Refusing Cochlear Implants: Is It Child Neglect?
Australian Graeme Clark developed the cochlear implant, or bionic ear, in the 1970s. It does not amplify sound but directly stimulates any functioning auditory nerves in the inner ear. The Australian Government has promised a screening program of all babies for deafness from 2011. At present, only 70 percent children who might benefit are picked up early. The earlier deafness is detected, the more effective treatment can be.
Lobby group Deaf Australia says the implant "implies that deaf people are ill or incomplete individuals, are lonely and unhappy, cannot communicate effectively with others and are all desperately searching for a cure for their condition. [This] demeans deaf people, belittles their culture and language and makes no acknowledgment of the diversity of lives deaf people lead, or their many achievements."
Some deaf parents have denied their children cochlear implants. Is this right?
I have argued that deafness, in the current world, does constitute a disability (See Kahane, G. and J. Savulescu (2009). The Welfarist Account of Disability. Disability and Disadvantage. In (eds) A. Cureton and K. Brownlee. Oxford, Oxford University Press: 14-53 and Savulescu, J. (2001). "Procreative Beneficience: Why We Should Select the Best Children." Bioethics 15: 413 – 426.), albeit mild. However, I have defended the rights of deaf couples to select embryos they know will become deaf children (Savulescu, J. (2002). "Deaf Lesbians, 'Designer Disability', and the Future of Medicine." British Medical Journal 325: 771 – 773).
Nonetheless, refusing a cochlear implant is different to choosing a deaf embryo. In the latter case, no child is harmed. No child is made worse off than he or she would otherwise have been. But when a couple deny an existing child a cochlear implant, they deny that child the opportunity to hear speech, sound, music and to participate in the dominant culture, as well as being able to participate in a signing community. They make that child worse off.
This is analogous to a deaf couple with a hearing child who, wanting that child to be like them, deafen that child. That would be child abuse.
But denying a child a cochlear impact can have a similar outcome. It is a neglectful as denying a child with an amputation a limb prosthesis, on the grounds that the child can walk well enough on crutches.
In the case of competent adults, we can leave it to them to decide for themselves whether they have a cochlear implant or remain deaf, or even if they choose to become deaf. I have vigorously defended the liberty individuals to make controversial choices (see Savulescu, J. (2007). Autonomy, the Good Life and Controversial Choices. The Blackwell Guide to Medical Ethics. R. Rhodes, L. Francis and A. Silvers, Oxford: Blackwell Publishing: 17- 37) . But when it comes to parents making choices for their children, there are two plausible principles. Firstly, the intervention must plausibly be in the child’s interests. In this case, the use of a cochlear implant is likely to make a child’s life go better than remaining deaf.
Secondly, we should protect the child’s right to decide for herself. In this case, being able to hear has one advantage over deafness. The hearing can easily become deaf, while the deaf cannot easily become hearing later in life. So a child given a cochlear implant could always choose to have it removed later in life, or turned off somehow. A child, unhappy with the hearing culture, can reject it as an adult. She can be made deaf. But a deaf child cannot easily hear later in life.
To my knowledge, no hearing adult has ever freely chosen to become deaf. But it would be easy to achieve. So the cochlear implant affords the deaf child an extra option: to be deaf or hearing later in life.
Both respect for liberty/autonomy and beneficence argue in favour making the provision of cochlear implants a legal requirement.