Skip to main content
SpringerLink
Log in

Enhancement Technology and Outcomes: What Professionals and Researchers Can Learn from Those Skeptical About Cochlear Implants

  • Original Article
  • Published:
Health Care Analysis Aims and scope Submit manuscript

Abstract

This text presents an overview of the bioethical debate on pediatric cochlear implants and pays particular attention to the analysis of the Deaf critique of implantation. It dismisses the idea that Deaf concerns are primarily about the upholding of Deaf culture and sign language. Instead it is argued that Deaf skepticism about child rehabilitation after cochlear surgery is well founded. Many Deaf people have lived experiences as subjects undergoing rehabilitation. It is not the cochlear technology in itself they view as problematic, but rather the subsequent rehabilitation process. Because they themselves have experienced what they describe as harmful effects which relate above all to the idea of normalization, they have articulated worries for the new generations of deaf children in need of rehabilitation following cochlear implant surgery. These insights have attracted little attention, but could represent relevant ethical questions of which both practitioners and researchers in the field of implantation might be aware.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. Even though the difference is far from clear, I follow the custom of differentiating between the medical condition of being deaf (which is written with a lowercase ‘d’) and being a member of a signing community (in which case Deaf is written with an uppercase ‘D’) (Woodward 1972; Markowicz and Woodward 1978; Padden and Humphries 1988). For an extensive analysis of these concepts see Kermit (2009).

  2. The first study describing American Sign Language as a natural language was published in 1960. However, it took some time before this discovery made an impact on the educational system of deaf children.

  3. This scenario has led me to suggest the application of what has been coined the “precautionary principle” when counseling parents of deaf children about their post-implantation choices [30].

  4. That competence is a more vital component of professional ethics than general kindness is an insight elegantly expressed in A. R. Jonsen’s quote, “I’d rather have a competent bastard do my surgery, than a bumbling humanist” [27].

  5. It can again be noted that the reasons advanced to support a bilingual education approach are wholly unrelated to issues concerning upholding Deaf culture. That would again imply reducing deaf children to mere instruments to be used for meeting unconsented ends.

References

  1. Armstrong, D. F., Karchmer, M. A., & Van Cleve, J. V. (2002). The study of signed languages: Essays in honor of William C. Stokoe. Washington, DC: Gallaudet University Press.

    Google Scholar 

  2. Balkany, T., Hodges, A. V., & Goodman, K. W. (1996). Ethics of cochlear implantation in young children. Otolaryngology - Head and Neck Surgery, 114(6), 748–755.

    Article  PubMed  CAS  Google Scholar 

  3. Balkany, T., Hodges, A., Menapace, C., Hazard, L., Driscoll, C., Gantz, B., et al. (2007). Nucleus Freedom North American clinical trial. Otolaryngology - Head and Neck Surgery, 136(5), 757–762.

    Article  PubMed  Google Scholar 

  4. Beadle, E. A., McKinley, D. J., Nikolopoulos, T. P., Brough, J., O'Donoghue, G. M., & Archbold, S. M. (2005). Long-term functional outcomes and academic-occupational status in implanted children after 10 to 14 years of cochlear implant use. Otology & Neurotology, 26(6), 1152–1160.

    Article  Google Scholar 

  5. Berg, A. L., Ip, S. C., Hurst, M., & Herb, A. (2007). Cochlear implants in young children: Informed consent as a process and current practices. American Journal of Audiology, 16(1), 13–28.

    Article  PubMed  Google Scholar 

  6. Blume, S. (2000). Land of hope and glory: Exploring cochlear implantation in the Netherlands. Science, Technology and Human Values, 25(2), 139–166.

    Article  Google Scholar 

  7. Ching, T. Y., Dillon, H., Day, J., Crowe, K., Close, L., Chisholm, K., et al. (2008). Early language outcomes of children with cochlear implants: Interim findings of the NAL study on longitudinal outcomes of children with hearing impairment. Cochlear Implants International, 10(Suppl 1), 28–32.

    Google Scholar 

  8. Christiansen, J. B., & Leigh, I. W. (2004). Children with cochlear implants—changing parent and deaf community perspectives. Archives of Otolaryngology - Head and Neck Surgery, 130(5), 673–677.

    Article  PubMed  Google Scholar 

  9. Cohen, N. L. (1994). The ethics of cochlear implants in young children. American Journal of Otolog, 15(1), 1–2.

    Article  CAS  Google Scholar 

  10. Crouch, R. A. (1997). Letting the deaf be deaf. Reconsidering the use of cochlear implants in prelingually deaf children. Hastings Center Report, 27(4), 14–21.

    Article  PubMed  CAS  Google Scholar 

  11. Davis, D. S. (1997). Cochlear implants and the claims of culture? A response to lane and grodin. Kennedy Institute of Ethics Journal, 7(3), 253–258.

    Article  PubMed  Google Scholar 

  12. Delore, C., Robier, A., Bremond, M., Beutter, P., & Ployet, M. J. (1999). Cochlear implants and sign language. International Journal of Pediatric Otorhinolaryngology, 47(2), 209–211.

    Article  PubMed  CAS  Google Scholar 

  13. Feinberg, J. (1980). The child’s right to an open future. In W. Aiken & H. LaFollette (Eds.), Whose child? Children’s rights, parental authority, and state power (pp. 124–153). Totowa, NJ: Littlefield, Adams & CO.

    Google Scholar 

  14. Ganek, H., McConkey Robbins, A., & Niparko, J. K. (2012). Language outcomes after cochlear implantation. Otolaryngologic Clinics of North America, 45(1), 173–185. doi:10.1016/j.otc.2011.08.024.

    Article  PubMed  Google Scholar 

  15. Geers, A. E. (2006). Factors influencing spoken language outcomes in children following early cochlear implantation. Advances in Oto-rhino-laryngology, 64, 50–65.

    Google Scholar 

  16. Grønlie, S. M. (2005). Uten hørsel? En bok om hørselshemming. Bergen: Fagbokforlaget.

    Google Scholar 

  17. Harris, J. (2000). Is there a coherent social conception of disability? Journal of Medical Ethics, 26, 95–100.

    Article  PubMed  CAS  Google Scholar 

  18. Hawker, K., Ramirez-Inscoe, J., Bishop, D. V., Twomey, T., O’Donoghue, G. M., & Moore, D. R. (2008). Disproportionate language impairment in children using cochlear implants. Ear and Hearing, 29(3), 467–471.

    Article  PubMed  Google Scholar 

  19. Hintermair, M., & Albertini, J. A. (2005). Ethics, deafness, and new medical technologies. The Journal of Deaf Studies and Deaf Education, 10(2), 184–192.

    Article  Google Scholar 

  20. Hladek, G. A. (2002). Cochlear implants, the deaf culture, and ethics: A study of disability, informed surrogate consent, and ethnocide. Monash Bioeth Review, 21(1), 29–44.

    Google Scholar 

  21. Holtsmark, H., & Borrebæk, J. (2009). Kostbare erfaringer for vårt døve barn. Tidskrift for Den norske Legeforening, 129(7), 662–663.

    Article  Google Scholar 

  22. Honneth, A. (1995). The struggle for recognition: The moral grammar of social conflicts. Oxford: Polity Press.

    Google Scholar 

  23. Honneth, A. (2000). Zwischen Aristoteles und Kant. Skizze einer Moral der Anerkennung. In W. Edelstein & G. Nunner-Winkler (Eds.), Moral im sozialen Kontext. Frankfurt am Main: Suhrkamp Verlag.

    Google Scholar 

  24. Hyde, M. (2006). Some ethical dimensions of cochlear implantation for Deaf children and their families. Journal of Deaf Studies and Deaf Education, 11(1), 102–111.

    Article  PubMed  Google Scholar 

  25. Hyde, M., & Power, D. (2000). Informed parental consent for cochlear implantation of young deaf children: Social and other considerations in the use of the ‘bionic ear’. Australian Journal of Social Issues, 35(2), 117–127.

    PubMed  CAS  Google Scholar 

  26. Johnston, T. (2005). In one’s own image: Ethics and the reproduction of deafness. Journal of Deaf Studies and Deaf Education Fall, 10, 4426–4441.

    Google Scholar 

  27. Jonsen, A. R. (1990). The new medicine and the old ethics. Cambrigde, MA: Harvard University Press.

    Google Scholar 

  28. Kant, I. (1983). Grunnlegging av moralens metafysikk (Grundlegung zur Metaphysik der Sitten). In E. Storheim (Ed.), Moral, politikk og historie. Oslo: Universitetsforlaget.

    Google Scholar 

  29. Kermit, P. (2006). Tegnspråk og anerkjennelsen av døve som en språklig minoritet. In S. R. Jørgensen & R. L. Anjum (Eds.), Tegn som språk: En antologi om tegnspråk. Oslo: Gyldendal Akademisk.

    Google Scholar 

  30. Kermit, P. (2010). Choosing for the child with cochlear implants: A note of precaution. Medicine, Health Care and Philosophy, 13(2), 157–167.

    Article  Google Scholar 

  31. Kirk, K. I., & Choi, S. (2009). Clinical investigations of cochlear implant performance. In J. K. Niparko (Ed.), Cochlear implants: Principles & practices (2nd ed., pp. 191–222). Philadelphia: Lippincott Williams & Wilkins.

  32. Kirkehei, I., Myrhaug, H. T., Garm, N., Simonsen, E., & Wie, O. B. (2011). Kommunikasjonsformer for barn med cochleaimplantat (p. 15). Oslo: Nasjonalt kunnskapssenter for helsetjenesten.

    Google Scholar 

  33. Kusche, C. A., Garfield, T. S., & Greenberg, M. T. (1983). The understanding of emotional and social attributions in deaf adolescents. (Article). Journal of Clinical Child Psychology, 12(2), 153.

    Google Scholar 

  34. Lane, H. (1999). The mask of benevolence; disabling the Deaf community. New York: DawnSignPress.

    Google Scholar 

  35. Lane, H. (2005). Ethnicity, ethics, and the deaf-world. The Journal of Deaf Studies and Deaf Education, 10(3), 291–310.

    Article  Google Scholar 

  36. Lane, H., & Grodin, M. (1997). Ethical issues in cochlear implant surgery: An exploration into disease, disability, and the best interests of the child. Kennedy Institute of Ethics Journal, 7(3), 231–251.

    Article  PubMed  Google Scholar 

  37. Leigh, G., & Marschark, M. (2005). Ethics and deafness: A matter of perspective? The Journal of Deaf Studies and Deaf Education, 10(2), 109–110.

    Article  Google Scholar 

  38. Levy, N. (2002). Reconsidering cochlear implants: The lessons of Martha’s Vineyard. Bioethics, 16(2), 134–153.

    Article  PubMed  Google Scholar 

  39. Lin, F. R., & Niparko, J. K. (2006). Measuring health-related quality of life after pediatric cochlear implantation: A systematic review. International Journal of Pediatric Otorhinolaryngology, 70(10), 1695–1706.

    Google Scholar 

  40. Marschark, M., Rhoten, C., & Fabich, M. (2007). Effects of cochlear implants on children’s reading and academic achievement. The Journal of Deaf Studies and Deaf Education, 12(3), 269–282.

    Article  Google Scholar 

  41. Nakamura, K. (2006). Deaf in Japan. Signing and the politics of identity. Ithaca, London: Cornell University Press.

    Google Scholar 

  42. Nicholas, J. G., & Geers, A. E. (2007). Will they catch up? The role of age at cochlear implantation in the spoken language development of children with severe to profound hearing loss. Journal of Speech, Language, and Hearing Research, 50(4), 1048–1062.

    Article  PubMed  Google Scholar 

  43. Niparko, J. K. (2009). The cultural implications of cochlear implants. In J. K. Niparko (Ed.), Cochlear implants; principles and practices (pp. 335–341). Philadelphia: Lippincott Williams & Wilkins.

    Google Scholar 

  44. Nunes, R. (2001). Ethical dimension of paediatric cochlear implantation. Theoretical Medicine and Bioethics, 22(4), 337–349.

    Article  PubMed  CAS  Google Scholar 

  45. Pisoni, D. B., Conway, C. M., Kronenberger, W. G., Horn, D. L., Karpicke, J., & Henning, S. C. (2008). Efficacy and effectiveness of cochlear implants in deaf children. In M. Marschark & P. C. Hauser (Eds.), Deaf cognition: Foundations and outcomes (pp. 52–101). Oxford: Oxford University Press.

  46. Ramsey, C. L. (1999). Ethics and culture in the deaf community response to cochlear implants. Seminars in Hearing, 2000, 21(1), 75–86.

    Article  Google Scholar 

  47. Savulescu, J. (2002). Deaf lesbians, “designer disability,” and the future of medicine. BMJ, 325(7367), 771–773.

    Article  PubMed  Google Scholar 

  48. Simonsen, E. (2000). Vitenskap og profesjonskamp: Opplæring av døve og åndssvake i Norge 1881–1963. Oslo: Unipub forl.

    Google Scholar 

  49. Spencer, L. J., Gantz, B. J., & Knutson, J. F. (2004). Outcomes and achievement of students who grew up with access to cochlear implants. Laryngoscope, 114(9), 1576–1581.

    Google Scholar 

  50. Stokoe, W. C., Jr. (2005). Sign language structure: An outline of the visual communication systems of the American deaf. The Journal of Deaf Studies and Deaf Education, 10(1), 3–37.

    Article  Google Scholar 

  51. Summerfield, A. Q., & Marshall, D. H. (1999). Paediatric cochlear implantation and health-technology assessment. International Journal of Pediatric Otorhinolaryngology, 47(2), 141–151.

    Article  PubMed  CAS  Google Scholar 

  52. Tait, M. E., Nikolopoulos, T. P., & Lutman, M. E. (2007). Age at implantation and development of vocal and auditory preverbal skills in implanted deaf children. International Journal of Pediatric Otorhinolaryngology, 71(4), 603–610.

    Google Scholar 

  53. Takala, T. (2003). The child’s right to an open future and modern genetics. In B. Almond & M. Parker (Eds.), Ethical issues in the new genetics, are genes us? (pp. 39–46). Aldershot: Ashgate.

    Google Scholar 

  54. Taylor, C. (1989). Sources of the self. The making of the modern identity. Cambrigde, Massachusetts: Harvard University Press.

    Google Scholar 

  55. Taylor, C. (1992). The ethics of authenticity. Cambrigde, Massachusetts, London: Harvard University Press.

    Google Scholar 

  56. Thoutenhoofd, E. D., Archbold, S. M., Gregory, S., Lutman, M. E., Nikolopoulos, T. P., & Sach, T. H. (2005). Paediatric cochlear implantation. London: Whurr Publishers.

    Google Scholar 

  57. Tobey, E. A., Geers, A. E., Brenner, C., Altuna, D., & Gabbert, G. (2003). Factors associated with development of speech production skills in children implanted by age five. Ear & Hearing, 24(1 Suppl), 36S–45S.

    Google Scholar 

  58. Tucker, B. P. (1998). Deaf culture, cochlear implants, and elective disability. Hastings Center Report, 28(4), 6–14.

    Article  PubMed  CAS  Google Scholar 

  59. United Nations. (2007). United Nations declaration on the rights of indigenous peoples. New York: United Nations.

  60. Utdanningsdirektoratet. (2009). Veileder for opplæring av barn og unge med hørselshemming. Oslo: Utdanningsdirektoratet.

  61. Wie, O. B., Falkenberg, E. S., Tvete, O., & Tomblin, B. (2007). Children with a cochlear implant: Characteristics and determinants of speech recognition, speech-recognition growth rate, and speech production. International Journal of Audiology, 46(5), 232–243.

    Google Scholar 

Download references

Acknowledgments

The author would like to thank NTNU Social Research in Trondheim, Norway, for funding this work.

Conflict of interests

None.

Author information

Authors and Affiliations

  1. NTNU Social Research, Dragvoll Allé 38B, 7491, Trondheim, Norway

    Patrick Kermit

Authors
  1. Patrick Kermit
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patrick Kermit.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kermit, P. Enhancement Technology and Outcomes: What Professionals and Researchers Can Learn from Those Skeptical About Cochlear Implants. Health Care Anal 20, 367–384 (2012). https://doi.org/10.1007/s10728-012-0225-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10728-012-0225-0

Keywords

Search

Navigation