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Fluoridation of Water
As an illustration of another measure contributing to the health in the community, the
fluoridation of water may be cited. This matter is of great topical interest at the present time.
The addition of fluoride to a water supply to bring it to almost 1 ppm. will help to prevent
dental caries in children. All evidence, such as it is, recommends it as a desirable measure.
Some consider that once the Medical Officer of Health has satisfied himself about its value, this
is the end of the matter. He must, of course, be fully convinced that it is a safe procedure. The
British Medical Officer of Health is merely a professional adviser on the scientific aspects of
the problem.
There are other ways of looking at it. For example, a recent annotation in The Lancet
stated 'passion has entered into the controversy over fluoridation because it is a measure that
restricts the liberty of the individual and none can doubt that this is worth caring for deeply.'
The Medical Officer of Health, who is very much aware of this, may consider that his
scientific recommendation is inadequate, and feel it is his duty to incorporate other considerations
in his report.
At the present time the Medical Officer of Health is besieged by propaganda with such
titles as 'M.O.H. morality'. In this it is stated 'it is hoped that this article will cause some
M.O.s to examine their own consciences and to decide whether or not they are living up to the
high standards of their profession.'
So it is obvious that some consider that there is an ethical factor to be considered and that
the recommendation to add fluoride to the public water supplies cannot be based on scientific
evidence alone. The opponents of fluoridation complain that the process involves forcing
fluoridated water upon them without respect of their personal freedom. This complaint may still
be validly made even by those who are convinced that the addition of fluoride to 1 ppm. is
beneficial to children's teeth and is safe as far as the general public is concerned. They argue
that in principle it is wrong to add this substance to a water supply and force the whole
community to drink it. By adding it to the water it makes it well nigh impossible for those who
wish to refrain from drinking such water to be able to do so. This is a denial of personal freedom,
they say. Worse may follow. Some have suggested that since 90 per cent of the community
is receiving barbiturates or tranquillisers under the National Health Service, a trace of a
suitable drug could be added to the water supply to achieve the same result, irrespective of a
minority who object to this encroachment on their personal freedom! Such views are honestly
held and, in so far as they are, they deserve respect and rational consideration.
Is it the responsibility of the Medical Officer of Health to incorporate advice in his
committee report as to what he considers the correct attitude in this matter? If so, this involves
him in taking a personal position in relation to what he considers to be the liberty of the
subject, and a definition of his understanding of the rights of free citizens living in a democratic
community such as ours.
Some are arguing that though the majority vote must rule in democracy, yet there are realms
where the State has no right to intervene and to impose its will on the minority. Most of us will
agree that this is so in matters of conscience and religious belief, and that the essence of
democracy is the maintenance of personal liberty. There are, however, those who believe that
fluoridation of the public water supply is one of those realms, and so should be resisted
obstinately. They believe that a surrender in principle means opening the door to the limitation
of personal freedom by the State.
Water is essential to life, so they argue that no option is left for the individual but to
consume it. It is practically impossible to remove fluoride completely from the public water
supply by filtration. There is a great difference between being compelled in some respect and
being disturbed or inconvenienced. The freedom of the individual to act as he or she chooses
is limited by the interest of the rest of the community. In other words, in the exercise of his
freedom he must have regard to the like liberty of others, otherwise there would be disorder
and anarchy in society. Freedom is relative and qualified. The individual may do or say what
he pleases, provided he does so without transgressing the law or infringing the legal rights of
others. Likewise public authority can only do what is legally permitted; it cannot interfere
with the subject.
The subject has liberties which are not expressly defined in any code of law, and there
are some matters in which he does not possess guaranteed rights. Parliament is the lawmaking
authority where the view of the majority prevails. In the modern world central and local
government are taking more and more responsibility in the social and public welfare of the
community. This legislative encroachment curtails the action of the individual. In public health,
as the knowledge of preventive medicine increases, measures are increasingly enacted which
the majority considers to be for the public good. In this way freedom of action of the individual
is further curtailed. In the final result only a few fundamental rights may remain as ultimately
sacrosanct, such as the peaceful enjoyment of property or freedom from illegal detention.
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