Community water fluoridation is often described as creating a tension between which two ethical principles?

Correct answer: B. Beneficence and autonomy

• A. Veracity and justice are not the principles in tension here — no deception is involved.
• B. Correct. Fluoridation delivers a population-level benefit (BENEFICENCE — reduced caries across an entire community, disproportionately helping those with least access to dental care) while simultaneously removing the individual's ability to opt out of ingesting a therapeutic agent (AUTONOMY). This is the classic public health ethics tension: collective good versus individual choice. The usual counter-argument invokes justice, since fluoridation narrows oral health inequities.
• C. Confidentiality has no bearing on a population water supply measure.
• D. Non-maleficence would be central only if fluoridation at optimal levels caused demonstrable harm, which it does not.