The ethics of community water fluoridation: Part 2 - how has the ethics of community water fluoridation been appraised in the literature? A scoping review

Aim To examine how the ethics of community water fluoridation has been appraised in the literature. Method A scoping review using an updated Arksey and O''Malley framework. Six electronic databases were searched: Medline via OVID; Scopus; Web of Science; Cochrane Library; StarPlus and Google Scholar. Grey literature and reference lists of included studies were also searched. Results In total, 51 studies from 15 countries were included. Many referred to biomedical ethical principles intended for clinical rather than public health interventions. Some primarily aimed to appraise its ethics whereas others considered it as part of more general discussions on fluoridation. While most acknowledged its complexity, those more supportive of fluoridation often emphasised collective benefit and those less supportive emphasised infringement of autonomy or personal liberty and concerns about harm. Few referred to public health ethics principles and frameworks available in the literature. Conclusion Different approaches have been taken to appraise the ethics of fluoridation. Frequently, these were conceived for individual medical rather than public health interventions and are inadequate to resolve tension between inevitable infringement of individual consent and collective benefit in public health. Other approaches conceived specifically for public health exist that have more utility in debates and ethical decision-making.