Fluoridation No! Seat Belts Yes!

Fluoridation No! Seat Belts Yes!

Stephen H. Unger
February 27, 2008

I don't believe government should compel people to do things for their own good. So how come I approve of laws requiring the use of automobile seat belts? Before explaining this apparent anomaly, I will set the stage with a discussion of some other well intended laws.

Stop Tooth Decay!

As a result of studies indicating that fluorides can reduce tooth decay, they have been added to the water supplies of many communities for over half a century. There were heated arguments from the outset. Some cast doubt on the efficacy of this action. Altho there is substantial evidence of a significant benefit, there are important arguments about the magnitude. The extent of possible detrimental side effects is also in dispute. A major concern is that there are big differences in water intake among people, benefits vary with age, and sensitivity to fluorides varies from person to person. Administering it via the water supply is a crude approach. Delivering fluorides in tablet form or as an ingredient in toothpaste allows much more precise dosage control.

Much has been written about the technical aspects of this controversy, which I won't discuss here. Rather, I will focus on a basic philosophical aspect, namely the circumstances (if any) under which people might properly be medicated without their consent.

First recall that, for almost a century, chlorine compounds have been routinely added to our water supplies. There has been some opposition to this, but not much. The reason is that it is generally accepted that this is critically important in preventing a number of deadly infectious diseases including cholera and typhoid fever. Chlorination has been successful to the extent that these diseases have been completely eliminated in industrialized countries. The justification for virtually compelling people to use chlorinated water is that, due to its infectious nature, a person contracting cholera becomes a danger to others.

Tooth decay, on the other hand, while sometimes painful, even disabling, and occasionally expensive to remedy, is not contagious. People who, perhaps due to neglect, develop rotten teeth, do not thereby inflict penalties on others. (I'm ignoring bad breath.) Therefore, in line with the principle enunciated by John Stuart Mill in Chapter IV of "On Liberty", namely that society has no legitimate authority over adult individuals in matters that concern only themselves, I believe it is fundamentally wrong to coerce people into using fluoridated water.

Seat Belts and Motorcycle Helmets

The principle that grown-ups should be free to do stupid things (or, more precisely, things that other people--even the great majority of other people--consider to be stupid) provided that nobody else is adversely affected, is one that I have always considered fundamental to a free society. However, its application is often far from simple, as Mill makes clear in his book. One complicating factor was brought to my attention very dramatically several decades ago.

Previously, I believed that obvious examples of unjustified coercion are laws mandating the use of seat belts or motorcycle helmets. It seemed obvious to me that, altho not using these very effective safety devices is stupid, the consequences of such stupidity are confined to the non-user. So somebody more concerned about a seat belt's effect on a trouser crease than about damage that one's skull might inflict on an automobile's front window, should be allowed to act in accordance with that concern as it does not endanger anybody else. A closer look reveals some defects in this argument.

When a person is seriously injured or killed, there are almost always significant consequences to others. Various combinations of grief, psychological pain, and financial hardship are usually inflicted on family members and friends. But if we could use such possible indirect harms to close acquaintances as a justification for constraining individual behavior, we would be on a truly slippery slope. The result could be laws restricting a person's eating habits, requiring people to exercise regularly, and to wear hats on cold days. There are, however, other indirect harms that might justify protective laws. The following episode refined my thinking on the subject.

Driving home one day, in the late afternoon when the light was starting to fade, I was proceeding slowly, having just made a right turn. One block later, with traffic very light, I started turning left. Suddenly, I peripherally sensed motion on my right, something forcefully struck the front of my car from the right, and a large body hurtled thru the air over the hood. Tho physically unscathed, I was stunned. My thought was that I had just killed a man. To my enormous relief, the body, apparently (and actually) not injured, soon stood up.

I was too shaken and too grateful for the non-tragic nature of the outcome to check into the details of what had happened. Suffice it to say that I was hit by a motorcycle that might or might not have been going too fast, but that, at a minimum, I bore a substantial share of responsibility for the accident. The motorcyclist was wearing a helmet, which might or might not have been a major factor in preventing injury. Since nobody was hurt, there were no legal actions. I incurred the cost of repairing my car, and my insurance company paid for the damage to the motorcycle.

Had the motorcyclist not been wearing a helmet, it is easy to see what a difference that might have made. Obviously, he would have been the principal victim. But the consequences to me would also have been substantial, both emotionally, and in financial and legal terms. Had it not been for the helmet, I might have had to pay a terrible price for a momentary attention lapse. Even if the circumstances had been such that I was legally blameless, I would have been grief stricken if a person had been seriously injured because I hadn't react quickly enough. (There are many situations in which one driver's timely reaction averts a serious accident that another driver's error might have caused.). One clear effect of this experience was to modify my thinking about laws mandating safe behavior.

Some Conclusions

The motorcycle case showed me that actions that might, at first thought, appear to endanger only the actor, can have significant negative effects on complete strangers. The effects on family and friends of hurting oneself might be put aside on the grounds that they generally have opportunities to reason with the actor about risky behavior. For example, friends and relatives, are usually in position to urge a person to quit smoking or to use seat belts. But sometimes others, with no such opportunities, are adversely affected. It seems to me that laws against potentially self-destructive behavior are justified if one plausible result of such behavior is to amplify substantially the penalty inflicted on someone else for a careless act. Assuming it has been well established that helmets and seat belts substantially reduce the likelihood of serious injuries and deaths, laws mandating their use are clearly in this category. No such case can be made to justify fluoridating a public water supply.

In general, determining whether a law against some allegedly self-destructive behavior is an acceptable intrusion on individual liberty is sometimes quite difficult. Particularly problematic are those involving children. An interesting twist discussed by Mill is that, while it might be wrong to use the law to prevent people from engaging in certain acts, it might be quite appropriate to prohibit others from facilitating or encouraging those acts for pecuniary reasons. So, for example, while a law making cigarette smoking a crime would not be acceptable, laws prohibiting cigarette advertising are defensible.

Comments can be sent to me at unger(at)cs(dot)columbia(dot)edu

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