1. The document discusses the complex issue of cochlear implants in children, weighing the perspectives of parents, the Deaf culture, ethics, and the child's best interest. 2. Cochlear implants are surgically implanted devices that stimulate the auditory nerve electrically to simulate hearing. They are recommended for children as young as 12 months old to maximize language development benefits, but also carry medical risks. 3. The Deaf culture views deafness as a difference rather than a disability and wants deaf children immersed in their culture. They believe cochlear implants prevent this and threaten their culture's existence by opening children up to the hearing world. Parents and advocates disagree on who can best care for a deaf child.

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Stacey-Ann Ellis
Bioethics
November 11, 2014
Semester Project
Cochlear Implants
Bioethics is the study of ethical implications between technology and its applications to medicine.
In this paper, I will be discussing these technological implications in terms of children receiving cochlea
Implants and the battle between ethics, parental decisions, and the deaf culture. With all three components
involved in the decision making process,it creates a complex system of what is right from wrong and
what will benefit the child most. It is also important to preserve the child’s dignity and autonomy, while
providing the child with resources to help him/her better adjust in society. The decision of whether or not
the child gets the cochlear implant is dependent upon whether or not the child was born to hearing
parents, both parent being part of a Deaf culture or one of the parents are deaf and the parent’s knowledge
and perspective on the Deaf culture. There are risk factors associated with this procedure and some
parents may have unrealistic expectations of the outcome.
The “Cochlear Implants are surgically implanted devices that allows to stimulate auditory nerve
fibers electrically, that is located in the cochlea, simulating hearing.” This kind of procedure is not readily
available to anyone with hearing loss. One has to have a profound to severe hearing loss or deafness. This
candidate would not have any kind of benefit from hearing aids or assistive listening devices. When the
procedure is being done, all of the residual hearing that the individual had left in one or both ears would
be completely wiped out in order to insert the electrodes, which is then stimulated through electrical
impulses and simulate the hearing capability. “The internally embedded electrodes are connected to an
external speech processor that converts the auditory signal into electrical impulses and allows the brain to
decode the impulses into the perception of speech”. In order for this to be done, a mastoidectomy has to
be performed, which is the drilling into the skull where the temporal bone is located. This procedure is
recommended as soon as the child is declared to be deaf or as soon as it is allowed to be done, in order for
the individual to receive the maximum potential benefit from the device.
No procedure that is done to the body goes without any risks, and the same applies for cochlear
implants. Due to the nature of children, they are more prone to infections, after the procedure. Recently,
the FDA have approved the procedure for children that are 12 months or older. Though the FDA has strict
policies and regulations concerning children, as technology advances,changes will be expected. During
the surgery there can be damage done to the facial nerves, but this may only occur due to anatomically
abnormal structures within the ear. There could also be the improper placement of the electrode array,
which would require the removal and reinsertion of the electrode arrays, which is another surgical
procedure. There is a risk of respiratory failure and the increased risk of bradycardia, which is an
abnormally slow heart action. As it states in the article, CochlearImplantsin Children: Ethics,Informal
Consent, and Parental Decision Making in the journal of Clinical Ethics, young children are also at a
higher risk of getting otitis media which could interfere with the functioning of the cochlear implant. This
would require aggressive treatment because otitis media can lead to the acquiring of meningitis, with a
risk up to 30 times the generalpopulation within the same age range.
When a parent decides to get cochlear implants, there are many associated burdens that
accompanies this decision process. There are lots of follow-up sessions to fine tune the aid, starting about
two weeks after the procedure, to ensure that all the swelling is reduced from the surgery. The electrodes
within the implant have between 4 – 22 channels, which is about 1% of the hairs presented in the cochlea.

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They are programmed to a certain amplitude of sound, but “no two electrodes can be stimulated at the
same time.” The audiologist has to program the implant to fit the patient’s environment, which requires
multiple visits each year. As the child gets older, they may need to upgrade the implant for it to fit with
the different body size in terms of their head proportion, from when they first had the implant. There is
also the burden of a parent constantly trying to keep up, being available to the child at all times, taking
sick days for appointments, and assisting in any other ways that requires the parent. Another burden on a
lot of the parents is the cost of the implant itself, the procedure, and the follow-ups, while trying to keep
up with the rest of the household.
Many parents have unrealistic expectation of cochlear implant. They expect the cochlear implant
to cure or restore their child’s normal range of hearing, to that of a hearing person. Other than this
unfortunate event, there are many great attributions to getting the implant. Implantation before a certain
age or within12 months of hearing loss has long term speech perception improvements along with the
speech production, language, and literacy development. The earlier one is able to get the procedure done,
the better the outcome will be. But even if this is the case, “the child’s socioeconomic status, IQ,gender,
family size, and their educational program affects the efficacy in terms of its quality.” This could also
contribute to burden as much as it may contribute to one’s benefits, in a different family setting.
“Nonverbal communication among experiences that are shared,attention given, and mutual understanding
along with family involvement and enrollment time in school affects how these children score on tests, in
comparison to normal hearing children.”
The Deaf culture is the culture of people who have fully immersed themselves in everything that
has to do with deafness and not much for the hearing society. The Deaf culture would rather have their
children who has congenital deafness or children who became deaf sometime before learning to speak,to
be completely immerged in their way of life such as boarding schools and horizontal acculturation. They
would rather to take over the responsibilities of the child and make decisions concerning aid, instead of
the parents themselves. The Deaf culture does not view their status as a disability, but it is viewed as a
difference. They have their own identity and language, just as the hearing world. The deaf culture has
very high opinions on what goes on with a child in terms of the approach that is taken along with the
parental perspectives as it also affect the deaf society.
The Deaf culture highly depends on the children of each generation to keep them going. Without
the presence of someone to keep their culture going over the years due to advances in technology, it
would lead to the destruction of the culture. According to the journal,this act is what they classify as
“genocidal.” This is what the Deaf culture considers to be “genocidal”. Deaf children are the future of the
culture, which it is highly dependent, unlike in the hearing world, where no matter your status,you are a
part of that culture. According to ASHA,“5,775,722 people in the United States in all 50 states,DC,and
Puerto Rico, in 2010, had hearing loss.” In comparison to the 316 million people in the United States,the
Deaf culture is approximately 1/54 of the population which is small.
The adults in the deaf community or adults who have recently become deaf does not pose any
threat to the deaf culture because they are either already a part of it or their identity is already established
in the hearing society. With being older, they cannot pose as much threat because they are already
established in their values, attributes and perspectives. As was mentioned before children are the future
and they will help to determine what happens for the future generations and what values to be passed on.
An older adult that has recently lost their hearing cannot contribute much to society as they did not grow
up with all the traditions and way of living. They may even resent the whole idea of being deaf and may
deny their hearing status.
Cochlear implants in the eyes of the Deaf association is a high risk factor to their existence. This
new technology helps children to become a part of the hearing world, preventing them from completely
immersing themselves in a culture that understand them. The deaf culture wants the children to be able to
be comfortable in who they are and embrace it as a much as they can. To provide the best education and

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to keep individuals around people who are like them and people who understand them more than that of
which a hearing person could, boarding school is provided. This takes the children out of their parent’s
home and only occasionally return home on some weekends and on breaks. With the cochlear implants, it
prevent the children from attending a Deaf cultured program, or if they do, they would not be able to be
completely and whole hearted immersed in the culture. They will have the increasing need to be more like
hearing people instead of more like the deaf. Cochlear implants open up many windows of opportunity.
With the implants and the threat possessed by such technology, the activist use organized efforts
to propaganda things that are not necessarily true. Nonetheless, it is used as an effort to protect the society
by the use of scare tactics and symbolizes the cochlear implant as a “vampire,” which does not have any
good associations. It is an effort to scare people who are not educated enough, persuading them indirectly
about the decisions they will make and how their child will be impacted. Since there are more and more
people getting educated on the subject in order to best care for their child or children, the Deaf culture
may start to accept cochlear implants as a way of expanding the realm of the society to protect their
society.
The Deaf society thinks that they own each child that is born deaf or became deaf shortly after
birth. They believe that these children are the foundation of their society and therefore should get sole
responsibility for them. The culture believes that they better know how to take care of the child, better
than that of a parent. This creates problems for both the parent and for the advocates because each
believes that they can provide the best care for the wellbeing of the child. The culture assumes that the
hearing parents are not qualified to make decisions for a child who is deaf because they,themselves are
not deaf and therefore cannot possibly relate to the child in any way. The parents’ side is that they are the
parent and regardless of anyone’s perspective, they know what is best for their child and what will benefit
them the most, especially if they have to deal with both the hearing and deaf culture. It is also questioned
what is the motivation behind wanting to keep the child solely in the one culture. It is question whether it
has to do with the conflict of interest or not.
At all cost during any discussion about the child in question, the child’s best interest should
always be put first over both the deaf culture and the parent’s,but the interest of the child along with
using available resources to maximize the child’s full potential. While the child’s best interest should be
placed first, the family’s privacy and the “freedom to oversight, control and intrude” is still valid. The
parent knows what is best for their child because they have spent more time bonding with that child and
knows the child’s characteristics and personality. The deciding factors that determines whether or not the
child gets the cochlear implant should be considered in great details and to not have any primary benefit
from the decision, but receive benefit on a secondary basis. It is best for the parent to be properly
informed in all areas in order to give the best support and to ensure that the child is not taken advantage of
by both societies.
The effects of society does influence a lot of the decision that a parent would make for their child.
If a mother decides to send her child off to a boarding school and immerse the child into a culture where
he/she was born into, the society would comment on why a person would do that, her parenting style, and
what she values. If the mother decides to give the child an implant, the deaf culture would view her as a
threat to their society. If neither side can come to terms with the horizontal or vertical acculturation, then
the government has the right to step in and make the best decision for the child and use factors that may
influence his/her life to best make a suitable choice. Making a decision in this would be hard because
one’s birthright has to be considered and whether their characteristics are being oppressed or manipulated
for the befit of others. Though society is a major contributor to what is going on based on perspectives
and comfort zones, it is imperative that society does not interject in any of the decisions that are being
made.

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I believe that a cochlear implant is a grave innovation that did not exist a few years ago. This
innovation helps a deaf person to perceive sound the best way they can through the device. According to
the American Speech-Language-Hearing Association (ASHA),
Cochlear implants has been around since 1985 for adults and 1990 for children…. As of
December 2010, approximately 70,000 individuals, over half of which are children, received
cochlear implants in the United States. There is more than 219,000 individuals worldwide with
cochlear implants.
So cochlear implants have been becoming an accepted procedure and device to give aide to hearing and
perceiving sounds. This innovation will only grow more and become more advanced over the years and
more individuals will start to accept it as they are better educated about it.
I also believe that the implantation, is a highly intrusive kind of procedure. It invades one’s bodily
anatomy to implant a device. The child have no say or control in what was takes place. The procedure is a
thin line that can be easily crossed; going from benefit to what leads to intrusion and unwelcomed
devices. It is hard for a particular culture to not benefit from the choices in inclusion or exclusion of one’s
way of life. The Deaf culture benefits from a person who embraces the culture as they grow older and the
hearing parents gain a child that knows spoken language and is able to speak English or their native
language spoken at home. Deciding for the child at a tender age can only make or break the child. I
proclaim this because like in the video that was shown in class, when the child got a bit older, he regretted
that his parents did not try all they could for him to be able to hear. They grow up having their opinions
on whether or not they agreed with their parents’ decision to get or not get cochlear implants, which either
leads to embracement or regret.
Since the procedure is a timely one and the time affects the outcome, it is imperative that it is
done at the earliest convenience to ensure language is learned and is perceived properly, but this accounts
to be a difficult task. Making the decision early ruins any possible hope of hearing naturally because all of
the residual hair cells would be wiped clean for the electrodes to be put in place. The early choice
accounts for better acquired education and helps the child to cope in both the hearing and non-hearing
world. This decision also takes away the patient’s autonomy decisions. Waiting too late on the other hand,
result in the child’s language to be suffering in comparison to that of the same age group. The acquired
education may be lessened. The child may resent the parents for not trying the hardest they could to help
with the hearing. One of the things that is positive about waiting is that the child might gain some chances
of making their decision that best suits them, restoring some autonomy. The patient’s potential dignity
should always be kept in mind and under no circumstance should be taken advantage of because they do
grow up and become part of a growing society.
In my opinion, society would comment on either side of the decision because everyone have their
own regard on what is right or wrong in their own eyes. Above all of those, what concerns me is whether
the Deaf culture goes through all of their efforts to protect their society in terms of their best interest.
Sure, it is important to maintain one’s culture and do whatever it takes to keep the culture alive, but to
what extent do they go to make sure they keep every child, even if that is not possible because some
families have more resources than others. I wonder if they are more worried about losing their culture to a
cochlear implant more than they would care for the actual patient. I personally think they are more
concerned with protecting their society and ensuring that they get funding, appropriately, but that is just
my opinion. Another thing that puzzles me, is why does the Deaf culture deny deafness as a disability, but
claim it as a difference, yet they still get funding under disability. I believe that the deaf culture has a lot
to figure out and how to categorize themselves as a whole community. The allocation of resources
provided are not matched under their classification with the classification of others.
I believe that a cochlear implant, though may be a risky procedure, is a good idea. The
advancement of technology is supposed to help us and help how we adjust to society with it. The

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implantation to society is the same way. It would be good to know that if I was a child and I was deaf,
that my parents would go to whatever measure to ensure that I lived a good life regardless of my hearing
abilities. Without a doubt, society would question why someone would do such a thing with a piece of it
hanging on by a magnet within the inside of the ear. None of the decisions being made should be about
what society want, it should be patient centered,as they are the ones who will be affected on either side.
To conclude, I think that a cochlear implant surgery rational should be clearly done. It is meant to
give aid, but it can also affect the wearer as a whole. There are many factors that plays in the decision for
implantation and I think that the main person that should be making any decision for the child is the
actual parent and not someone from a society you have never before had any association with, claiming
that they know what is best for you and your child. Getting an implant opens many windows of
opportunity, that otherwise would be closed; like the ability to learn a verbal language and the ability to
be a part of both cultures and embrace each equally. Being a part of two different groups generates
differences and I believe that in order for the Deaf culture to remain active for many years to come, they
need to accept these societal changes,not the procedure necessarily, but the accepting of the individual
whether or not they got the procedure done and not teach the students to classify it as a “vampire.”
Leading to a more positive association in the academic setting. A setting where they are not seen as
different, but as someone who is equipped with something extra, one who can serve as a resource and as a
person that is part of their culture regardless of whether or not a magnetic receiver is hanging off one of
both sides of the temporal bone. If the Deaf culture is being threatened then they should reconsider who is
a part of it and what they should cut back on overall. Changing is easier said than done, but if one is
threatened for genocide, then in this case tightening their realm only hurts them more.