Ethical Issues of Cochlear Implants

Hey guys, I’m writing a term paper on cochlear implants and the philosophical debate surrounding them. here’s my rough draft, feel free to provide some input! My opinion changed entirely throughout the writing process.

 

Cochlear Implants: Destroying Deaf Culture?

Cochlear implants are small electronic devices that are surgically implanted in the inner ear, usually during infancy. These hot-button devices work to partially or fully restore hearing in deaf individuals. I will argue that cochlear implant surgery is permissible without undermining the mere-difference view. I will also discuss how cochlear implants keep the patient’s autonomy intact, and that it will enrich their lives in many ways, without demonizing physical disability. In short, cochlear implant surgery in pre-lingually deaf infants is not only permissible, but should be encouraged.

First, it is important to note that I will be taking the mere-difference stance from Barnes’ article “Valuing Disability, Causing Disability.” In short, the mere-difference view is that disability by itself does not make a person worse off. It is a mere variation from non-disability, but the lack of accommodation for those with disability is what makes their well-being lower on average. As Professor Thompson states in her presentation, disability is the loss of an intrinsic good, not merely the loss of an intrinsic good (Disability and Wellbeing PPT, slide 12). Essentially, those with disability lose one ability, but can experience others that non-disability individuals miss out on.

Next, I will explain why it is necessary for cochlear implantation to occur when the infant is in the pre-lingual phase. Cochlear implants are most effective in infants aged 0-2 years old. In a study conducted by Karen Kirk et al., infants who received the implant prior to two years of age had much more advanced communication skills than those who had the surgery later in life. The Critical Period Hypothesis states that the first few years of life constitute the ability to learn language readily. After this period, it is much more difficult for a child to communicate as effectively (source). This makes it critical for infants to have the surgery early in life, rather than later. In those who choose to undergo the procedure much later in life, it is significantly less effective, as their communication skills are not nearly as refined. Making the change very early allows the child to adapt and fine tune their language skills during the critical period.

I will now discuss the relationship of autonomy with cochlear implants. Many might say that this elective surgery undermines the autonomy of the patient, that it takes away their right to choose. However, I find that this is untrue. Implanting the device very early in life is just as any other procedure that the child will undergo up until they are of legal consenting age. Infants are not considered to be capable of making their own medical decisions, and it is the parent’s responsibility. By the time the individual is old enough to competently make medical decisions, it will be too late for the cochlear implant to work very effectively. Since we cannot know whether the deaf child will embrace or resent their disability, it is necessary to implant the device anyway. I argue this because the child can either use the cochlear implant and partake in hearing culture, or turn it off and embrace Deaf culture. They can also participate in both cultures and communicate effectively in the hearing and Deaf worlds, just as any other bilingual individual would. This option gives the patient more autonomy than not undergoing the surgery. If the patient were to miss the critical period for the implant and turn out to take the bad-difference view of disability, then it is likely too late for them to fix their perceived problem. In short, the surgery allows the patient to choose their preferred culture because they will be equipped with the communication skills for both.

Another issue we face in the Deaf versus hearing debate is proxy consent. In Glenn Hladek’s article “Cochlear Implants, The Deaf Culture, And Ethics” he discusses the role of Deaf adults in the decisions of deaf infants’ medical procedures. In short, he explains that members of the Deaf community have pushed to be a part in the decision to “balance out the bias of the hearing parent.” However, Hladek argues that since this third party is not disinterested, it is not helpful. In addition, at this stage in the child’s life, it is the parents’ autonomy to choose for their child. Outside interference would simply go against their autonomy. In many other cases, we would say that it is nobody’s business but the family’s to decide what is right, so this question should be no different.

The Deaf community is a rich culture with just as much value as hearing culture. Cochlear implants do not undermine the value of the culture, nor do they destroy it. Some opponents of cochlear implants argue that the only way to fix hearing deficits is to destroy the Deaf culture. It is a common misconception that many infants and even adults will get cochlear implants and abandon the Deaf culture altogether. This is simply not true, as individuals who are born deaf and get the implant still experience some level of difference from hearing culture. This view that a deaf child choosing the hearing community is morally wrong, because it is putting the ends of the culture before the ends of the individual. The individual’s hopes and dreams should certainly come before the collective hopes and dreams of the Deaf community. Cochlear implants do not destroy the Deaf culture, because those who have them can still partake in the culture if they so choose. In addition, the presence of the cochlear implant does not lower the individual’s ability to effectively communicate in sign language.

I will further argue that having cochlear implants is very beneficial to infants in terms of language development. Infants can learn more than one language at a time, and they will benefit greatly from doing so while in the critical language period. With the cochlear implant, the child will be more capable of hearing voices and sounds when learning spoken language. Unlike a hearing aid, which only makes sounds louder, the cochlear implant helps send sound waves to the brain itself. There are many benefits to teaching a verbal child sign language, such as increased reading and vocabulary skills, increased memory retention, and self-confidence. Studies have shown that verbal infants who also sign are learning in several ways at once: physically, mentally, and verbally, and this improves their cognitive function. So, while deafness is a mere-difference and lacks some intrinsic goods, cochlear implants can actually be very beneficial, as it is the combination of two languages and several modes of learning.

Finally, I will discuss the vast range of opportunities that will become available to those who have cochlear implants. For every career, there are physical and mental tasks that must be performed. Without the ability to perform such tasks, one likely cannot choose that career path. For example, a career in surgery or nuclear engineering requires many years of education, and those who cannot pass the rigorous mental tests probably would not be successful in this career. Just the same, there are some jobs that deaf people simply cannot excel in. Cochlear implants will increase the number of jobs that deaf individuals can succeed in. In fact, they will have significantly more options if they choose to be a member of both Deaf and hearing society.

I have brought up some issues that opponents of cochlear implants might vocalize, but another is the risks of the surgery itself. Some risks of the surgery include but are not limited to: ringing in the ears, inability to undergo some medical procedures such as MRIs, cochlea damage, and slight facial nerve damage. I argue that the benefits of this procedure heavily outweigh the risks, as the risks are not life-threatening. To save time, I will put it simply that the benefits of multiculturalism and autonomy trump the few risks that are associated with cochlear implants.

Overall, cochlear implants are not only permissible, but encouraged, even under the mere-difference view. Even though deafness is a mere-difference from non-disability, the surgery should still be done in order to keep the parents’ current autonomy intact, as well as the patient’s future autonomy. In addition, I argued that the surgery should be encouraged because the child’s communication and cognitive skills will be enriched. Finally, the decision to undergo the procedure does not undermine the Deaf culture, and the autonomy of the individual trumps the wishes of the culture. In essence, the benefits and diversity one can experience from cochlear implants outweighs the risks of forgoing the procedure.

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