GESTIÓN EN SALUD PÚBLICA: BioEdge: Taiwan grapples with the public health ethics of discouraging betel nut

sábado, 11 de marzo de 2017

BioEdge: Taiwan grapples with the public health ethics of discouraging betel nut

Taiwan grapples with the public health ethics of discouraging betel nut

by Michael Cook | 11 Mar 2017 |

Betel nut, a mild stimulant often used by truck drivers, fishermen, and construction workers, stains the teeth and lips of Taiwanese who chew it. And it also leads to dire health consequences. Taiwan has the highest incidence of oral cancer in the world. Chewing betel nut is associated with a 28 times risk of oral cancer. If it is consumed along with alcohol and cigarettes, the risk rises to 122 times (compared to people who use none of them). There are other serious risks as well, including oesophageal cancer, coronary artery disease and stillbirths.

However, as an article in the Journal of Medical Ethics points out, the government of Taiwan is finding it difficult to curb its use, despite the huge health care costs. The areca palm from which it is harvested is easy to grow, profitable and popular. About 10% of the population chews betel nut, but 43% of indigenous people do. Sales amount to about US$3 billion a year.

The bioethicists argue that the government needs to campaign against betel nut with health information and innovative economic incentives. “From a utilitarian point of view, the financial burden of diseases caused by the betel nut greatly outweighs the potential benefits from the trade ... Given the dire consequences, it is reasonable to argue that significant lowering of the incidence of betel nut chewing is in conformity with safeguarding human dignity and rights.”

However, there has been stiff resistance to anti-betel nut policies, as chewing is deeply embedded into the local culture.

A State Senator in Hawaii, Breene Harimoto gave an emotional address this week to persuade his colleagues to vote against a bill for legalising physician-assisted suicide for the terminally ill. He said that in 2015 he had been diagnosed with pancreatic cancer, which has a low survival rate and can be quite painful. But he was cured. “It is a miracle that I am still alive,” he said.

His point was that “terminal illness” is almost meaningless. Margaret Dore, a Seattle lawyer who lobbied against the bill, recalls an even more dramatic incident. “A few years ago, I was met at the airport by a man who at age 18 or 19 had been diagnosed with ALS (Lou Gehrig's disease) and given 3 to 5 years to live, at which time he would die by paralysis. His diagnosis had been confirmed by the Mayo Clinic. When he met me at the airport, he was 74 years old. The disease progression had stopped on its own."

If Senator Harimoto or Ms Dore’s friend had the option of assisted suicide, they might stopped fighting their disease and chosen a quick death. They would have chopped decades off their lives. “Terminal illness” is a pillar of assisted suicide legislation – and it just doesn’t make sense.