Ethics for the Pediatrician

Introduction

A cochlear implant is a small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. Implants all have four key components: (1) a microphone, which picks up sound from the environment; (2) a processor, which selects and arranges sounds picked up by the microphone; (3) a transmitter and receiver/stimulator, which converts signals from the processor into electric impulses; and (4) a group of electrodes that sends impulses from the stimulator to different regions of the auditory nerve. After implantation of the device, recipients must undergo an extensive program of speech therapy to learn how to make the implant useful. As of December 2010, ∼219,000 people had received implants worldwide, including 71,000 people in the United States, of whom 28,400 were children. (1)

Over the past two decades, doctors, parents, policymakers, and members of the Deaf community have struggled to understand the benefits, risks, and implications of using cochlear implants for children. These struggles were the latest episode in a debate about medical and educational approaches to deafness that have lasted over a century. They also reflected the fact that there were no good long-term outcome data on cochlear implants. Thus, complex issues of clinical and research ethics are intertwined with complex cultural issues and a long history of discrimination and stigmatization of children who are deaf. In this article, I will review the origins of the controversy, discuss its most heated moments, and summarize the current state of the debate.