Conclusion: The present results support adequate psychometric properties in terms of factorial validity, reliability, convergent validity, and measurement invariance for the PHQ-4 in young adults in Hong Kong. The PHQ-4 demonstrated a substantial mediating role in the relationship between meaning in life and SI in the distress group. These findings support clinical relevance for using the PHQ-4 as a brief and valid measure of psychological distress in the Chinese context.

Introduction: The Kenyan government has put a spirited reform to ensure all Kenyans get universal healthcare. This has led to restructuring of several entities among them the health insurance industry. This is geared at alleviating the burden of catastrophic expenditure on health from the poor Kenyans. However, insurance uptake remains at less than a quarter of the population with many Kenyans still paying for healthcare out-of-pocket. These out-of-pocket payers often don’t afford the ever-increasing cost of healthcare in Kenya. This study (...) looked at how doctors deal with patients given their modality of payment. Methodology: This was an online based survey that was distributed to Kenyan doctors via email by Kenya Medical Association. The survey sought information from the respondents on how they dealt with patients given their modality of payment. In addition, respondents were asked to provide an example of a case they had dealt with that touched on each payment modality. Results: Respondents gave their experiences where insurance had influenced their clinical decisions. Codes developed from the prose were; “inability to pay”, “harmful to the patient”, “changed the prescription” among others Health insurance played a crucial role whenever respondents made decisions. Top on the list of things that the majority indicated would be considered is insurance status and/or their ability of patients to pay for the services. Conclusion: Respondents are stuck in a limbo; striving to give the best care to patients but limited by the patients’ inability to pay. In explaining their experiences, respondents explain a situation where they intend to offer the best, but patients cannot afford. This especially so for those without health insurance who end up either not getting services or at the very best, get inferior services. (shrink)

Putnam’s most famous contribution to mathematical logic was his role in investigating Hilbert’s Tenth Problem; Putnam is the ‘P’ in the MRDP Theorem. This volume, though, focusses mostly on Putnam’s work on the philosophy of logic and mathematics. It is a somewhat bumpy ride. Of the twelve papers, two scarcely mention Putnam. Three others focus primarily on Putnam’s ‘Mathematics without foundations’ (1967), but with no interplay between them. The remaining seven papers apparently tackle unrelated themes. Some of this disjointedness would (...) doubtless have been addressed, if Putnam had been able to compose his replies to these papers; sadly, he died before this was possible. In this review, I do my best to tease out some connections between the paper; and there are some really interesting connections to be made. (shrink)

This is a book review of Karim Bschir and Jamie Shaw (eds.); Interpreting Feyerabend: critical essays. Cambridge: Cambridge University Press, 2021, 290 pp, $99.99 HB.

I offer some responses to Prosser’s ‘Experiencing Time’, one of whose goals is to debunk a view of temporal experience somewhat prevalent in the metaphysics literature, which I call ‘Perceptualism’. According to Perceptualism: it is part of the content of perceptual experience that time passes in a metaphysically strong sense: the present has a metaphysically privileged status, and time passes in virtue of changes in which events this ‘objective present’ highlights, and moreover this gives us evidence in favor of strong (...) passage. Prosser argues that perception cannot be sensitive to whether the strong passage obtains, and therefore cannot represent strong passage in a way that gives us evidence of its truth. Although I accept this conclusion, I argue that Prosser’s argument for it is problematic. It threatens to over-generalize to rule out uncontroversial cases of perceptual knowledge, such as our knowledge that we live in a spatial world. Furthermore, a successful argument ruling out perceptual evidence for strong passage would have to give constraints on the theory/observation distinction of a kind not provided by Prosser’s discussion. I also comment on several other parts of the book. (shrink)

I assess a number of connected ideas about temporal experience that are introspectively plausible, but which I believe can be argued to be incorrect. These include the idea that temporal experiences are extended experiential processes, that they have an internal structure that in some way mirrors the structure of the apparent events they present, and the idea that time in experience is in some way represented by time itself. I explain how these ideas can be developed into more sharply defined (...) views, and then argue that these views are inconsistent with certain empirical facts about how time is represented in the brain. These facts instead support a kind of atomic view, on which temporal experiences are temporally unstructured atoms. (shrink)

This paper examines the relationship of ethical decision-making by individuals to corporate business ethics and organizational performance of three groups: SMEs, Outstanding SMEs and Large Enterprises, in order to provide a reference for Taiwanese entrepreneurs to practice better business ethics. The survey method involved random sampling of 132 enterprises within three groups. Some 524 out of 1320 questionnaires were valid. The survey results demonstrated that ethical decision-making by individuals, corporate business ethics and organizational performance are highly related. In summary, then, (...) high levels of organizational performance were directly attributable to high levels of applied corporate and individual ethics. Furthermore, there is a demonstrable tendency for Outstanding SMEs to reject ethically unsound practices such as padded expense accounts, tax evasion and misleading advertising. The measurement criteria used to assess organizational performance, however, did not include an objective evaluation of financial performance. (shrink)

I give an account of the difference between "Holistic" and "Atomistic" views of conscious experience. On the Holistic view, we enjoy a unified "field" of awareness, whose parts are mere modifications of the whole, and therefore owe their existence to the whole. There is some tendency to saddle those who reject the Holistic field model with a (perhaps) implausible "building block" view. I distinguish a number of different theses about the parts of an experience that are suggested by the "building (...) block" metaphor, but which can be rejected by those who also reject the holistic field view. (shrink)

The principle of sufficient reason threatens modal collapse. Some have suggested that by appealing to the indefinite extensibility of contingent truth, the threat is neutralized. This paper argues that this is not so. If the indefinite extensibility of contingent truth is developed in an analogous fashion to the most promising models of the indefinite extensibility of the concept set, plausible principles permit the derivation of modal collapse.

This essay draws on the work of Jacques Derrida and Angela Y. Davis towards a philosophical resistance to the death penalty in the U.S. I find promise in Derrida’s claim that resistance to the death penalty ought to contest a political structure that founds itself on having the power to decide life and death, but I move beyond Derrida’s desire to consider the abolition of the death penalty without engaging with the particular histories and geographies of European colonialism. I offer (...) a critique of Derrida’s recently published work on the death penalty by engaging with the work of Davis and argue that discussions of state violence in nations that inherit European forms of sovereignty must take seriously the racist violence on which those sovereign powers rely. (shrink)

During the Standing Rock protests in North Dakota, USA/Turtle Island, a group of military veterans knelt in front of Oceti Sakowin Elders asking forgiveness for centuries of settler colonial military ventures in Oceti Sakowin Territory. Leonard Crow Dog forgave them and immediately demanded respect for Native Nations throughout the U.S. Lacking such respect, he said, Native people will cease paying taxes. Crow Dog’s post-forgiveness remarks speak to the political context of the military veterans’ request: They seek collective forgiveness amidst ongoing (...) occupation and harms committed by the collective they represent. In this chapter, I examine this case study and argue that ongoing harm undermines requests for forgiveness on behalf of collectives. I look to the work of Glen Coultard, Waziyatawin, and Leanne Simpson to consider what a responsible request for collective forgiveness would entail. (shrink)

This Essay analyzes an essay by H. L. A. Hart about discretion that has never before been published, and has often been considered lost. Hart, one of the most significant legal philosophers of the twentieth century, wrote the essay at Harvard Law School in November 1956, shortly after he arrived as a visiting professor. In the essay, Hart argued that discretion is a special mode of reasoned, constrained decisionmaking that occupies a middle ground between arbitrary choice and determinate rule application. (...) Hart believed that discretion, soundly exercised, provides a principled way of coping with legal indeterminacy that is fully consistent with the rule of law. This Essay situates Hart’s paper – Discretion – in historical and intellectual context, interprets its main arguments, and assesses its significance in jurisprudential history. In the context of Hart’s work, Discretion is notable because it sketches a theory of legal reasoning in depth, with vivid examples. In the context of jurisprudential history, Discretion is significant because it sheds new light on long-overlooked historical and theoretical connections between Hart’s work and the Legal Process School, the American jurisprudential movement dominant at Harvard during Hart’s year as a visiting professor. Hart’s Discretion is part of our jurisprudential heritage, advancing our understanding of legal philosophy and its history. (shrink)

The articles that comprise this special issue of Intellectual History Review are briefly described.

Recently some philosophers have defended the thesis that naturalness, or joint-carvingness, is an aim of belief. This paper argues that there is an important class of counterexamples to this thesis. In particular, it is argued that naturalness is not an aim of our beliefs concerning what is joint carving and what is not.

The case for secrecy in voting depends on the assumption that voters reliably vote for the political outcomes they want to prevail. No such assumption is valid. Accordingly, voting procedures should be designed to provide maximal incentive for voters to vote responsibly. Secret voting fails this test because citizens are protected from public scrutiny. Under open voting, citizens are publicly answerable for their electoral choices and will be encouraged thereby to vote in a discursively defensible manner. The possibility of bribery, (...) intimidation or blackmail moderates this argument but such dangers will be avoidable in many contemporary societies without recourse to secrecy. (shrink)

In two rarely discussed passages – from unpublished notes on the Principles of Philosophy and a 1647 letter to Chanut – Descartes argues that the question of the infinite extension of space is importantly different from the infinity of time. In both passages, he is anxious to block the application of his well-known argument for the indefinite extension of space to time, in order to avoid the theologically problematic implication that the world has no beginning. Descartes concedes that we always (...) imagine an earlier time in which God might have created the world if he had wanted, but insists that this imaginary earlier existence of the world is not connected to its actual duration in the way that the indefinite extension of space is connected to the actual extension of the world. This paper considers whether Descartes’s metaphysics can sustain this asymmetrical attitude towards infinite space vs. time. I first consider Descartes’s relation to the ‘imaginary’ space/time tradition that extended from the late scholastics through Gassendi and More. I next examine carefully Descartes’s main argument for the indefinite extension of space and explain why it does not apply to time. Most crucially, since duration is merely conceptually distinct from enduring substance, the end or beginning of the world entails the end or beginning of real time. In contrast, extension does not depend on any enduring substance besides itself. (shrink)

matter of knowing that -- that injustice is wrong, courage is valuable, and care is As a result, what I'll be doing is primarily defending in general -- and due. Such knowledge is embodied in a range of capacities, abilities, and skills..

In this work, we attempt to define a notion of compositeness compatible with Quantum Field Theory. Considering the analytic properties of the S-matrix, we conclude that there is no satisfactory definition of compositeness compatible with Quantum Field Theory. Without this notion, one must claim that all bound states are equally fundamental, that is, one cannot rigorously claim that everyday objects are made of atoms or that atoms are made of protons and neutrons. I then show how an approximate notion of (...) compositeness may be recovered in the regime where the mass of a bound state is close to a multi-particle threshold. -/- Finally, we see that rejecting compositeness solves several of the "problems of everyday objects" encountered in an undergraduate metaphysics course. (shrink)

What is the connection between having a phenomenal property and knowing that one has that property? A traditional view on the matter takes the connection to be quite intimate. Whenever one has a phenomenal property, one knows that one does. Recently most authors have denied this traditional view. The goal of this paper is to defend the traditional view. In fact, I will defend something much stronger: I will argue that what it is for a property to be phenomenal is (...) for it to be a property one must know oneself to have when on has it. As we will see, this theory has a number of surprising and welcome upshots, suggesting that the traditional view has been unjustly maligned. (shrink)

We defend and explore the view that bringing philosophy, political science, and economics together in the study of social and political institutions sheds light and banishes shadows in ways that no subset of these three disciplines could possibly accomplish.

Propositions represent the entities from which they are formed. This fact has puzzled philosophers and some have put forward radical proposals in order to explain it. This paper develops a primitivist account of the representational properties of propositions that centers on the operation of application. As we will see, this theory wins out over its competitors on grounds of strength, systematicity and unifying power.

The educational philosophies of John Dewey, Paulo Freire and Tsunesaburo Makiguchi were born at different times and in different cultures but the themes they propound resonate with the ordinary people. Although there are ideas that are unique to each philosophy, this paper tries to uncover the themes that are similar in them. The purpose to uncovering these themes is to try in some way to form a unifying force that opens a path to making the ideas rather than the person (...) resonate among people. The three philosophers were not interested in recognition but rather sought the welfare of their fellow human beings as their purpose. As such, their hope was that their ideas would be turned to action by people rather than adoration of their philosophies. Increasingly, educators are seeking ways to harmonize their ideas and ideals with other educators in order to build a strong counterbalance to the historically prevalent divisive and prejudicial societal structures that inhibit human development. Paolo Freire points out that such a counterbalance would ultimately benefit the oppressed and the oppressor. In order to accomplish this, educators will need to put aside small philosophical differences and focus on the more meaningful themes that unite them. The interconnectedness of humanity and nature is becoming increasingly apparent in all realms of human activity. Future research and educational work must begin to turn away from its divisive nature and look for themes of harmony within and between disciplines. Instead of looking for ways to reject each other we need to research ways of uniting each other, not only for our own sake but for the sake are future generations. (shrink)

In the last century, philosophers turned their attention to language. One place they have looked for clues about its nature is Plato’s Cratylus, which considers whether names are naturally or conventionally correct. The dialogue is a source of annoyance to many commentators because it does not take a clear position on the central question. At times, it argues that language is conventional, and, at other times, defends the view that language is natural. This lack of commitment has led to a (...) longstanding dispute over the outcome of the dialogue. I argue that the Cratylus provides no clear resolution to this problem because it presupposes certain unexamined metaphysical commitments about the nature of reality, which are in need of thorough investigation. (shrink)

A number of philosophers think that grounding is, in some sense, well-founded. This thesis, however, is not always articulated precisely, nor is there a consensus in the literature as to how it should be characterized. In what follows, I consider several principles that one might have in mind when asserting that grounding is well-founded, and I argue that one of these principles, which I call ‘full foundations’, best captures the relevant claim. My argument is by the process of elimination. For (...) each of the inadequate principles, I illustrate its inadequacy by showing either that it excludes cases that should not be ruled out by a well-foundedness axiom for grounding, or that it admits cases that should be ruled out. (shrink)

It is often said in physics that if two models of a theory are related by a symmetry, then the two models provide (or could provide) two different representations of the very same situation, alike the case of two maps of different color for the very same city. It is also said that the situations represented by two models of a theory are indiscernible in some ways when the models in question are related by a symmetry of the theory, just (...) like the situation in the interior of the cabin of a train when the train is at rest in the station is empirically indiscernible from the situation in the interior when the train is moving uniformly (in classical mechanics, these two situations are represented by two models related by a boost). In recent years, philosophers of physics have focused a lot of attention in developing various principles that aim to elucidate these and similar remarks on symmetries, models, physical equivalence, and representation that are widespread in physics practice. The goal of the current article is to provide a critical review of these principles, and suggest a new framework for thinking about these kinds of questions. One important upshot of the paper is that questions of indiscernibility, and questions of the representational capacity of models, must be distinguished from one another. (shrink)

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. (shrink)

While this article sets out to advance our knowledge about the characteristics of Nigerian cybercriminals (Yahoo-Boys), it is also the first study to explore the narratives of the Economic and Financial Crimes Commission (EFCC) officers concerning them. It appraises symbolic interactionist insights to consider the ways in which contextual factors and worldview may help to illuminate officers’ narratives of cybercriminals and the interpretations and implications of such accounts. Semi-structured interviews of forty frontline EFCC officers formed the empirical basis of this (...) study and were subjected to a directed approach of qualitative content analysis. While prior studies, for example, indicated that only a group of cybercriminals deploy spiritual and magical powers to defraud victims (i.e. modus operandi), our data analysis extended this classification into more refined levels involving multiple features. In particular, analysis bifurcates cybercriminals and their operations based on three factors: [a] educational-attainment, [b] modus-operandi, and [c] networks-collaborators. Results also suggest that these cybercriminals and their operations are embedded in “masculinity-and-material-wealth”. These contributions thus have implications for a range of generally accepted viewpoints about these cybercriminals previously taken-for-granted. Since these criminals have victims all over the world, insights from our study may help various local and international agencies [a] to understand the actions/features of these two groups of cybercriminals better and develop more effective response strategies. [b] to appreciate the vulnerabilities of their victims better and develop more adequate support schemes. We also consider the limitations of social control agents’ narratives on criminals. (shrink)

In the book “A Theory of Justice”, John Rawls examines the notion of a just society. More specifically, he develops a conception of justice—Justice as Fairness—derived from his novel interpretation of the social contract. Central to his account are two lexically-ordered principles of justice by which primary social institutions, or the basic structure of society, are ideally to be organized and regulated. Broadly speaking, the second of Rawls’ two principles pertains to “the distribution of income and wealth”, and its formulation (...) is to be understood as an expression of Rawls’ Difference Principle—roughly, the principle that “inequality in expectation is permissible only if lowering it would make the [worst-off] class even more worse off.”1 2 I want to suggest that Rawls’ Difference Principle (DP) entails the following worrisome outcome: Because DP maximizes the absolute level of expectation (and disregards the relative level), it authorizes potentially immense levels of inequality, such that this inequality itself can become a source of social discord and injustice. This paper will (§2) present Rawls’ formulation of DP, (§3) motivate the worrisome outcome entailed by DP, and (§4) offer a prima facie plausible solution in the form of an addendum to DP. (shrink)

This is a co-authored dialogue which explores epistemological and metaphysical questions raised by a social constructivist approach to science.

Can an ugly experiment be a good experiment? Philosophers have identified many beautiful experiments and explored ways in which their beauty might be connected to their epistemic value. In contrast, the present chapter seeks out (and celebrates) ugly experiments. Among the ugliest are those being designed by AI algorithms. Interestingly, in the contexts where such experiments tend to be deployed, low aesthetic value correlates with high epistemic value. In other words, ugly experiments can be good. Given this, we should conclude (...) that beauty is not generally necessary or sufficient for epistemic value, and increasing beauty will not generally tend to increase epistemic value. (shrink)

In the essay “Reasonable Religious Disagreements,” Dr. Richard Feldman examines reasonable disagreements between peers. More specifically, he asks whether such disagreements are possible, and also whether the parties to such a disagreement could think that both their own belief and the belief of their peer with whom they disagree are reasonable. Feldman argues that there cannot be any such thing as a reasonable disagreement, and furthermore, that the parties to a disagreement are not epistemically licensed to think that their own (...) belief and their opponents belief are both reasonable. As Feldman notes, “open and honest discussion seems to have the puzzling effect of making reasonable disagreement impossible”. My project herein will be (in §2) to explain Feldman’s notion of a reasonable disagreement, and then reconstruct and assess his argumentation, and (in §3) advance three objections to Feldman’s argument. I will focus on denying Feldman’s answer to his first question—that reasonable disagreement between peers is not possible—and my suggestion is that if any of these three objections to Feldman’s argument go through, then the argument falls. And if Feldman’s argument falls, then his argument no longer provides grounds for our thinking that reasonable disagreement is impossible. (shrink)

Siblings compete for parental care and feeding, while parents must allocate scarce resources to those offspring most likely to survive and reproduce. This could cause offspring to evolve traits that advertise health, and thereby attract parental resources. For example, experimental evidence suggests that bright orange filaments covering the heads of North American coot chicks may have evolved for this fitness-advertising purpose. Could any human mental disorders be the equivalent of dull filaments in coot chicks—low-fitness extremes of mental abilities that evolved (...) as fitness indicators? One possibility is autism. Suppose that the ability of very young children to charm their parents evolved as a parentally selected fitness indicator. Young children would vary greatly in their ability to charm parents, that variation would correlate with underlying fitness, and autism could be the low-fitness extreme of this variation. This view explains many seemingly disparate facts about autism and leads to some surprising and testable predictions. (shrink)

In the essay “Epistemic Self-Trust and the Consensus Gentium Argument,” Dr. Linda Zagzebski examines the reasonableness of religious belief. More specifically, she argues that truth demands epistemic self-trust—roughly, a trust in the reliability of our own faculties. Furthermore, it is asserted that this self-trust commits me to an epistemic trust in others, which in turn provides grounds for believing that because many other people (to whom we have granted this epistemic trust) believe in God, this prevalence of belief thereby provides (...) a reason for me to believe in God, too. A critical step in Zagzebski’s argument is the move from epistemic self-trust to granting this sort of trust to other people—a move for which a sub-argument can be drawn out of her essay. My paper’s focus will be to examine Zagzebski’s sub-argument for her second premise (i.e., granting epistemic trust to others) to which I will advance two objections. (shrink)

This essay is about the relationship between the notions of practical reason, the will, and choice in Kant’s practical philosophy. Although Kant explicitly identifies practical reason and the will, many interpreters argue that he cannot really mean it on the grounds that unless they are distinct, irrational and, especially, immoral action is impossible. Other readers affirm his identification but distinguish the will from choice on the same basis. We argue that proper attention to Kant’s conception of practical reason as a (...) capacity reveals that these distinctions are neither textually grounded nor philosophically necessary. His moral psychology concerns a single capacity, practical reason, which is the will, and whose actualities in this or that individual fall under the title of choice. Practical reason is the will and choice because it is the rational faculty of desire: a rational being’s capacity to be, by means of her representations, the cause of the actuality of their objects. This, we argue, is entailed by his conception of rational action: action not just in accordance with, but in and through the representation of, principles. The possibility of irrational action is explained not by a distinction between capacities but by the finitude, and thereby the fallibility, of human reason. (shrink)

Can the issue of how important it is whether or not there is a God be decided prior to deciding whether or not there is a God? In this paper, I explore some difficulties that stand in the way of answering this question in the affirmative and some of the implications of these difficulties for that part of the Philosophy of Religion which concerns itself with assessing arguments for and against the existence of God, the implications for how its importance (...) may best be defended within secular academe. (shrink)

If what we believe can directly modify our (visual) experience, our experience is doxastically variable. If so, the following seems possible: our false and irrational background beliefs can modify our experience such that in it, things look distorted, or that it conforms with and appears to confirm the false and irrational beliefs that helped bring it about in the first place. If experience is doxastically variable, it seems, its epistemic function can be undermined. However, in this dissertation, I argue that (...) we can devise accounts of (visual) experience that meet two requirements: they are fully compatible with all kinds of doxastic variation and on them, even doxastically variable experience serves to rationally constrain our beliefs. I begin with a novel interpretation of Hanson’s account of theory-laden observation—a valiant, yet ultimately unsuccessful attempt to meet both these requirements. Next, I analyze and reject various contemporary relationalist accounts of experience and the most sophisticated recent representationalist attempt to accommodate phenomena of doxastic variation: Siegel’s (Rich) Content View. Then, based on the lessons learned and drawing on Hanson’s and Gupta’s work, I show what shape a successful account may take. Ultimately, I argue for the following theses: 1) Neither of the two dominant accounts of experience—relationalism and standard representationalism—currently succeeds in satisfactorily meeting both requirements. 2) To arrive at accounts that do meet them, we should drop both the restrictive relationalist conception of experience as a relation to mind-independent items and the standard representationalist conception of experience as justifying beliefs. 3) We make progress by adopting both the general conception of experience as making rational transitions to beliefs, judgments, and actions and a (slightly) modified version of Gupta’s presentationalist account of experiential phenomenology. Finally, 4) the possibility of devising successful accounts is independent of a major issue dividing relationalists and representationalists: whether experience has content. In the final chapters, I address various follow-up questions concerning the nature of views, conceptual capacities, conceptual content, and linkages between a subject’s experience and her responses. In concluding, I show that the account of experience I recommend is widely applicable in philosophy and beyond. (shrink)

Sensation should be understood globally: some infant behaviors do not make sense on the model of separate senses; neonates of all species lack time to learn about the world by triangulating among different senses. Considerations of natural selection favor a global understanding; and the global interpretation is not as opposed to traditional work on sensation as might seem.

(1 ∼ 4)The place of consciousness in nature; (5 ∼ 9) hard problem, Multiple Draft Model, Orch OR theory; (10 ∼ 11) space-time field; (12 ∼ 13)methodology; (14 ∼ 17)application of physio-phenomenology; (18) on electroencephalography signals; (19 ∼ 23) mental imagery; (24 ∼ 26) pandemonium process and hallucinations; (27 ∼ 30) awareness and attention; (31) measurement problem; (32 ∼ 33) futureworks; (34) Summary.

The ethics of betel nut use in Taiwan are examined in this article. It first presents scientific facts about the betel quid, its consumption and negative health consequences and then analyses the cultural background and economic factors contributing to its popularity in Asia. Governmental and institutional attempts to curb betel nut cultivation, distribution and sales are also described. Finally, the bioethical implications of this often ignored subject are considered.