Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul 03080, Korea.
Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide 5000, Australia.
Int J Environ Res Public Health. 2021 Mar 1;18(5):2372. doi: 10.3390/ijerph18052372.
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.
社区饮水氟化（CWF）是一种历史悠久的公共卫生干预措施，从赞成和反对的观点都对其进行了科学证据的研究。用科学证据为 CWF 辩护不可避免地需要进行伦理辩护，这就提出了一个问题，即口腔健康是个人关注还是社会责任。由于龋齿是一个公共卫生问题，因此应该应用公共卫生伦理来处理这个问题，而不是一般的临床伦理。从赞成和反对氟化的观点来看，CWF 是一项需要大量干预的公共卫生政策。因此，除了简单的功利性之外，还需要进一步考虑为 CWF 辩护的理由。为了进一步考虑 CWF 的伦理问题，提出了三个警告：程序正义、社会背景和信任维护。为 CWF 辩护的过程也应该是合理的，不仅要通过多数规则来证明，还要通过透明和多元化民主的参与式决策来证明。社会背景应该是解决公共卫生干预中冲突价值观的过程的一部分。在考虑过程中，应该维护公众对牙科专业和口腔保健系统的信任。本文建议将合理性问责制作为一个框架，考虑 CWF 的侵权行为，为其实施进行公共辩护。
