Monday, February 10, 2014

An Obligation to Opportunity

By: Samantha Page

This post is written in response to Bonnie Poitras Tucker’s piece “Deaf Culture, Cochlear Implants, and Elective Disability,” with reference to Norman Daniels’s Just Health: Meeting Health Needs Fairly. In her article, Tucker first establishes the difference between “deaf” and “Deaf” to shed light on the divisive question of giving cochlear implants to children. While people in both the deaf and Deaf categories identify as having impaired hearing, members of the latter group separate themselves from hearing society through a distinct cultural identity while deaf people do not. In affiliation with their culture, Deaf people protest the use of cochlear implants as an attack on their community.

An essential point in Daniels’s work is the idea that health is equal to “normal functioning” (Daniels 2008, 35). To Daniels, this means that a person has a “full range…of opportunities,” in which she can pursue what is expected to be a normal lifestyle. When a person encounters an obstacle to her health that interferes with this expected way of life, Daniels calls it a “pathology” (Daniels 2008, 35, 37). In this post I apply Daniels’s ideas to Tucker’s discussion on cochlear implants to argue that it is unethical and impermissible for parents to withhold cochlear implants from children who have impaired hearing. 

Cochlear implants manifest the miraculous abilities of medicine by “restoring hearing and speech understanding to…[the] severely or profoundly deaf” (Tucker 1998, 6). One complication is that, to yield the best results, the devices must be put into effect in patients as young as possible. Most often the potential recipient is a child who lacks the full ability to understand and express her wishes on the matter. This forces parents to ultimately make life-altering decisions on their child’s behalf, raising the question of whether parents have an obligation to promote their child’s “normal functioning.” Though supporters of Deaf culture argue that cochlear implants destroy their community and should not be imposed onto deaf children, the costs of forgoing a resource that could ward off such “pathology” greatly outweigh the benefits associated with Deaf culture (Daniels 2008, 37).

When parents who have financial means to give their deaf child cochlear implants choose not to, they deliberately do not treat their child’s “impairments” and are willfully allowing her deafness to reduce her “range of…opportunities” (Daniels 2008, 35). This acceptance of the impairment is a form of neglect on the parents’ parts because they are not fulfilling their roles as guardians to best promote their child's health (Daniels 2008, 35). It is considered negligence for parents not to care for their child if she has the flu or a broken bone, and the costs and limitations of being deaf, if untreated, are far greater than these ailments.

As a defense against the implementation of cochlear implants, supporters of Deaf culture argue for its maintenance as a distinctive identity, leveraging the importance of their way of life against the benefits of being part of hearing society. Created from a need for a strong community where deaf people would not feel isolated or disadvantaged, Deaf culture is highly dependent on the shared language—American Sign Language (ASL). With this as its keystone, though, Deaf culture cannot be limited strictly to the deaf, because hearing people have access to ASL as well. The implementation of cochlear implants in deaf children is not necessarily permanent, either, because patients have the power to turn them off if they later wish to do so. However, not allowing a deaf child access to the device is an irreversible decision. Earlier implementation yields results, such as improved hearing and speech abilities, that are far greater than those gained by implementation in older patients. In attempts to avoid the destruction of Deaf culture, parents who do not give their deaf child cochlear implants deprive her of the autonomy to choose the hearing world, and potentially the Deaf one as well.

Parents should strive to give their child the most opportunities possible; because, as guardians of her basic needs their responsibilities include promoting health. The importance of timing when treating deafness with cochlear implants, and the accessibility of benefits associated with the Deaf community to people outside of that cultural identity, attributes a net loss of opportunities to a deaf child who does not receive the implants. Therefore, parents should not be allowed to forgo the procedure on behalf of their children when the device is within the family’s means. When parents do not provide their deaf child with cochlear implants, they limit their child’s future opportunities to choose to participate in hearing and Deaf culture. Additionally, they limit her physical autonomy through a potential life independent of the many aids deaf people need daily to succeed. However, when parents choose to give their deaf child cochlear implants they allow her greater future opportunities by giving her access to the hearing world, as well as providing her the option to participate in Deaf culture, if she wishes. 

Samantha Page is a first-year student at Smith College, where she was first introduced to the field of Bioethics. She is interested in studying American history and art history.

Works Cited:
• Daniels, Norman. Just Health: Meeting Health Needs Fairly, Cambridge 2008.
• Tucker, Bonnie Poitras. “Deaf Culture, Cochlear Implants, and Elective Disability,” Hastings Center Report 28, no. 4 (1998): 6-14. 

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