Revisiting the ethical framework governing water fluoridation and food fortification

Abstract

Food fortification and water fluoridation are two public health initiatives that involve the passive consumption of nutrients through food and water supplies. While ethical analyses of food fortification and water fluoridation have been done separately, none have been done together. In this paper, we will consider whether the similarities between food fortification and water fluoridation override their differences and thus what ethical conclusions can be cross-pollinated between the two interventions. This study does three things: first, we review the origin, reasoning and mechanisms behind food fortification and water fluoridation. From there, we deduce the primary ethical dilemma that overshadows food fortification and water fluoridation – they both require a form of deception and are consumed passively without the need for informed consent. Finally, we look at various approaches ethicists have taken to understand the ethical issues surrounding the programs. Two key ethical models appear in this discussion: the justificatory approach and the stewardship model. Beyond these two frameworks, one ethical analysis deduces from the Nuremberg Code that water fluoridation is unethical based on the definition of consent. As recent scientific papers and the general public have started discussing and debating the passive consumption of various drugs via public water supplies, it is prudent that we revisit the ethics behind food fortification and water fluoridation programs; this will ultimately allow us to better navigate complex problems in nutritional ethics and passive delivery.