Abstract
This article addresses the ethics of betel nut use in Taiwan. It first presents scientific facts about the betel quid and its consumption and the generally accepted negative health consequences associated with its use: oral and esophageal cancer, coronary artery disease, metabolic diseases, and adverse effects in pregnancy. It then analyzes the cultural background and economic factors contributing to its popularity in Asia. The governmental and institutional attempts to curb betel nut cultivation, distribution, and sales are also described. Finally, the article analyzes the bioethical implications of this often-ignored subject from the perspectives of human dignity, the good of health, vulnerable groups, cultural diversity, informed consent, and ethical blind spots.
This is a preview of subscription content, access via your institution.
Notes
Research done on website on November 4, 2015. https://bioethics.georgetown.edu/library-materials/bioethics-research-library-databases/ethxweb/
An abridged version of this paper has been previously published: J. Tham, G. Sem, E. Sit, M. Tai, “The ethics of betel nut consumption in Taiwan,” in Journal of Medical Ethics. Published Online First: 06 March 2017. doi: 10.1136/medethics-2016-103,990
References
Adams, Peter J., Stephen Buetow, and Fiona Rossen. 2010. Vested interests in addiction research and policy poisonous partnerships: Health sector buy-in to arrangements with government and addictive consumption industries. Addiction (Abingdon, England) 105 (4): 585–590. https://doi.org/10.1111/j.1360-0443.2009.02815.x.
Bazerman, Max, and Francesca Gino. 2012. Behavioral ethics: Toward a deeper understanding of moral judgment and dishonesty, January 2012. http://www.hbs.edu/faculty/Pages/item.aspx?num=42452.
Bazerman, Max, and Ann Tenbrusel. 2012. Blind spots: Why we fail to do what’s right and what to do about it. 1st ed. Princeton: Princeton University Press.
Beauchamp, Tom L., and James F. Childress. 2001. Principles of biomedical ethics. Oxford University Press.
Brundtland, G. 2002. Reducing risks to health, promoting healthy life. JAMA 288 (16): 1974–1974. https://doi.org/10.1001/jama.288.16.1974.
Cancer.net. 2015. Esophageal cancer—Statistics. http://www.cancer.net/cancer-types/esophageal-cancer/statistics.
Chen, Sheng-Hung, Jie-Min Lee, Hsiang-Hsi Liu, Hui-Cheng Wang, and Chun-Yuan Ye. 2011. The cross-effects of cigarette and betel nut consumption in Taiwan: Have tax increases made a difference? Health Policy and Planning 26 (3): 266–273. https://doi.org/10.1093/heapol/czq041.
Cheng, JD, JP Lin, SY Lu, LS Huang, and HL Wu. 2008. Hydrological characteristics of betel nut plantations on slopelands in Central Taiwan / Caractéristiques Hydrologiques de Plantations de Noix de Bétel Sur Des Versants Du Centre Taïwan. Hydrological Sciences Journal 53 (6): 1208–1220. https://doi.org/10.1623/hysj.53.6.1208.
Control Yuan, Taiwan. 2013. 監察院全球資訊網 ─ 調查報告. January 2013. http://www.cy.gov.tw/sp.asp?xdUrl=./di/edoc/eDocForm_Read.asp&ctNode=910&AP_Code=eDoc&Func_Code=t01&case_id=102000020.
Council of Agricultural, Executive Yuan, Taiwan. 1998. 檳榔問題管理方案 [Management plan for the control of the betel nut problem]. 1998. https://www.google.it/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwj8p--mtLbJAhVCCw8KHevgAHQQFggoMAE&url=http%3A%2F%2Fws.ndc.gov.tw%2FDownload.ashx%3Fu%3DLzAwMS9hZG1pbmlzdHJhdG9yLzEwL3JlbGZpbGUvNTY4Ny80NzI4LzAwMjc2MDJfOC5wZGY%253D%26n%3DNTcyNjE2MjE1MTcxLnBkZg%253D%253D%26icon%3D..pdf&usg=AFQjCNEaER2-pc2AKRx97qUBVgXwaUFoqA&bvm=bv.108194040,d.bGQ.
————. 2008. 檳榔園廢園、轉作作業規範 [Destroy betel nut farms and substitute for other use]. 2008. http://www.coa.gov.tw/show_%20news.php?cat=show_news&serial=9_diamond_20080108115251.
————. 2011. 行政院農業委員會編訂:中華民國九十年十一月. November 2011. http://www.coa.gov.tw/view.php?catid=979.
————. 2014. 檳榔管理方案 [Management plan of the betel nut]. 2014. http://www.coa.gov.tw/view.php?catid=20321.
Department of Health, Taiwan. 2014. 兒童、青少年檳榔防制工作計畫 [Education plan on betel nut prevention for children and adolescents]. 2014. cpd.moe.gov.tw/_downfile.php?id=893.
Dolby, Ieuan. 2003. The betel nut sucker. ThingsAsian. 28 December 2003. http://thingsasian.com/story/betel-nut-sucker.
ETtoday. 2013. 沒把檳榔管理好 行政院、農委會被監院糾正. http://www.ettoday.net/news/20130110/150971.htm.
Pope Francis. 2015. Encyclical Letter Laudato Si (on care for our common home). http://w2.vatican.va/content/francesco/en/encyclicals/documents/papa-francesco_20150524_enciclica-laudato-si.html.
Gracey, Michael, and Malcolm King. 2009. Indigenous health part 1: Determinants and disease patterns. The Lancet 374 (9683): 65–75. https://doi.org/10.1016/S0140-6736(09)60914-4.
Guo, Su-Er, Tung-Jung Huang, Jui-Chu Huang, Ming-Shyan Lin, Rei-Mei Hong, Chia-Hao Chang, and Mei-Yen Chen. 2013. Alcohol, betel-nut and cigarette consumption are negatively associated with health promoting behaviors in Taiwan: A cross-sectional study. BMC Public Health 13 (1): 257. https://doi.org/10.1186/1471-2458-13-257.
Gupta, P.C., and C.S. Ray. 2004. Epidemiology of betel quid usage. Annals of the Academy of Medicine, Singapore 33 (4 Suppl): 31–36.
Hsu, Stacy. 2014. Betel nut classes target curbing habit, preventing cancer. Taipei Times, 4 April 2014. http://www.taipeitimes.com/News/taiwan/archives/2014/04/19/2003588400.
International Agency for Research on Cancer. 2004. Betel-quid and areca-nut chewing and some areca-nut-derived nitrosamines. http://monographs.iarc.fr/ENG/Monographs/vol85/index.php.
Kaye, Melati. n.d. Betel nut explosions: The maturing of a Taiwanese drug culture and market. http://www.reed.edu/luce/documents/KayeLuceReport.pdf.
King, Malcolm, Alexandra Smith, and Michael Gracey. 2009. Indigenous health part 2: The underlying causes of the health gap. The Lancet 374 (9683): 76–85. https://doi.org/10.1016/S0140-6736(09)60827-8.
Ko, Y.C., Y.L. Huang, C.H. Lee, M.J. Chen, L.M. Lin, and C.C. Tsai. 1995. Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan. Journal of Oral Pathology & Medicine: Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology 24 (10): 450–453.
Lee, Chien-Hung, Albert Min-Shan Ko, Saman Warnakulasuriya, Bang-Liang Yin, Sunarjo, Rosnah Binti Zain, Salah Osman Ibrahim, et al. 2011. Intercountry prevalences and practices of betel-quid use in South, Southeast and Eastern Asia regions and associated oral preneoplastic disorders: An international collaborative study by Asian betel-quid consortium of South and East Asia. International Journal of Cancer. Journal International Du Cancer 129 (7): 1741–1751. https://doi.org/10.1002/ijc.25809.
Lin, Chin-Feng, Jung-Der Wang, Ping-Ho Chen, Shun-Jen Chang, Yi-Hsin Yang, and Ying-Chin Ko. 2006. Predictors of betel quid chewing behavior and cessation patterns in Taiwan aborigines. BMC Public Health 6 (1): 271. https://doi.org/10.1186/1471-2458-6-271.
Lu, C.T., S.J. Lan, C.C. Hsieh, M.J. Yang, Y.C. Ko, C.C. Tsai, and Y.Y. Yen. 1993. Prevalence and characteristics of areca nut chewers among junior high school students in Changhua County, Taiwan. Community Dentistry and Oral Epidemiology 21 (6): 370–373.
Madigan, Talmage-Bowers. 2016. How dangerous is betel nut? Healthline. http://www.healthline.com/health/betel-nut-dangers.
Messick, David M., and Ann E. Tenbrunsel. 1996. Codes of conduct: Behavioral research into business ethics: Behavioral research into business ethics. Russell Sage Foundation.
Miller, Jennifer E., Elinor Amit, and Ann-Christin Posten. 2015. Behavioral economics. In Encyclopedia of global bioethics, edited by Henk ten Have. Cham: Springer International Publishing, p. 1–6. http://link.springer.com/10.1007/978-3-319-05544-2_37-1.
Ministry of Health and Welfare. 2015. 2015 health promotion administration annual report. http://health99.hpa.gov.tw/media/public/pdf/21791.pdf.
Petti, Stefano, Mohd Masood, and Crispian Scully. 2013. The magnitude of tobacco smoking-betel quid chewing-alcohol drinking interaction effect on oral cancer in South-East Asia. A meta-analysis of observational studies. PLoS ONE 8 (11). doi:https://doi.org/10.1371/journal.pone.0078999.
PLoS Medicine Editors. 2011. Let’s be straight up about the alcohol industry. PLoS Medicine 8 (5). doi:https://doi.org/10.1371/journal.pmed.1001041.
Sandford, Amanda. 2003. Government action to reduce smoking. Respirology (Carlton, Vic.) 8 (1): 7–16.
Sgreccia, Elio. 2010. Manuale di bioetica: 2. 4th ed. Milano: Vita e Pensiero.
Stenius, Kerstin, and Thomas F. Babor. 2010. The alcohol industry and public interest science. Addiction (Abingdon, England) 105 (2): 191–198. https://doi.org/10.1111/j.1360-0443.2009.02688.x.
Sun, Yu-huay. 2006. Taiwan’s 60,000 betel-nut beauties thwart effort to curb cancer. https://article.wn.com/view/2006/01/26/Taiwans_60000_BetelNut_Beauties_Thwart_Effort_to_Curb_Cancer/.
Sunshine Social Welfare Foundation. 2012. 行政院輕忽檳榔致癌 防制工作事倍功半. http://www.sunshine.org.tw/SunTalk/TalkView.asp?STID=320.
Tham, Joseph, Alberto Garcia, and Gonzalo Miranda, eds. 2014. Religious perspectives on human vulnerability in bioethics. 2014 edition. New York: Springer.
Tham, Joseph, Alberto Garcia, and Kai Man Kwan. 2017. Religious perspectives on bioethics and human rights. New York: Springer.
The Oral Cancer Foundation. n.d. Oral cancer facts. http://www.oralcancerfoundation.org/facts/.
Tracy, Sarah W., and Caroline Jean Acker. 2004. Altering American Consciousness: The history of alcohol and drug use in the United States, 1800–2000. University of Massachusetts Press.
Tsai, Wei-Chung, Ming-Tsang Wu, Guei-Jane Wang, Kun-Tai Lee, Chien-Hung Lee, Ye-Hsu Lu, Hsueh-Wei Yen, et al. 2012. Chewing areca nut increases the risk of coronary artery disease in Taiwanese men: A case-control study. BMC Public Health 12 (1): 162. https://doi.org/10.1186/1471-2458-12-162.
UNESCO. 2005. Universal declaration on bioethics and human rights. http://www.unesco.org/new/en/social-and-human-sciences/themes/bioethics/bioethics-and-human-rights/.
Warnakulasuriya, Saman, Chetan Trivedy, and Timothy J. Peters. 2002. Areca nut use: An independent risk factor for oral cancer. BMJ (Clinical Research Ed.) 324 (7341): 799–800.
Wolters Kluwer Health. 2009. Betel nut uses, benefits & dosage—Drugs.com herbal database. 2009. http://www.drugs.com/npp/betel-nut.html.
World Health Organization. 2003. Framework Convention on Tobacco Control (FCTC). http://apps.who.int/iris/bitstream/10665/42811/1/9241591013.pdf.
Wu, I.C., C.Y. Lu, F.C. Kuo, S.M. Tsai, K.W. Lee, W.R. Kuo, Y.J. Cheng, E.L. Kao, M.S. Yang, and Y.C. Ko. 2006. Interaction between cigarette, alcohol and betel nut use on esophageal cancer risk in Taiwan. European Journal of Clinical Investigation 36 (4): 236–241. https://doi.org/10.1111/j.1365-2362.2006.01621.x.
Yang, M.J., T.C. Chung, M.J. Yang, T.Y. Hsu, and Y.C. Ko. 2001. Betel quid chewing and risk of adverse birth outcomes among aborigines in Eastern Taiwan. Journal of Toxicology and Environmental Health. Part A 64 (6): 465–472. https://doi.org/10.1080/152873901753215920.
李家同. 2014. 政府別再逃避責任!李家同:請關心勞動族健康,檳榔加警語 | 名家 | 三立新聞網. SETN.COM. http://www.setn.com/ColumnNews.aspx?NewsID=30200.
林富士. 2014. 試論影響食品安全的文化因素:以嚼食檳榔為例. 月旦法學知識庫 10 (1):43–04.
林昱廷. 2010. 檳榔對台灣經濟的影響. http://saturn.cksh.tp.edu.tw/~webadmin/site2/data/user/library/files/201005061435430.pdf.
潘姿吟. 2015. 好命自己拼:來穿檳榔葉 拖鞋紅回台 月賣百萬元. 蘋果日報. http://www.appledaily.com.tw/appledaily/article/finance/20150526/36570701/.
陳昱安. 2010. 台灣口香糖─檳榔之探討. http://saturn.cksh.tp.edu.tw/~webadmin/site2/data/user/library/files/201005061435430.pdf?_sm_au_=iVVfDJMt2QQ33tFs.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tham, J., Sem, G., Sit, E. et al. A Scientific and Socioeconomic Review of Betel Nut Use in Taiwan with Bioethical Reflections. ABR 9, 401–414 (2017). https://doi.org/10.1007/s41649-017-0028-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s41649-017-0028-6
Keywords
- Betel nut
- Bioethics
- Medical ethics
- Addiction
- Oral cancer
- Indigenous population
- Vulnerable groups
- Behavioral ethics