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Medicine, Health Care and Philosophy

, Volume 13, Issue 2, pp 157–167 | Cite as

Choosing for the child with cochlear implants: a note of precaution

  • Patrick Kermit
Scientific Contribution

Abstract

Recent contributions to discussions on paediatric cochlear implantation in Norway indicate two mutually exclusive doctrines prescribing the best course of post-operative support for a child with cochlear implants; bilingually with sign language and spoken language simultaneously or primarily monolingually with speech only. This conflict constitutes an ethical problem for parents responsible for choosing between one of the two alternatives. This article puts forth the precautionary principle as a possible solution to this problem. Although scientific uncertainty exists in the case of both doctrines, there exists a scenario of possible irreversible harm to some of the children habilitated monolingually. An application of the precautionary principle may hence suggest that it is rational to agree on the bilingual approach, at least for the time-being.

Keywords

Children Ethics Deafness Habilitation Cochlear implants Language 

Notes

Acknowledgments

I wish to thank Bjørn Myskja at the Department of Philosophy, Norwegian University of Science and Technology, for invaluable help with writing this text. I also want to thank both Berge Solberg, Department of Social Work and Health Science, Norwegian University of Science and Technology, and Sidsel Holiman, Department of Educational Sciences, Norwegian University of Science and Technology, for their help and comments.

References

  1. Ahlgren, I., and K. Hyltenstam. 1994. Bilingualism in deaf education. Hamburg: Signum.Google Scholar
  2. Archbold, S.M., T.P. Nikolopoulos, M. Tait, G.M. O’Donoghue, M.E. Lutman, and S. Gregory. 2000. Approach to communication, speech perception and intelligibility after paediatric cochlear implantation. British Journal of Audiology 34: 257–264.PubMedGoogle Scholar
  3. Archbold, S., and G.M. O’Donoghue. 2009. Education and childhood deafness: changing choices and new challenges. In Cochlear implants: principles & practices, ed. J.K. Niparko, 313–321. Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  4. Armstrong, D.F., M.A. Karchmer, and J.V. Van Cleve. 2002. The study of signed languages: essays in honor of William C. Stokoe. Washington, D.C: Gallaudet University Press.Google Scholar
  5. Bakhshaee, M., M. Ghasemi, M. Shakeri, N. Razmara, H. Tayarani, and M. Tale. 2007. Speech development in children after cochlear implantation. European Archives of Oto-Rhino-Laryngology 264: 1263–1266.CrossRefPubMedGoogle Scholar
  6. Balkany, T., A. Hodges, C. Menapace, L. Hazard, C. Driscoll, B. Gantz, et al. 2007. Nucleus freedom North American clinical trial. Otolaryngology—Head and Neck Surgery 136: 757–762.CrossRefPubMedGoogle Scholar
  7. Beadle, E.A., D.J. McKinley, T.P. Nikolopoulos, J. Brough, G.M. O’Donoghue, and S.M. Archbold. 2005. Long-term functional outcomes and academic-occupational status in implanted children after 10 to 14 years of cochlear implant use. Otology & Neurotology 26: 1152–1160.CrossRefGoogle Scholar
  8. Cummins, J. 1999. The ethics of doublethink: language rights and the bilingual education debate. TESOL journal 8: 13–17.Google Scholar
  9. Dettman, S.J., D. Pinder, R.J. Briggs, R.C. Dowell, and J.R. Leigh. 2007. Communication development in children who receive the cochlear implant younger than 12 months: risks versus benefits. Ear and Hearing 28: 11S–18S.CrossRefPubMedGoogle Scholar
  10. Engen, T.O., and L.A. Kulbrandstad. 2004. Tospråklighet, minoritetsspråk og minoritetsundervisning. Oslo: Gyldedal Akademisk.Google Scholar
  11. Erlenkamp, S. 2009. Et synlig språk? Omtalen av norsk tegnspråk i offentlige dokumenter. In Hørsel—språk og kommunikasjon; en artikkelsamling, ed. Å.L. Hansen, N. Garm, and E. Hjelmervik, 160–168. Trondheim: Møller Kompetansesenter.Google Scholar
  12. Geers, A.E. 2004. Speech, language, and reading skills after early cochlear implantation. Archives of Otolaryngology—Head & Neck Surgery 130: 634–638.CrossRefGoogle Scholar
  13. Geers, A.E. 2006. Factors influencing spoken language outcomes in children following early cochlear implantation. Advances in Oto-Rhino-Laryngology 64: 50–65.PubMedGoogle Scholar
  14. Grønlie, S.M. 2005. Uten hørsel? En bok om hørselshemming. Bergen: Fagbokforlaget.Google Scholar
  15. Hauser, P.C., and M. Marschark. 2008. What we know and what we don’t know about cognition and deaf learners. In Deaf cognition: foundations and outcomes, ed. M. Marschark and P.C. Hauser, 439–457. Oxford: Oxford University Press.CrossRefGoogle Scholar
  16. Hawker, K., J. Ramirez-Inscoe, D.V. Bishop, T. Twomey, G.M. O’Donoghue, and D.R. Moore. 2008. Disproportionate language impairment in children using cochlear implants. Ear and Hearing 29: 467–471.CrossRefPubMedGoogle Scholar
  17. Heian, A., and S. Hillesøy. 2009. Auditiv-verbal tilnærming—en vei til Rom? In Hørsel—Språk og Kommunikasjon. En Artikkelsamling, ed. Å.L. Hansen, N. Garm, and E. Hjelmervik, 39–47. Trondheim: Møller Kompetansesenter.Google Scholar
  18. Holtsmark, H., and J. Borrebæk. 2009. Kostbare erfaringer for vårt døve barn. Tidsskrift for Den Norske Legeforening 129: 662–663.CrossRefGoogle Scholar
  19. Jonas, H. 1985. Technik, Medizin und Ethik: zur Praxis des Prinzips Verantwortung. Frankfurt am Main: Insel Verlag.Google Scholar
  20. Kermit, P. 2006. Tegnspråk og anerkjennelsen av døve som en språklig minoritet. In Tegn som språk: En antologi om tegnspråk, ed. S.R. Jørgensen and R.L. Anjum. Oslo: Gyldendal Akademisk.Google Scholar
  21. Kermit, P. 2009. Deaf or deaf? Questioning alleged antinomies in the bioethical discourses on cochlear implantation and suggesting an alternative approach to d/deafness. Scandinavian Journal of Disability Research 11: 159–174.CrossRefGoogle Scholar
  22. Kim, C.S., S.H. Oh, S.O. Chang, H.M. Kim, and D.G. Hur. 2008. Management of complications in cochlear implantation. Acta Oto-Laryngologica 128: 408–414.CrossRefPubMedGoogle Scholar
  23. Kirk, K.I., and S. Choi. 2009. Clinical Investigations of cochlear implant performance. In Cochlear implants: principles & practices, 2nd edition, ed. J.K. Niparko, 191–222. Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  24. Kunnskapsdepartementet. 1998. Lov om grunnskolen og den vidaregåande opplæringa.Google Scholar
  25. Kusche, C.A., T.S. Garfield, and M.T. Greenberg. 1983. The understanding of emotional and social attributions in deaf adolescents. Journal of Clinical Child Psychology 12: 153.Google Scholar
  26. Lahey, M. 1988. Language disorders and language development. New York: Macmillan.Google Scholar
  27. Lane, H., and M. Grodin. 1997. Ethical issues in cochlear implant surgery: an exploration into disease, disability, and the best interests of the child. Kennedy Institute of Ethics Journal 7: 231–251.CrossRefPubMedGoogle Scholar
  28. Levy, N. 2002. Reconsidering cochlear implants: the lessons of Martha’s Vineyard. Bioethics 16: 134–153.CrossRefPubMedGoogle Scholar
  29. Lian, A. 2008. Cochleaimplantat og spesifikke språkvansker. Tidsskrift for Den Norske Legeforening 128: 712.PubMedGoogle Scholar
  30. Lin, F.R., and J.K. Niparko. 2006. Measuring health-related quality of life after paediatric cochlear implantation: A systematic review. International Journal of Paediatric Otorhinolaryngology 70: 1695–1706.CrossRefGoogle Scholar
  31. Marschark, M., C. Rhoten, and M. Fabich. 2007. Effects of cochlear implants on children’s reading and academic achievement. The Journal of Deaf Studies and Deaf Education 12: 269–282.CrossRefGoogle Scholar
  32. Mellon, N.K. 2009. Implications of parental choice of communication mode: understanding the options. In Cochlear implants: principles & practices, ed. J.K. Niparko, 343–345. Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  33. Miyamoto, R.T., M.J. Hay-McCutcheon, K.I. Kirk, D.M. Houston, and T. Bergeson-Dana. 2008. Language skills of profoundly deaf children who received cochlear implants under 12 months of age: a preliminary study. Acta Oto-Laryngologica 128: 373–377.CrossRefPubMedGoogle Scholar
  34. Nakamura, K. 2006. Deaf in Japan. Signing and the politics of identity. Ithaca and London: Cornell University Press.Google Scholar
  35. Nicholas, J.G., and A.E. Geers. 2007. Will they catch up? The role of age at cochlear implantation in the spoken language development of children with severe to profound hearing loss. Journal of Speech, Language and Hearing Research 50: 1048–1062.CrossRefGoogle Scholar
  36. Niparko, J.K. 2009. The cultural implications of cochlear implants. In Cochlear implants; principles & practices, ed. J.K. Niparko, 335–341. Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  37. Nunes, R. 2001. Ethical dimension of paediatric cochlear implantation. Theoretical Medicine & Bioethics 22: 337–349.CrossRefGoogle Scholar
  38. Padden, C., and T. Humphries. 1988. Deaf in America, voices from a culture. Cambridge, Massachusetts: Harvard University Press.Google Scholar
  39. Peterson, M. 2007a. Should the precautionary principle guide our actions or our beliefs? Journal of Medical Ethics 33: 5–10.CrossRefPubMedGoogle Scholar
  40. Peterson, M. 2007b. The precautionary principle should not be used as a basis for decision-making. EMBO Reports 8: 305–308.CrossRefPubMedGoogle Scholar
  41. Pisoni, D.B., and M. Cleary. 2003. Measures of working memory span and verbal rehearsal speed in deaf children after cochlear implantation. Ear and Hearing 24: 106S–120S.CrossRefPubMedGoogle Scholar
  42. Pisoni, D.B., C.M. Conway, W.G. Kronenberger, D.L. Horn, J. Karpicke, and S.C. Henning. 2008. Efficacy and effectiveness of cochlear implants in deaf children. In Deaf cognition: foundations and outcomes, ed. M. Marschark and P.C. Hauser, 52–101. Oxford: Oxford University Press.CrossRefGoogle Scholar
  43. Richter, B., S. Eissele, R. Laszig, and E. Lohle. 2002. Receptive and expressive language skills of 106 children with a minimum of 2 years’ experience in hearing with a cochlear implant. International Journal of Paediatric Otorhinolaryngology 64: 111–125.CrossRefGoogle Scholar
  44. Rydberg, E., L.C. Gellerstedt, and B. Danermark. 2009. Toward an equal level of educational attainment between deaf and hearing people in Sweden? Journal of Deaf Studies and Deaf Education 14: 312–323.CrossRefPubMedGoogle Scholar
  45. Sagi, E., M.B. Fitzgerald, and M.A. Svirsky. 2007. What matched comparisons can and cannot tell us: the case of cochlear implants. Ear and Hearing 28: 571–579.CrossRefPubMedGoogle Scholar
  46. Sarant, J.Z., P.J. Blamey, R.C. Dowell, G.M. Clark, and W.P.R. Gibson. 2001. Variation in speech perception scores among children with cochlear implants. Ear and Hearing 22: 18–28.CrossRefPubMedGoogle Scholar
  47. Schauwers, K., S. Gillis, K. Daemers, B.C. De, C.G. De, M. Yperman, et al. 2004. Normal hearing and language development in a deaf-born child. Otology and Neurotology 25(6): 924–929.CrossRefPubMedGoogle Scholar
  48. Siem, G., O.B. Wie, and S. Harris. 2008. Cochleaimplantat og tegnspråk. Tidskrift for Den norske Legeforening 128: 69.Google Scholar
  49. Spencer, L.J., B.J. Gantz, and J.F. Knutson. 2004. Outcomes and achievement of students who grew up with access to cochlear implants. Laryngoscope 114: 1576–1581.CrossRefPubMedGoogle Scholar
  50. Stokoe Jr., W.C. 2005. Sign language structure: an outline of the visual communication systems of the American deaf. The Journal of Deaf Studies and Deaf Education 10: 3–37.CrossRefGoogle Scholar
  51. Svartholm, K. 2005. Döva barn bör få lära sig både teckenspråk och svenska. Läkartidningen 102: 1667–1668.PubMedGoogle Scholar
  52. Tait, M., R.L. De, and T.P. Nikolopoulos. 2007. Deaf children with cochlear implants before the age of 1 year: comparison of preverbal communication with normally hearing children. Internatinal Journal of Paediatric Otorhinolaryngology 71: 1605–1611.CrossRefGoogle Scholar
  53. The United Nations Conference on Environment and Development. 1992. Rio Declaration on Environment and Development. The United Nations.Google Scholar
  54. Thoutenhoofd, E.D., S.M. Archbold, S. Gregory, M.E. Lutman, T.P. Nikolopoulos, and T.H. Sach. 2005. Paediatric cochlear implantation. London: Whurr Publishers.Google Scholar
  55. Tobey, E.A., A.E. Geers, C. Brenner, D. Altuna, and G. Gabbert. 2003. Factors associated with development of speech production skills in children implanted by age five. Ear and Hearing 24: 36S–45S.CrossRefPubMedGoogle Scholar
  56. Tomblin, J.B., B.A. Barker, and S. Hubbs. 2007. Developmental constraints on language development in children with cochlear implants. International Journal of Audiology 46: 512–523.CrossRefPubMedGoogle Scholar
  57. Uziel, A.S., M. Sillon, A. Vieu, F. Artieres, J.P. Piron, J.P. Daures, et al. 2007. Ten-year follow-up of a consecutive series of children with multichannel cochlear implants. Otology & Neurotology 28: 615–628.CrossRefGoogle Scholar
  58. Vygotskij, L. 1978. Mind in society: the development of higher psychological processes. Cambridge, Mass: Harvard University Press.Google Scholar
  59. Wei, B.P., G.M. Clark, S.J. O’Leary, R.K. Shepherd, and R.M. Robins-Browne. 2007a. Meningitis after cochlear implantation. British Medical Journal 335: 1058.CrossRefPubMedGoogle Scholar
  60. Wei, B.P.C., R.K. Shepherd, R.M. Robins-Browne, G.M. Clark, and S.J. O’Leary. 2007b. Threshold shift: Effects of cochlear implantation on the risk of pneumococcal meningitis. Otolaryngology—Head and Neck Surgery 136: 589–596.CrossRefPubMedGoogle Scholar
  61. Wie, O.B., E.S. Falkenberg, O. Tvete, and B. Tomblin. 2007. Children with a cochlear implant: characteristics and determinants of speech recognition, speech-recognition growth rate, and speech production. International Journal of Audiology 46: 232–243.CrossRefPubMedGoogle Scholar
  62. Wittgenstein, L. 1967. Philosophical investigations. Oxford: Blackwell.Google Scholar
  63. World Commission on the Ethics of Scientific Knowledge and Technology. 2005. The Precautionary Principle. United Nations Educational, Scientific and Cultural Organization.Google Scholar
  64. Young, G.A., and D.H. Killen. 2002. Receptive and expressive language skills of children with 5 years of experience using a cochlear implant. Annals of Otology, Rhinology and Laryngology 111: 802–810.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.Department of Social Work and Health ScienceNorwegian University of Science and TechnologyTrondheimNorway
  2. 2.Sør-Trøndelag University CollegeTrondheimNorway

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