Cloggy
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Found this essay
Regarding the often used argument about the high costs of CI, I found one of the last passages very informative...
Will have to look for "Clark et al., 1997".
That was 10 years ago... must be even better nowadays..
Moral and Ethical Issues Involving Cochlear Implants
Rick Chen
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Cochlear Implants
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The invention of cochlear implants has been considered one of the major breakthroughs in the biomedical engineering field. For a long period of time, people with minor to severe hearing loss had to rely on conventional hearing aids. Although the hearing aids allowed them to "hear," the sound was either not loud enough to be heard or too loud to be understood. With the population of deaf people steadly growing, scientists and engineers were determined to revolutionize today's hearing assistive devices; thus the cochlear implant was born. The first research on cochlear implants was published in the early 1960s. Since then, a great effort has been put into the improvement of the device's capabilities. In the mid 70s, more than half of the pepole who had cochlear implants could understand sentences with 80-100 percent accuracy (Tucker, 1972).
In recent years, with the help of advanced technology, the quality of the device has been no less than remarkable: more compact, lighter in weight, little to no wires, more natural sound . . . the list goes on and on. But just when the dream that there will be no more deaf people has slowly become a realistic goal in the future, the issue of being disabled has taken root among the general public. Is being deaf a disability? Or are deaf people just one of the many groups that exist in this diverse society, comparable to the gay and lesbian community. To begin answering these difficult questions, one needs to be familiar with the culture developed within the deaf community.
Deaf Culture
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Within the larger deaf community, there are two types of people: ones that consider themselves as “deaf”, and ones that consider themselves as “Deaf.” People who are deaf believe that being deaf is an impairment and try to assimilate back into the hearing society. Therefore, they do not view themselves as part of a separate culture. People who are Deaf think that being deaf is a cultural and social identity, and therefore consider themselves a member of a unique Deaf culture.
What is Deaf Culture? Deaf culture is a social pheonomenon that emerged because of the advancement of the hearing assistive device (Levy, 2002). It is a viewpoint created by a minority of Deaf people and those who share the same mind set. People in the Deaf culture consider themselves as normal people. They do not think that not being able to hear should limit their opportunities in society. Members within this culture argue that being deaf is not a disability, but rather just having a different language (Cherny, 1999). American Sign Language, or ASL, is the language claimed by the people in the Deaf community. They strongly oppose the idea that American Sign Language is just a conversion of English and that it is an inferior language or not even a language at all. Back in the 1960s, the publication of sign language dictionary by Bill Stokoe, Carl Cronenberg, and Dorothy Casterline stressed the fact that ASL is a complete, sophisticated language that is equal if not above the English language (Cherny, 1999). Being Deaf is high valued in the Deaf culture. Deaf people who support those cultural values are very proud and glad that they are Deaf.
After exposed to the Deaf culture and their ideas, one could understand why they are against the cochlear implants. Deaf people view that the effort made by the medical world to “cure” something that they see no wrong in is absolutely pointless (Levy, 2002). This sense of resentment is even more prevalent when it comes to Deaf children. They are convinced that putting the implant in a child will only lower their self-esteem. In addition, the implant will also hinder their ability to learn because it forces the disability upon them, so they have to bear the pressure of learning at the same pace as the other children with normal hearing (Levy, 2002). Although this argument seems to be valid, one big issue that comes with it is the free will of the children versus the responsibility of the parents. Should the children have the freedom to choose to participate in or separate themselves from mainstream society? Or should the parents, in the name of the child’s well being, have the responsibility to make the decision for them?
The Controversy
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The biggest and the most debated reason why the Deaf culture opposes the cochlear implant so strongly is the notion that a widespread use of it would mean the end of the Deaf culture (Levy, 2002). Since 90% of all the deaf children are born to hearing parents, the population of the Deaf culture cannot be sustained through traditional means. Only if the deaf children realize and accept their own deafness will the Deaf culture be preserved (Cherny, 1999). This requirement however is very hard to achieve because most of the hearing parents do not understand what it means to be deaf. They typically will fit the child with the cochlear implant and want them to lead a “normal” life. In contrast, most of the Deaf parents would like to have children that are deaf as well. They want their children to be a part of the Deaf culture and share similar cultural values. This type of thinking where the parents make the decision denies the children the right to choose for themselves whether to participate in or be separate from the hearing world. In addition, hearing parents often are poorly informed about the deaf community, and vice versa, the Deaf parent does not necessarily fully understand the benefits of being able to hear. Thus, the parent might make the wrong decision for the child, which could potentially have irreversible consequences (Cherny, 2002). An alternative way is to let the children decide for themselves. Initially this might seem like the best approachHowever, the child has to be old enough to make the decision, but by that time the child has probably gotten use to communicating through sign language and being comfortable with their deafness. So more likely than not the child will choose to remain deaf. In terms of oral communication, it is very difficult to learn how to speak again at an older age.
Ignore all the other factors temporarily and consider this issue from the economic standpoint. In Australia, the overall cost of a cochlear implant is around $45,000 (includes device, surgical procedure, and rehabilitation program). It costs the Australia government about $4,420 per year to educate a child in a specialized program and $1,110 per year to attend a normal school. Now assume that 3 years after the implantation the child is allowed back into mainstream education, the government can save from $7,877 up to $19,599 if the child gets the implant (Clark et al., 1997). Looking at that statistic, clearly the implant is a better choice from the financial side.
Conclusion
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After all the discussion and debate, the bottom line is that the moral and ethical issues involving the cochlear implant are never going to have a definite solution. It deals not only with the patient and his/her family, but with the society as a whole as well. From the law perspective, the issue juggles between the right to free will and parental responsiblility. From the sociological perspective, the controversy affects how society defines being normal and being disabled. The head-on collision between the medical technology and the right to be deaf cannnot be avoided; what is imporant is that both sides have to learn how to fit together to improve the quality of living, not to create more corrals.
Regarding the often used argument about the high costs of CI, I found one of the last passages very informative...
Will have to look for "Clark et al., 1997".
That was 10 years ago... must be even better nowadays..
