has reflected upon any diseases which took
place due to deficiency of fluoride in humans.
Simultaneously, according to Kerzner (2017), the regulatory bodies like NHS,CQC, etc.
with public health services related organisations must have been vigilant and tried to minimised
this process through proper interventions. Professionals like doctors, nurses and more would
have also participated to mitigate the risks and other damages to the human bodies. It was found
in the year by 2017 when the Environmental Protection Agency (EPA) denied a petition due to
lack of scientific proof regarding the harmful effects of fluoridated water (McKinley, D. C., Miller-
Rushing, A. J., Ballard, H. L., Bonney, R., Brown, H., Cook-Patton, S. C., ... & Ryan, S. F. (2017). Citizen science can
improve conservation science, natural resource management, and environmental protection. Biological Conservation, 208,
15-28.). They were not convinced that water fluoridation process releases neurotoxic harms,
however one of the senior scientist maintained that the agency ignored the rising risks and must
have taken this type of harm in more serious manner.
Laudon (2016) stated that this fluoridation process has been enforced on the public
through government led bodies and has no option to put a stop on it. There are also studies that
there are beneficial effects by putting resistance on the formation of tooth cavities and help men,
women, children and elderly. However, this enforcement is a clear violation of their principle of
autonomy or self-rule and this right holds the right to take decisions independently with the
complete consensus. There is need to understand that autonomy can be practised only when
every effort is discussed in fulfilling the patients' charts. Iheozor‐Ejiofor et al., (2015) critiqued
that it is mostly not practised in the healthcare setting and has an impact on the operations like
water fluoridation process. This right of autonomy must be exercised to bring a balance and help

professionals and individuals to move in forwarding direction. Henceforth, the medical
institutions must frame an outline to safeguard the rights under a legal and ethical order.
Moreover, Foyal (2016) stated that water fluoridation has increased the total fluoride
intake and has exceeded the optimal dosage which led to think about the benefits of this process
in the longer run. This also described that people must question the government who blindly still
following this methodology without giving thought about its impact on the society. Nevertheless,
there are no tools or techniques to monitor the intake via different water sources and must not be
adopted on continuous levels. Moreover, SA (2016) clearly defines the ethical and legal issues
awarded to people who are not aware and feel into this vicious cycle of medical treatments and
number of check-ups. Insurance and other additional related medications related to dentistry also
impacted the violation of individual rights, however this is also person centric and is specific in
nature. The people involved in this process at professional levels might have taken some
measures to mitigate the risks associated with it. They must have put a ban on this process or
would have stopped the usage of it on the regular basis.
Additionally, Sanchez (2019) explained that there are several environmental pollutants
for the entire growth and development of children. Henceforth, addition of fluoride has potential
threats on the progression of diseases (Cross, 2015). There are reviews that emphasized that
people consuming such fluoridated water shows lower intelligence quotient (IQ) and has
developmental neurotoxic effects on the cognitive capacities and physical performance.
However, it is also imperative to know the hampering impact on the human's well being. When
consumed on the consistent basis or say more advanced levels, then the public is on the verge of
more adversities as compared to enjoy the benefits of water fluoridation process (Spencer,Do and
Ha, 2018).
In addition to this, this is a clear violation of human rights and must not be entertained.
The public must be made aware about the ill effects of consuming this water and the warning
signs on the overall physical and mental development. The Universal Declaration of Human
Rights (UDHR) has clearly outlined the legal rights that is conferred on every person. Article 25
(1) has given the right to living standards adequately in context to necessities of life including
medical care, housing, food etc. with the right to security in uncertain or special situations like
disability, sickness and more. The people must be given choices to select the type of water for
consumption as it is under basic human right to live and comes under the right to freedom (Ramos,

A. K. (2018). A human rights-based approach to farmworker health: An overarching framework to address the social
determinants of health. Journal of agromedicine, 23(1), 25-31.).
Furthermore, P.W.P (2016) shed light on the bioethics which is the conceptual
framework that supports in the public healthcare. The policy makers always faced challenges and
often were morally confused to resolve the conflicts related to water fluoridation. It has been
crossed with the verification of the scientific evidence and the risks or damages in regard to this
particular issue. Rica (2016) elucidated on the evidence that there were plurality in the expected
results for talking fluorides. It has been found out from several studies that several processed
foods and dentifrices are used to complete the required levels, however, the fluorides are still
available in the water supply and has a compulsion for consumption. This impacted the
imposition of consuming this fluoride containing water which is not healthy for adults and
children as well. It leads to restrictions in terms of the moral values which impacted the
collective safety and freedom of people on the whole. This is again violating the constitutional
rights and has led to negative influence on the health of people in the communities.
In regard to the same, ethical theories such as Utilitarianism and Deontology can be
considered to understand the challenges and issues related to the water fluoridation. Deontology
is one of the important theories for gaining knowledge about the ethical standards and civil code
of conduct. It reflected upon the compliance to follow the obligations and duties in an ethical
manner in order to take the decisions and complete the assigned duties properly. This ideology
has demonstrated a relationship between duty and moral values with respect to the actions of an
individual or collective action (Piacquadio, 2017). For instance, the dentist or the general
practitioner might have informed people not to consume this water on regular periods. Although
they never took initiative to conduct sessions to inform about the consequences and other health
problems in people, they would have generated awareness through campaigns and promotional
activities using several authentic channels (Sacco et al., 2017). Nonetheless, this theory has
helped the professionals and people involved in gaining insights to generate awareness regarding
both the advantages and disadvantages with a sense of responsibility and ethically sound.
Moreover, this theory has a drawback of absence of rationale which infers that an
individual is not bound to fulfil the duty or moral obligation. Thus, there is probability of failing
in completing the assigned work properly or leads to ineffectiveness while performing the task or
given job (May, J. (2014). Moral judgment and deontology: Empirical developments. Philosophy Compass, 9(11), 745-

755.). For the issue, this drawback has been proved as an exploratory point which highlighted that
people were unaware and totally disregard the consequences of this water fluoridation process.
Another theory known as utilitarianism is based on understanding the abilities of an individual's
action to gain benefits on a larger scale under a legal and ethical framework. It has been noted
that there are two types of utilitarianism such as rule utilitarianism and act utilitarianism (Lyons,
2015). Both these types are important in gaining knowledge about the water fluoridation process
and its implications which have put challenging situations for the entire human race. Rule
utilitarianism highlighted on those means which have been acquired through legal, just and fair
system and reach the targets with beneficence.
Whereas, act utilitarianism means performing a particular work to benefit the whole
community and the involved people without any barriers or emotions involved to complete it.
One must know that these two types have disadvantages in which there is prevalent lack of
clarity and accuracy regarding the fulfilment of any task (Swenson, 2016). Thus, water
fluoridation process also has uncertainties attached and might answer by implementing the types
of utilitarianism. The ambiguity related to adopting this method has reflected on the consensual
permission of people for using the fluoridated water. Here, it is also important to understand that
using Act utilitarianism, this methodology has benefited population but at individual levels, the
autonomy got affected which has hampering effects on the well being (Bloom and Murphy,
2017). Christopher (2016) stated that Environmentalists and socialists have also responded to the
adoption of this methodology and urged to stop using it on such regular intervals. This method
has an intangible impact led to adverse influence on the health and well-being of people who are
consuming this water. However, the rule utilitarianism has widespread reach in terms of
legalities and laid the foundation of decision making in context to any method or subject. Thus,
this process has been benefited from both types, but rule utilitarianism would lead towards
justice and beneficence or an individual's autonomy.
Both the types in this theory and Deontology has helped in underpinning the drawbacks
and the need to bring justiciable and fair treatment processes to minimise the harmful effects of
water fluoridation on the populace (Mandal, J., Ponnambath, D. K., & Parija, S. C. (2016). Utilitarian and
deontological ethics in medicine. Tropical parasitology, 6(1), 5.). Along with this, there is analysis and ongoing
evaluation to address the queries framed by the concerning authorities from international and
national levels organisations. There is also an involvement from the professionals working in the

health and social care sector (Bratton 2017). The violation of rights is one of the major ethical
and legal issue that must be oppressed on the larger scales. Firstly, the professionals and the
social activists have raised questions about the removal of this process due to its negative
consequences. With small dose of fluoride consumption over a longer period had produced
adverse results such as damaging the parathyroid hormones, bones depletion, onset of skeletal
fluorosis which might lead to fractures or such risks and has effects on the physical, social and
biological development of both children and adults (Spencer et al., 2017).
In addition to the above, Gold (2016) suggests there are several challenges with water
fluoridation which include onset of diseases such as bone fluorosis, osteoporosis, hyper
calcification and more. The fluorine facilitates the collection of calcium and can lead to harmful
effects on the buckle cavity and the enamel part. However, dental fluorosis has been refereed as
one of the concerns to be looked into to have a better understanding of the chronic fluoride
poisoning. The professionals working in the dentistry must impart education and organise
awareness programs to bring transparency and improve the communication between the people
and them. Schwalbe (2015) put emphasis on the findings that consumption of fluoride has been
done through using products and several packaged foods which again add on the high levels of
this intoxicated element in the body. For instance, barley and rice have high fluoride content and
thus it tends to accumulate onto the bone tissues and leading to harmful impact by reaching the
limited range. This hampers the overall body system and let the entire body suffer in degraded
ways by affecting the entire growth and development.
To sum up, water fluoridation has reaped benefits to the human life, especially the
children and has supported in reducing the dental problems. This is beneficial in giving
protection from any decay and preserves the natural structure of tooth from any type of fillings.
However, at initial levels, this process helped in mitigating the deficiency of fluorides in the
human body but gradually with time, it has hampered the health and led to several diseases in
humans. The consumption of this public water supply is an enforcement to use this water.
Moreover, the utilitarian theory has shed light on the justification of using this process and also
emphasized on the need to make professionals and the responsible authorities to help the public
in mitigating the issues related to it. Lastly, the people has now become aware and gained
knowledge and changing their living patterns. They are discarding the use of this water along
with the bottled water to maintain the body fluid equilibrium under the normal ranges.

REFERENCES
Bratton, J. and Gold, J., 2017. Human resource management: theory and practice. Palgrave.
Christopher, M., 2016. Logistics & supply chain management. Pearson UK.
Cross, D., 2015. An unhealthy obsession with fluoride. Nanotechnol. Perceptions. 11. pp.169-
185.
Fayol, H., 2016. General and industrial management. Ravenio Books.
Iheozor‐Ejiofor, Z. et al., 2015. Water fluoridation for the prevention of dental caries. Cochrane
Database of Systematic Reviews, (6).
Iheozor‐Ejiofor, Z. et al., 2015. Water fluoridation for the prevention of dental caries. Cochrane
Database of Systematic Reviews. (6).
Kerzner, H. and Kerzner, H.R., 2017. Project management: a systems approach to planning,
scheduling, and controlling. John Wiley & Sons.
Laudon, K.C. and Laudon, J.P., 2016. Management information system. Pearson Education
India.
Lippert, F. and Juthani, K., 2015. Fluoride dose-response of human and bovine enamel artificial
caries lesions under pH-cycling conditions. Clinical oral investigations. 19(8). pp.1947-1954.
Lyons, D., 2015. Utilitarianism. Wiley Encyclopedia of Management. pp.1-4.
Morabia, A., 2016. Community water fluoridation: Open discussions strengthen public
health. American journal of public health. 106(2). p.209.
Piacquadio, P.G., 2017. A fairness justification of utilitarianism. Econometrica. 85(4). pp.1261-
1276.
Rugg-Gunn, A.J. et al., 2016. Critique of the review of'Water fluoridation for the prevention of
dental caries' published by the Cochrane Collaboration in 2015. British dental journal. 220(7).
p.335.
SA, P.W.P. and Rica, C., 2016. Forest management.
Sacco, D.F. et al., 2017. The adaptive utility of deontology: Deontological moral decision-
making fosters perceptions of trust and likeability. Evolutionary Psychological Science. 3(2).
pp.125-132.
Sanchez, P.A., 2019. Properties and Management of Soils in the Tropics. Cambridge University
Press.
Schneider, D., 2016. Apparatus for enhancing the biophysical effects of water. U.S. Patent
Application 14/965,679.
Schwalbe, K., 2015. Information technology project management. Cengage Learning.
Spencer, A.J., Do, L.G. and Ha, D.H., 2018. Contemporary evidence on the effectiveness of
water fluoridation in the prevention of childhood caries. Community dentistry and oral
epidemiology. 46(4). pp.407-415.
Spencer, A.J. et al., 2017. Preventive benefit of access to fluoridated water for young
adults. Journal of public health dentistry. 77(3). pp.263-271.Bloom, P.N. and Murphy, P.E.,
2017. Ethical issues in Social Marketing. In Marketing the Public Sector (pp. 68-78). Routledge.
Swenson, P., 2016. Subjective deontology and the duty to gather information. Ethics. 127(1).
pp.257-271.