The Brain and Beyond...
Pediatric Cochlear Implants: The Great Debate Author: Aviva Weinberg, University Of Pennsylvania Faculty Sponsor: Paulr R. Wolpe, Ph.D. Abstract: The rise and refinement of the cochlear implant, a device meant to correct for sensorineural hearing loss in prelingually deaf children, has faced much debate and criticism. The controversy over this corrective technology has revealed a significant social divide between the hearing and the non-hearing parents of these deaf children. While the hearing parents welcome the implant as an exciting new medical remedy for their children’s deafness, the nonhearing parents reject the implant as a tool of discrimination. The source of this divide seems to lie in two very different operative paradigms for deafness: the pathological and the sociocultural. The hearing parents’ pathological view places deafness as an auditory deficit meant to be repaired, while the non-hearing parents view deafness as a sociocultural identity. Understanding these divergent social perspectives sheds light on the heavy controversy surrounding the cochlear implant and its hopes for future use.
Over the past several years, cochlear implant technology and its attendant train of ethical quandaries have made headline news. The debate over the determination to use cochlear implants in prelingually deaf children brings to light a host of legal and ethical issues, including informed consent and parental decision making, questions of the cost-effectiveness of surgery and therapy, risk assessment, and the ethical dilemma of refusal of treatment. The sociological dimension of this bioethical debate highlights two per vasive trends: a distinct misunderstanding of Deaf Culture, and a more general socio-cultural blindness to those who are “different.” This socio-cultural blindness is not unique to the issue of cochlear implants. In the case of physician-assisted suicide and the disability community’s protests, it was the existence of a cultural ignorance on the part of the socalled “normal” community which made it nearly impossible for the disability community’s wishes to be understood and respected. American society tends to operate on these cultural assumptions and social biases, Aviva Weinberg is a Senior at the University of Pennsylvania and is a Fine Arts major. Email: avivaw@sas.upenn.edu Paul Root Wolpe, Ph.D. is the faculty sponsor for this submission. He is the Senior Fellow at the Center of Bioethics and an Assistant Professor of Psychology at the University of Pennsylvania. Address: 3401 Market St, Suite 320; Philadelphia, PA 19104 Email: wolpep@mail.med.upenn.edu Penn Bioethics Journal Vol. I, Issue 1 Spring 2005
thus perpetuating a selfish social doctrine which suggests “you’re not as good as us if you’re not like us” (Correll, 2002). The cochlear implants controversy originated in the 1980’s with the first pediatric cochlear implant surgery at the House Ear Institute in Los Angeles (Delost and Lashley, 2000). What evolved from this technological leap was a huge rift between the hearing and the non-hearing parents of deaf children. The proponents of cochlear implants support the use of this technology which can medically repair deafness in children with prelingual sensorineural hearing loss. These hearing parents are supported by medical professionals, the National Institute of Health (NIH), the Cochlear Implant Association, Inc., the American Medical Association (AMA), the American Academy of Otolaryngology-Head and Neck Surgery and the vast majority of hearing society. On the other side of this rift is the Deaf Community, whose members recognize deafness not as a disability but rather as a cultural identity. This Community includes non-hearing parents of deaf children, many deaf educators and organizations such as the National Association of the Deaf (NAD). Cochlear Implant Technology In the case of a sensorineural hearing loss, the tiny hair cells which typically conduct auditory signals in our cochlea have either been damaged or are absent from the inner ear. As a result, the electrical impulses which usually travel from these hair cells to auditory nerve fibers for interpretation are inefficacious; the nerve fibers are not enervated and there is no hearing response. The cochlear implant is an electrical device which proposes to remedy this incapacity by functioning in place of the damaged hair cells and providing the necessary electrical stimulation. The implant mimics patterns of nerve activity present in the normal human ear and allows for the “spontaneous recognition of all types of sound” and eventual acquisition of speech (Eddington, 1994). While there are many adults with the implant, the most profound improvements in hearing and speech have been observed in children. The younger the child is when the implant surgery takes place, the better the outcome. As a result, this debate has profound consequences for those deaf people who cannot make the decision for themselves—the children. Deafness: Pathological vs. Sociocultural Perspectives The core of the bioethical debate is rooted in the battle to define disability and understand deafness. In his
www.bioethicsjournal.com
pbj 1