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Jessica Padgett
Adam Padgett
English 102
14 April 2017

Whats all the Fuss About Cochlear Implants? Pros vs. Cons.

Throughout history there have been ethical debates surrounding the advancement of the

medical field, whether it be the first successful organ transplant or the discovery that antiseptic

handwashing can help prevent the spread of deadly germs in the mid 1800s. These ideas were

ridiculed and even considered unethical at one point, but are now considered standard practice in

todays medicine. Today, in attempt to avoid these debates of ethics surrounding new healthcare

devices and procedures, there is the Food and Drug Administration (FDA). The FDA is

responsible for a wide range of issues but among its many responsibilities, one is protecting

public health by assuring efficacy, safety and security of biomedical devices. Some of these

medical devices are very controversial, such as the Cochlear Implant. It is a small device that

provides a person with profound or severe hearing loss with a sense of sound. The implant does

not restore hearing in the individual, but it provides a sense of sound from the environment

around them to help them to understand speech. The implant works by directly stimulating the

8th auditory nerve and the signals generated by the implant are sent via the nerve pathway to the

brain to be interpreted into sound. The Multichannel Cochlear Implant was first approved for use

in children by the FDA in June of 1990 and in 2000 cochlear implants were FDA-approved for

use in infants meeting specific criteria as early as 12 months of age (Gifford). In December of

2012, there was approximately 58,000 devices implanted in adults and 38,000 in children in the

United States and 324,200 total registered devices worldwide (NIDCD). According to the
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National Institute on Deafness and Other Communication Disorders (NIDCD), About two-thirds

of every 1000 children in the United states are born with detectable levels of hearing loss in one

or both ears. Of those children, more than 90 percent of those children are born to hearing

parents, but is the cochlear implant the right choice? Just like any other medical procedure there

are a list of pros and cons, but based on the present knowledge of cochlear implants and the

current cultural divide on its ethicality there is a side that out-benefits the other.

To begin the weighing of the benefits, the topic of Deaf Culture need be discussed. Many

argue over the validity of the Deaf culture, but per Hladek, A culture is defined as the ideas,

customs, skill and art of a given people in a given period and a common language is often

accepted as necessary to share these aspects of the culture. (Weisler, Hladek) According to

these definitions then, the Deaf community must be a culture of its own. They possess a language

of their own, American Sign Language (ASL), they have specific social customs, literary

traditions, folklore, and schools specific to educate the children. There is a divide among the

Deaf Community though; There are those who see their deafness as a medical condition and

those who see it as an identifying factor (Denworth). This is what distinguishes between the deaf

and the Deaf. Deaf with a lower-case d is used when referring to the condition of deafness and

those who dont consider themselves part of the culture and Deaf with a capital D is used when

referring to those who are a part of the culture. Those apart of the culture often marry within it,

socialize within it, and since two Deaf people have increased genetic chances to give birth to a

Deaf child, theyll raise their child within the culture as well. In Padden and Humphries book,

Deaf in America: Voices from a Culture, they wrote:

Our goal is to write about Deaf people in a new and different way Thinking

about the linguistic richness uncovered in [work on sign language] has made us
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realize that the language has developed through the generations as a part of an

equally rich culture heritage. It is a heritage the culture of Deaf people that

we want to begin to portray. (Denworth & Padden).

This new way of talking about the Deaf was all in an effort to remove the medicalization

of being deaf and discuss how its merely just a difference that brings about a whole new

culture.

I want to discuss the culture in such depth to attempt to get the full perspective of the

situation. Imagine this scenario: Its the height of your cultures civil rights movements, Deaf

students protesting for their rights and winning, Leaders from Deaf culture stating that from the

time God made earth until today, this is probably the best time to be Deaf (Denworth, Hilibok),

and then out of nowhere comes the approval from the FDA for cochlear implants in children as

young as 1 year old. You see this as nothing but another fix for something that you dont want

or see a need to be fixed and how could you not? Late-deafened adults who arent raised within

deaf culture are old enough to weigh the options and understand their choices, but the children

who are born deaf are a completely different story and this is how it seems most members of the

deaf community see the situation. As Denworth said in her TIME Magazine article, the deaf

community felt ignored by the medical and scientific supporters of the cochlear implants; many

believed deaf children should have the opportunity to make the choice for themselves once they

were old enough. This sentiment is where the ethical dilemma of consent comes into play. To

perform the implantation on a child because of the necessity to implant within the first three

years of life for maximum success or wait until the child can provide consent for a future altering

device. As shown in Graph 1, the number of infants with recognizable hearing impairments

versus the number of infants enrolled in some form of early intervention of any kind has steadily
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increased in recent years. Some questions whose autonomy trumps whose in this situation and

whether it is the parental autonomy or the potential autonomy of the child (Hladek 31). As an

article from Monash Bioethics Review writes, the issue is complicated when viewed from the

perspective not only changing the biological status of the individual, but also the potential

culture of the individual. The words discrimination, genocide and eradication, then began

flying amongst the debate. If the Deaf culture is defined by their inability to hear along with their

use of American Sign language, and the Cochlear Implant eradicates the need for ASL then

wouldnt it in turn eradicate the culture as a whole?

Now imagine this scenario; youre Lydia Denworth a parent of a 3-year-old child that has

suddenly lost his ability to hear. Youre being consulted by physicians about how he is within a

critical period where the development of language occurs and if you as a parent are going to

choose the path of the cochlear implant the decision needs to be made soon. Youve researched

and discovered a great divide on the morality of the device and you are left to weigh the options

and decide what is best for your child. The medical and scientific community views the cochlear

implant as a revolutionary device that can change lives for the better, and some arguments have

been made that describe how the Deaf communitys argument on why the devices are morally

problematic is morally problematic within itself. To the Deaf community, each time a child

receives the implantation it is a means to a cultures end. So, if all children that are born deaf are

implanted with the device, the culture will in turn come to an end. In this way of thought the child

serves as a fulfiller of the aspirations of a culture, not of the childs own dreams. When discussing

this topic, one author said, the autonomy of the individual ethically trumps the autonomy of the

group (Hladek). If the group alters the choices that will be available to the child in the future,

respect for the individual requires support for the child, even if the choice will eventually result in
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the death of a group or culture. (Hladek). Some question if these children should limit their future

based on a single trait. Is it morally sound to lessen the amount of opportunities available to deaf

children simply because they are deaf?

Advocates of the Deaf culture often say that the children can still live fulfilling lives

without the aid of the cochlear implant, but because of the small size of this community can this

be true? The Deaf community is measured to be at about 700,000 and considered to be exclusive.

The decision against the cochlear implants restricts the child to a limited community that does

not involve the childrens parents, unless they are among the mere 10% of deaf children born to

parents of the same condition. These communities are also few and far between; they arent

present in rural communities so this further restricts the child to living within the few urban

locations that have the proper accommodated facilities. While the future employment

opportunities have been increased in the past, the possible places for employment will still be

limited. A fact that is apparent to both the hearing culture and the deaf culture is that those who

are deaf lack one of the 5 critical senses. They cannot perform some of the most basic tasks of

daily living without some sort of assistance. Hladek said, They cannot talk on the phone without

assistance, go to a movie, hear music, their children and grandchildren laugh or cry, get a job

without having to consider how their deafness will interfere with the job duties and in his article

when an adult with the implant was asked if he felt the device took away his Deaf pride, he

responded with:

What the hell is deaf pride? Proud not to hear your child's voice, pianos, the birds in

the trees? That's not pride, it's bullheadedness and selfishness.... I feel the implant

enhances my pride. I am proud to be overcoming what was considered a severe


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handicap, proud to be part of a community as a whole, not to a "club" of narrow-

minded people."

This man would be considered deaf with a lower-case D. He recognizes that this single trait was

something that limited his life and did not permit him to go about his daily life with the

fulfilment that others were able to do. It may seem as though the distinction between a Deaf

person and a deaf person is as extreme as republican versus democrat, but the divide isnt that

significant. Though through my research, I have found that there has been some tension and

animosity towards those who chose to get the cochlear implant later in life and those who dont

wish to be a part of the Deaf culture.

Those among the Deaf culture argue that by implanting the cochlear device on a child

before the age of consent is unethical, it is stripping away their rights and will ultimately lead to

the declination of their culture as a whole. Those among the hearing community argue that

waiting until the age of consent to allow the child to make an informed decision has effectively

made the decision for the child, thus minimizing the childs future opportunities. While there

isnt any question that a child has the right to become a part of the Deaf culture, the opposite

scenario must be considered as well. The child also has the right to the culture of their biological

family (Teagle). This argument is the great divide between the hearing and the Deaf. Some offer

an explanation for this unreconcilable difference; Padden and Humphries described in their book,

the Deaf communities view themselves as having a different center, Members of the hearing

culture see the ability to hear as a norm, but those of the Deaf culture see their deafness as a

norm. This difference in what is norm is potentially what causes such a disconnect and inability

for members of each group to understand each other in respects to the Cochlear Implant. Though

despite the center of either culture, as said in an article from the Journal of Child Neurology,
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Cochlear implantation offers children who are deaf the ability to achieve their potential in all

venues of life (Teagle). I fully believe in the value of the Deaf culture and the impact that it

makes in thousands of peoples lives and any culture that positively impacts an individuals life

is worth preserving. But while being a part of a culture as rich as that of the Deaf culture, the

option of affording the child with as many opportunities as possible, I believe in the end is the

more practical and beneficial option.

Infants with Hearing Loss


4000

3500

3000

2500

2000

1500

1000

500

0
1999 2000 2001 2002 2003 2004 2005 2006 2007

Total Enrolled in Early Intervention

(Centers for Disease Control and Prevention (CDC). Identifying infants with hearing loss - United States, 1999-2007. MMWR Morb Mortal Wkly Rep. 59(8): 220-223.)
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Status of infants who did not pass initial hearing screening

Lost to follow-up/lost to documentation.

Work Cited
Centers for Disease Control and Prevention (CDC). Identifying infants with hearing loss - United
States, 1999-2007. MMWR Morb Mortal Wkly Rep. 59(8): 220-223.
"Cochlear Implants." National Institutes of Health. U.S. Department of Health and Human
Services, 06 Mar. 2017. Web. 03 Apr. 2017.
Denworth, Lydia. "Deaf Culture and Cochlear Implants: Genocide or Salvation?" Time. Time,
25 Apr. 2014. Web. 31 Jan. 2017.
Gifford, Rene H. Cochlear Implant Patient Assessment: Evaluation of Candidacy, Performance,
and Outcomes. San Diego: Plural, 2013.
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Hladek, Glenn A. "Cochlear Implants, the Deaf Culture, and Ethics." Monash Bioethics Review
21.1 (2002): 29-44. Web.
Tucker, Bonnie Poitras. Deaf Culture, Cochlear Implants, and Elective Disability. The
Hastings Center Report, vol. 28, no. 4, 1998, pp. 614., www.jstor.org/stable/3528607
Niparko JK, Tobey EA, Thal DJ, Eisenberg LS, Wang N, Quittner AL, Fink NE, CDaCI
Investigative Team FT. Spoken Language Development in Children Following Cochlear
Implantation. JAMA. 2010;303(15):1498-1506. doi:10.1001/jama.2010.451
Padden, Carol, and Tom Humphries. Deaf in America: Voices from a Culture. Cambridge, MA:
Harvard UP, 2003. Print.
Teagle, H. F. B. "Cochlear Implantation for Children: Opening Doors to Opportunity." Journal of
Child Neurology 27.6 (2012): 824-26. Web.
Weisler, Pedro. No such Thing as a blind culture.Journal of Child Neurology, vol. 27, no. 6,
June 2012, pp. 819-82. EBSCOhost, doi:10.1177/0883073812441249
Zohdi, Ismail, Mikhail Wadie Abdelmessih, Amira Maged El Shennawy, Baher Mohamed
Badreldin Ashour, and Gamal Eldin Hady Kandil. "Statistical Analysis of Various Factors
Affecting the Results of Cochlear Implantation." The Journal of International Advanced
Otology 10.2 (2014): 118-23. Web.