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No. Articial fluoridation of municipal water is not ethical.Water, like air, is a shared resource that is necessary to life. There are many for whom consumption of even ‘optimally’ fluoridated water is harmful. But even if low concentrations weren’t harmful to some consumers, fluoridation is still a medical assault and battery on any individual who does not individually consent to that treatment.”Any preventive, diagnostic and therapeutic medical intervention is only to be carried out with the prior, free and informed consent of the person concerned, based on adequate information. The consent should, where appropriate, be express and may be withdrawn by the person concerned at any time and for any reason without disadvantage or prejudice.” - UNESCO on Medical Consent in Bioethics and Human Rights, Article 6 (2005)“In no case should a collective community agreement or the consent of a community leader or other authority substitute for an individual’s informed consent.” - UNESCO documents on Medical Consent in Bioethics and Human Rights, Article 6 (2010)I suggest that the most recent high quality NIH sponsored studies out of the ELEMENT and MIREC projects on the impact of ‘optimal dose’ fluoride exposure are a very sobering indictment of fluoridation policy ethics.MIREC REFERENCESAssociation Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada. Rivka Green, Bruce Lanphear, Richard Hornung, et al. JAMA Pediatrics. August 19, 2019 [online ahead of print].Fluoride exposure and thyroid function among adults living in Canada: Effect modification by iodine status. Ashley J. Malin, Julia Riddell, Hugh McCague, Christine Till. Environment International. Volume 121, Part 1, December 2018, Pages 667-674.Community Water Fluoridation and Urinary Fluoride Concentrations in a National Sample of Pregnant Women in Canada. Christine Till, Rivka Green, John G. Grundy, et al. Environmental Health Perspectives. 2018.ELEMENT REFERENCESPrenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6–12 Years of Age in Mexico. Morteza Bashash, Deena Thomas, Howard Hu, et al. Environ Health Perspect. Sept 2017. Vol 125, Issue 9.OP V – 2 Prenatal fluoride exposure and neurobehavior among children 1–3 years of age in Mexico. Deena Thomas, Brisa Sanchez, Karen Peterson, et al. Occup Environ Med. 2018;75:A10.Prenatal fluoride exposure and attention deficit hyperactivity disorder (ADHD) symptoms in children at 6–12 years of age in Mexico City. Morteza Bashash, Maelle Marchand, Howard Hu, et al. Environment International. Volume 121, Part 1, December 2018, Pages 658-666.Fluoride exposure and pubertal development in children living in Mexico City. Yun Liu, Martha Téllez-Rojo, Howard Hu, et al. Environ Health. 2019 Mar 29;18(1):26.

This is something for which there is a medical guideline. From the WPATH Standards of Care:Adolescents may be eligible for puberty suppressing hormones as soon as pubertal changes have begun. In order for adolescents and their parents to make an informed decision about pubertal delay, it is recommended that adolescents experience the onset of puberty to at least Tanner Stage 2. Some children may arrive at this stage at very young ages (e.g., 9 years of age). Studies evaluating this approach only included children who were at least 12 years of age (Cohen-Kettenis, Schagen, Steensma, de Vries, & Delemarre-van de Waal, 2011; de Vries, Steensma et al., 2010; Delemarre-van de Waal, van Weissenbruch, & Cohen Kettenis, 2004; Delemarre-van de Waal & Cohen-Kettenis, 2006).[1][1][1][1]The requirements for an adolescent to begin puberty suppressing hormone therapy are:The adolescent has demonstrated a long-lasting and intense pattern of gender nonconformity or gender dysphoria (whether suppressed or expressed);Gender dysphoria emerged or worsened with the onset of puberty;Any co-existing psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start treatment;The adolescent has given informed consent and, particularly when the adolescent has not reached the age of medical consent, the parents or other caretakers or guardians have consented to the treatment and are involved in supporting the adolescent throughout the treatment process. [2]Ultimately, there are physiological milestones of development that will determine when an adolescent is physically old enough for this kind of treatment. It’s important to remember physiological development alone doesn’t dictate treatment. It does, however, significantly influence treatment because pubertal development can intensify the distress caused by gender dysphoria[3][3][3][3] and delaying treatment can have an adverse impact on the patient’s mental health as well as adversely impacting the long term outcomes of gender affirming care. (i.e., if you allow breast development to progress in trans masculine individuals, they may require a surgical intervention, mastectomy and chest reconstruction, to remove breast tissue as a result of having postponed puberty delaying treatment.)For people concerned about puberty delaying treatment, it’s important to remember that there is no neutral decision. It’s a bit like the trolley dilemma:For those un-familiar, the trolley dilemma presents a trolley on the tracks, on course to run over 5 people. You can throw a switch and the trolley will only run over 1 person. It asks us if we would make the deliberate decision to harm one person or passively accept harm coming to more than one person.With puberty delaying therapy, we postpone pubertal development in order for the adolescent to mature enough to make decisions about more permanent interventions. If the adolescent decides that they really aren’t trans, that they are comfortable living as the gender they were assigned at birth, they go off puberty delaying medication and development occurs more or less as normal. They may have some stunted development, they will have had years where they lagged behind their peers in physical development and that isn’t without consequence. At the same time, the consequence of doing nothing means that a gender dysphoric child goes through additional distressing development and the physiological development that occurs can only be treated with significantly more expensive, invasive and painful surgical interventions. Those same surgical interventions may not produce the quality of outcomes that would have been achieved with puberty delaying hormone therapy and cross sex hormone therapy during adolescence.Neither decision is free of consequence. However, medical ethicists have pointed out that the choice to do nothing has significantly greater adverse consequences for the child[4][4][4][4] and I’m inclined to agree with them that our ethical obligation is to act rather than passively wait and hope that the dysphoria goes away.Footnotes[1] https://www.wpath.org/media/cms/Documents/Web%20Transfer/SOC/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf[1] https://www.wpath.org/media/cms/Documents/Web%20Transfer/SOC/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf[1] https://www.wpath.org/media/cms/Documents/Web%20Transfer/SOC/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf[1] https://www.wpath.org/media/cms/Documents/Web%20Transfer/SOC/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf[2] https://www.wpath.org/media/cms/Documents/Web%20Transfer/SOC/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf[3] Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People: Health considerations for gender non-conforming children and transgender adolescents[3] Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People: Health considerations for gender non-conforming children and transgender adolescents[3] Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People: Health considerations for gender non-conforming children and transgender adolescents[3] Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People: Health considerations for gender non-conforming children and transgender adolescents[4] Lives in a chiaroscuro. Should we suspend the puberty of children with gender identity disorder?[4] Lives in a chiaroscuro. Should we suspend the puberty of children with gender identity disorder?[4] Lives in a chiaroscuro. Should we suspend the puberty of children with gender identity disorder?[4] Lives in a chiaroscuro. Should we suspend the puberty of children with gender identity disorder?

Female pain is not taken seriously.I will repeat, FEMALE PAIN IS NOT TAKEN SERIOUSLY.The most common reasons for a 12 year old to need the contraceptive pill are to reduce menstruation pain and control heavy periods. I am not particularly concerned whether, if you put said 12 year old next to a woman with the most severe pain and bleeding in Given Country Of Prescription, the 12 year old’s suffering will turn out to be objectively less. From her perspective she is having a terrible time.The contraceptive pill is an effective medication for uterine pain and bleeding reduction. Prescribing it to a competent 12 year old with heavy periods will improve her school performance and reduce her embarrassment as well as improving her quality of life. Yes, evaluate her competence and also her risk of abuse. The very moral panic around prescribing this medication to legal children is precisely the reason doctors need to be able to prescribe it without parental consent— because when a parent is shouting, “NO CHILD OF MINE GETS BIRTH CONTROL!”, any suffering daughter of theirs needs a way round that block.(I am against all instances where parents can refuse suitable medical treatment that improves their child's life simply Because I Say So. Adults can refuse medical treatment for themselves at whim. They should not have the power to make their minor children's lives worse than otherwise. Also note that I live in a country where all medical treatment for children is free and also all contraceptive pills are free no matter the age of the person getting them.)