Abstract
In congenitally or prelingually deaf childrencochlear implantation is open to seriousethical challenge. The ethical dimension ofthis technology is closely related to both asocial standard of quality of life and to theuncertainty of the overall results of cochlearimplantation. Uncertainty with regards theacquisition of oral communicative skills.However, in the western world, available datasuggest that deafness is associated with thelowest educational level and the lowest familyincome. Notwithstanding the existence of aDeaf-World, deafness should be considered as ahandicap. Therefore, society should provide themeans for the fulfilment of a deaf child'sspecific needs.For the time being there is no definitiveanswer with regard the best way to rehabilitatea particular deaf child. Therefore,communitarian values may be acceptable. If thedeaf child parents' decide not to implant,their decision should be respected. Guardiansare entitled to determine which standard ofbest interest to use in a specificcircumstance. They are the proper judges ofwhat (re)habilitation process is best for theirdeaf child. However, most deaf children areborn to two hearing parents. Probably, theywill not be acculturated in the Deaf-World. Itfollows that cochlear implantation is awelcomed (re)habilitation technology.If auditory (re)habilitation will in the futureprovide the necessary communicative skills, inparticular oral language acquisition, customs,values and attitudes of the hearing worldshould be regarded as necessary to accomplish adeaf child's right to an open future. Ifcochlear implantation technology will provideall deaf children with the capacity to developacceptable oral communicative skills –whatever the hearing status of the family andthe cultural environment – then auditory(re)habilitation will be an ethical imperative.
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REFERENCES
Morell R, Kim H, Hood L, et al. Mutations in the connexin 26 gene (GJB2) among Ashkenazi Jews with nonsyndromic recessive deafness. N Engl J Med 1998; 339: 1500–1505.
Steel K. A new era in the genetics of deafness. N Engl J Med 1998; 339: 1545–1547.
As reported, for instance, by the California Department of Rehabilitation. See Harris J, Anderson J, Novak R. An outcome study of cochlear implants in deaf patients. Archives of Otolaryngology Head and Neck Surgery 1995; 121: 398–404.
Comité Consultatif National D'Éthique Pour les Sciences de la Vie et de la Santé: Avis sur l'implant cochleaire chez l'enfant sourd pré-lingual, Décembre, 1994.
Lane H, Hoffmeister R, Bahan B. A Journey into the Deaf-World. San Diego: DawnSign Press, 1996.
NAD (National Association of the Deaf). Cochlear Implants in Children. A position paper of the National Association of the Deaf. Silver Spring, Maryland, 1993.
Rose D, Vernon M, Pool A. Cochlear implants in prelingually deaf children. American Annals of the Deaf 1996; 141: 258–261.
Lane H. The Mask of Benevolence – Disabling the Deaf Community. New York: Vintage Books, 1992.
Lane H, Grodin M. Ethical issues in cochlear implant surgery: An exploration into disease, disability, and the best interests of the child. Kennedy Inst Eth J 1997; 7: 231–251.
Beauchamp T, Childress J. Principles of Biomedical Ethics, 4th edn. New York: Oxford University Press, 1994.
Kemp P, Rendtorff J. Basic Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. Report to the European Commission of the Biomed II-Project, Basic Ethical Principles in Bioethics and Biolaw 1995–1998. Centre for Ethics and Law, Copenhagen, 2000.
Callahan D. Bioethics. In Reich W, ed. Encyclopedia of Bioethics. New York, Macmillan Library Reference USA: Simon & Schuster Macmillan, 1995.
Nelson H, Nelson J. Family. In Reich W, ed. Bioethics: Sex; Genetics and Human Reproduction, Macmillan Compendium. New York, Macmillan Library Reference USA: Simon & Schuster Macmillan, 1998.
Engelhardt T. The Foundations of Bioethics. New York: Oxford University Press, 1986.
There is no scientific data with regard this issue. However, the quality of life of a deaf child may be associated to his or her psychosocial behaviour and, therefore, to the degree of familial and social adaptation. As stated by Furth, and although this author acknowledges the difference between being acculturated in a deaf environment or a hearing one, “the point ... is rather to stress that their (deaf youngsters) psychological responses to these challenges as a rule are quite adequate to lead to the development of an autonomous, intellectually and socially mature adult. ” See Furth H. Psychosocial behavior. In Van Cleve JV, ed. Gallaudet Encyclopedia of Deaf People and Deafness. New York: McGraw-Hill Book Company, 1987.
Lane H. When the Mind Hears: A History of the Deaf. New York: Vintage Books, 1989.
The British Deaf Association. Policy on Cochlear Implants. Carlisle: The British Deaf Association, 1994.
Danish Deaf Association and World Federation of the Deaf Position Paper on Cochlear Implants, October, 1993.
Tucker B. Deaf culture, cochlear implants and elective disability. Hastings Center Report 1998; 28: 6–14.
Lane H, Bahan B. Ethics of cochlear implantation in young children: A review and reply from a Deaf-World perspective. Otolaryngology, Head and Neck Surgery 1998; 119: 297–307.
Davis D. Genetic dilemmas and the child's right to an open future. Hastings Center Report 1997; 27: 7–15.
Davis D. Cochlear implants and the claims of culture? A response to Lane and Grodin. Kennedy Inst Eth J 1997; 7: 253–258.
Balkany T, Hodges A, Goodman K. Ethics of cochlear implantation in young children. Otolaryngology, Head and Neck Surgery 1996; 114: 748–755.
Feinberg J. The child's right to an open future. In William A and LaFollette, eds Whose Child? Children's Rights, Parental Authority and State Power. Totowa, NJ: Littlefield, Adams & Co., 1980.
Wisconsin v. Yoder, 406 U.S. 205, (1972).
Te G, Hamilton M, Rizer F, Schatz K, Arkis P, Rose H. Early speech changes in children with multichannel cochlear implants. Otolaryngology, Head and Neck Surgery 1996; 115: 508–512.
Nunes R. Cochlear implantation in prelingually deaf children. Otolaryngology, Head and Neck Surgery 1998; 118: 421.
Nottingham Paediatric Cochlear Implant Program. Progress Report. Outcomes for Paediatric Cochlear Implantation in Nottingham: Safe, Effective, Efficient. Nottingham Paediatric Cochlear Implant Program, 1997.
Balkany T, Hodges A, Goodman K. Additional comments to “Ethics of cochlear implantation in young children: A review and reply from a Deaf-World perspective”. Otolaryngology, Head and Neck Surgery 1998; 119: 312–313.
Holden L, Skinner M, Holden T. Speech recognition with the MPEAK and SPEAK speech-coding strategies of the Nucleus Cochlear Implant. Otolaryngology, Head and Neck Surgery 1997; 116: 163–167.
Crouch R. Letting the deaf be deaf. Reconsidering the use of cochlear implants in prelingually deaf children. Hastings Center Report 1997; 27: 14–21.
Shannon R. Review of “Ethics of cochlear implantation in young children: A review and reply from a Deaf-World perspective”. Otolaryngology, Head and Neck Surgery 1998; 119: 308–309.
Quittner A. Cochlear implants in children: A study of parental stress and adjustment. Am J Otology 1991; 12(Supplement): 95–104.
Pollard R. Conceptualizing and conducting preoperative psychological assessments of cochlear implant candidates. Journal of Deaf Studies and Deaf Education 1996; 1(1): 16–28.
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Nunes, R. Ethical Dimension of Paediatric Cochlear Implantation. Theor Med Bioeth 22, 337–349 (2001). https://doi.org/10.1023/A:1011810303045
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DOI: https://doi.org/10.1023/A:1011810303045