Inspired by Geoff Walsh’s 1993 ‘each way bet‘ stumble.
A well-known proponent of fluoridation meets a rookie journalist on the steps of State Parliament (Victoria). Due to the busy workload over the holiday period, the editor of the newspaper has not yet had time to brainwash the journalist and explain the protocol that, “we never question fluoridation.” A disaster unfolds. The journalist starts asking real questions, just like the old days.
JOURNALIST: Are you familiar with the principle of informed consent to treatment?
PROPONENT: Yes, of course.
JOURNALIST: So, you would agree with the numerous bioethics declarations that enshrine this as a basic human right?
PROPONENT: Yes, naturally. Australia fully supports these types of modern ethical principles.
JOURNALIST: How would you describe the process of public water fluoridation?
PROPONENT: The controlled addition of fluoride compounds to public water supplies.
JOURNALIST: For what purpose?
PROPONENT: To help fight tooth decay.
JOURNALIST: Is that a disease?
JOURNALIST: How does fluoridation work to fight it?
PROPONENT: By making the teeth of all the little kiddies out there strong, so they resist decay better.
JOURNALIST: So, like, a prevention?
PROPONENT: Yes, exactly.
JOURNALIST: What about people who already have teeth formed?
PROPONENT: Then they will get the benefit of a constant ‘repair kit’ throughout the day, as fluoridated water washes over their teeth.
PROPONENT: Yep. That’s it.
JOURNALIST: Right. So, just to clarify, is dental caries a disease?
JOURNALIST: And by supposedly preventing or alleviating this disease, the process of water fluoridation could be called a treatment for that disease?
PROPONENT: I suppose so, yes.
JOURNALIST: Well, why don’t dentists just make everyone have fluoride treatment in their clinics? You’re a former dentist, aren’t you?
PROPONENT: Yes, I am. But it doesn’t work that way. You can’t just force your patients to have treatments, even if you believe it’s good for them. You need their permission.
JOURNALIST: What happens if you do, though?
PROPONENT: Well, as a dentist, obviously I never would, but ADA policy says there are some pretty serious consequences if a dentist did that – in fact, not even a doctor could force a treatment.
JOURNALIST: Does the ADA have a formal policy document on this?
PROPONENT: Yes, certainly.
JOURNALIST: Can you remember what it says?
PROPONENT: Yes, actually, I do.
JOURNALIST: Would you mind repeating it for the benefit of our audience?
PROPONENT: “Dentists must obtain the consent of a patient before providing treatment to that patient. Failure to obtain consent can give rise to any one or more of the following: a cause of action against the dentist in assault or battery; a negligence claim; or a complaint of professional misconduct.”
PROPONENT: I graduated top of my class. I had to remember that section for a test, back at dental school.
JOURNALIST: And just to confirm, this includes fluoride treatment?
PROPONENT: Yes, any treatment.
JOURNALIST: Since you’re on a roll, would you mind another memory test?
PROPONENT: Sure, why not.
JOURNALIST: Well, you should remember this one easily. You were part of the Committee that drafted it for State Parliament: The Victorian Charter of Human Rights and Responsibilities Act 2006.
PROPONENT: Surely, you don’t want me to recite the whole Act, kid?
JOURNALIST: No, of course not. Just the part about informed consent, since we are on that topic.
PROPONENT: Oh yes, that was one of the most important points we covered as a Committee. It pretty much re-states all other bioethical conventions. No treatment without consent. Period. I can’t recall the exact wording, though, this time, sorry.
JOURNALIST: No, no, that’s okay. But what about if someone wanted to restrict that right? Surely that would be possible, I mean, especially by an expert body or authority?
PROPONENT: No, most certainly not.
JOURNALIST: What do you mean?
PROPONENT: The Act states that, “nothing in this Charter gives a person, entity or public authority” a right to limit or destroy human rights.
JOURNALIST: Including the right of informed consent to treatment?
PROPONENT: Yes, definitely.
JOURNALIST: But didn’t you mention earlier that fluoride added to public drinking water is a treatment for the disease of dental caries?
PROPONENT: Yes, but that’s completely different.
JOURNALIST: How so?
PROPONENT: The Fluoridation Act gives the Secretary – the Head of the Department of Health – the right to direct water supply authorities to fluoridate.
JOURNALIST: To treat their communities?
JOURNALIST: Didn’t you say earlier that “nothing in this Charter gives a person, entity or public authority” a right to limit or destroy human rights?
PROPONENT: Yes, that’s a different Act though. This is the Fluoridation Act.
JOURNALIST: Who made both Acts?
PROPONENT: Parliament, of course.
JOURNALIST: So with one Act, Parliament is saying that no person, entity or public authority has the right to treat people without their consent; but the other Act is saying that’s the Secretary’s decision, and not the decision of individuals to make?
JOURNALIST: Is the Department of Health a ‘public authority’?
JOURNALIST: Is the Secretary of the Department a ‘person’?
JOURNALIST: Is Parliament an ‘entity’?
JOURNALIST: So, what gives this ‘entity’ the right to draft legislation, which empowers this ‘person’ – as Head of this ‘public authority’ – to override the enshrined human right of informed consent to treatment, as promised to all individuals within the community?
PROPONENT: Oh, look. That’s my car waiting…
JOURNALIST: Just a few more questions, I’ll try to be brief. Your time is greatly appreciated.
PROPONENT: Uum, sure, okay.
JOURNALIST: Just on the previous question, have all individuals, currently being treated with fluoridated water, given their informed consent to this treatment?
PROPONENT: No, the Fluoridation Act doesn’t say referendums or consent forms are needed. As I said before, that is the Secretary’s call to make.
JOURNALIST: To force treatment?
PROPONENT: Well, hang on, that’s a strong word.
JOURNALIST: Which one?
JOURNALIST: I’m sorry, I assumed that some people objected to this treatment, given what I’ve heard.
PROPONENT: Well, yes, many people object. But that’s why we make sure we educate them about what is best for them, so they can be sure about the good of the treatment.
JOURNALIST: Like a doctor or dentist would give the patient information about a treatment?
PROPONENT: Yes, exactly.
JOURNALIST: But the doctor or dentist couldn’t force the treatment?
PROPONENT: No. But now you’re just being silly.
JOURNALIST: I’m simply repeating your own words back to you. I mean, I shouldn’t have to, since you’re the one with the great memory.
PROPONENT: Look, kid, water fluoridation is different.
PROPONENT: It just is, because it has been done for many years. Decades in fact.
JOURNALIST: So, decades of treatment without consent?
PROPONENT: It helps people with their teeth!
JOURNALIST: Like Statins, with cholesterol; Warfarin, with blood; Lithium, with mental health; and so on?
PROPONENT: Exactly. These are the wonders of modern medicine. They’re good for people.
JOURNALIST: Good treatments? Effective?
JOURNALIST: So, doctors must have been able to force these treatments, I mean, upon all those pesky objectors over the years?
PROPONENT: No, of course not! Doctors have never forced these treatments on people. As I said, that’s just not done.
JOURNALIST: Well, why don’t we simply add these substances – and others – to public water supplies, as treatments, then consent to treatment could be bypassed, just like it is with fluoridation?
PROPONENT: That’s absurd. You can’t just go throwing things into water.
JOURNALIST: But you said these treatments are good for people. So why not?
PROPONENT: Obviously, you’d need to control the dose they get. You can’t just give a “one size fits all” treatment to everyone. Everyone is at different stages of life, and at different levels of health.
JOURNALIST: So the dose needs to be tailored for the individual, based on their specific situation and monitored with professional oversight?
JOURNALIST: So who provides the professional oversight, when water departments deliver fluoride treatment?
PROPONENT: That’s not their job.
JOURNALIST: But they are the ones providing the treatment, are they not?
PROPONENT: Yes, technically, but…
JOURNALIST: And how do they control the dose for each individual?
PROPONENT: They don’t have to. The amount in water is carefully controlled by them, as they are the water treatment experts.
JOURNALIST: You mean the concentration in water. Yes, the ‘water treatment’ experts they may be, but aren’t we talking about the treatment of human beings here? So who controls their dose – that is, how much fluoridated water they ingest?
PROPONENT: Ha! Next you’re going to tell me that Hitler used fluoride as a mind-altering agent! Time for the tin foil hats, is it?
JOURNALIST: You and I both know that’s not validated by historical evidence. Is something about this informed consent to treatment issue bothering you? Now, once and for all, did you or did you not admit earlier that fluoridating drinking water can be considered a treatment for teeth; and are teeth not a part of the human body; and therefore, is fluoridating drinking water not a treatment for the human body?
PROPONENT: Yes, I did say that. But you are now nit-picking. Why can’t you just be happy that all those little kiddies are being given a good treatment for their teeth?
JOURNALIST: Sir, I’m merely attempting to clarify your position, for the benefit of my readers. Oh and by the way, you just brought up another good point.
PROPONENT: Oh, God!
JOURNALIST: Regarding these “little kiddies”; I was also under the impression that children require the informed consent of their parents, for them to be treated?
PROPONENT: Well, obviously!
JOURNALIST: How many children would you estimate are treated with fluoride treatment, via public water supplies, in Victoria, every day?
PROPONENT: Thousands. Perhaps a million or more.
JOURNALIST: And how many of their parents gave consent?
PROPONENT: None. But they should be happy. We know what’s best. That’s all that matters.
JOURNALIST: I thought informed consent mattered most.
PROPONENT: Okay, time’s up kiddo.
JOURNALIST: One last question.
PROPONENT: Oh, what the heck. Yeah? You anti-fluoridationists are all the same.
JOURNALIST: I never said I was anti-fluoridation. I’m pro-clarification.
PROPONENT: Of what?
JOURNALIST: Your position on informed consent to treatment.
PROPONENT: I’ve made myself clear.
JOURNALIST: If you say so.
JOURNALIST: Well, there you have it ladies and gentlemen, the sound ‘logic’ of mandatory water fluoridation.