An Open Letter to Audiologists

An Open Letter to Audiologists and Surgeons

An open letter to audiologists and surgeons,

The cochlear implant is a magnificent piece of recent biotechnology that represents a very sincere effort to improve the life of deaf individuals. In 2013, the World Health Organization estimated that nearly 360 million people worldwide had hearing loss classified as disabling, thus representing a unique subset of patients that could benefit from cochlear implant surgery (O’Donoghue 1190). More than anything, cochlear implants represent a unique opportunity to be more effectively integrated into hearing society.  Much of the opposition surrounding cochlear implants comes from studies in history recounting oppression against the deaf community. The accounts are far more concerned with the issue of what it means to be deaf instead of recognizing the unique potential that neuroprosthetic devices present for deaf individuals.  However, it is necessary to recognize the detrimental effect that the language of ‘disability’ has on especially young patients and deaf individuals in general.

The notion that something is fundamentally wrong with deaf children is completely misguided. Yes, deaf individuals lack the ability to hear.  Yes, some aspects of sound are fundamental to being raised in a world that appreciates constant stimulation and musical appreciation. Yes, cochlear implants may present an opportunity that allows for some partial integration into the normal world. However, the word, “disability,” must be dropped from the vocabulary of audiologists, surgeons and general public alike in reference to deaf individuals. Unfortunately, the doctor’s office is where the issue of cochlear implants is often first introduced.  It is here that deafness is also most closely associated with disability in a negative way. Since 90% of deaf children are born to hearing parents, audiologists are at the frontline of emotionally charged fear and uncertainty (Wrigley 25). It is reasonable to understand that at the time of the first appointment, parents’ minds immediately retract to the things their child will not be able to do instead of focusing on everything their child will still have the opportunity to try.  The issue of sensory loss turns to an issue of inability for the child (Mauldin 132). Language neutrality is of utmost importance: it is at this crucial moment that the vocabulary of “disabled” must be erased from the language surrounding parents. By recognizing that being deaf is an issue that will lead to hardship, hearing parents look for solutions and potentially neglect other options.  On the news that their child is deaf, it is much more plausible for a parent to think, “My child will never get to hear me say, ‘I love you,’” than for a parent to consider “Wow! This is a fantastic opportunity for my child to learn a beautiful and unique language and have the chance to be integrated into a like-minded culture.” In these moments of uncertainty, our minds are clouded in fear and the parents are not entirely at fault. Society has effectively intertwined the word “disabled” with the idea of “incapable.” It has become a blanket-term with negative connotations for deaf individuals by focusing almost entirely on inability.

One of the primary claims by proponents of the cochlear implant is that it gives people a choice; it is much simpler and perhaps more lucrative (a cochlear implant, with associated rehabilitation can cost upwards of $100,000) for the medical community to interpret the Hippocratic Oath in the situation of a deaf child as, “There is a problem. We have a solution. Here are the pros and cons of the surgery.”  I am suggesting that audiologists and surgeons stop at the first conditional marker: the problem.  If we can start to see deaf people as a minority group that uses a different method of communication instead of a people group with a medical problem, we can begin to remove the negative stigma that has been associated with being deaf.  A re-interpretation of the same Hippocratic Oath with a new awareness may be able to acknowledge the importance of medical intervention with equal consideration for not performing the surgery at all.  Perhaps not doing any harm means not doing any surgery.  By giving equal chance to either choice, a deaf child may be able to avoid invasive surgery, continual rehabilitation, expensive medical costs and ostracism from the deaf community. Inversely, actually getting the surgery opens the doors for a multicultural appreciation for hearing and manual language.  Neither option is inherently wrong, but by removing the idea of fixing a problem and the vocabulary of disability, we are truly giving parents of deaf individuals a fair choice.

I am never suggesting that doctors remove cochlear implant surgery from their procedure list.  The technology is revolutionary.  The ability to register vibrations in the air at different wavelengths, convert the microphone data to ones and zeroes, transfer that information through the skin to an implanted receiver, and electrically stimulate a sensory nerve to give the perception of sound is phenomenal.  The emotional joy that exudes from the viral videos of children hearing their parent for the first time is absolutely contagious.  I would never suggest taking that sort of joy from any parent. However, I do emphatically suggest that everyone consider the side of the argument that is in favor of doing nothing. The first step to accepting that as a viable option is to revitalize an outdated vocabulary.  Deaf is not a bad word.  Hearing impaired is a much more offensive word to deaf individuals.  So let’s start there by saying, “Yes, Mr. and Mrs. Smith, your child is deaf.” We must also remove the notion of inability from disability. Let us consider all of the amazing things that a deaf child could do rather than immediately judge all the things they may not get to do.  Lastly, I think that we need to reconsider the importance of verbal communication: why does the visual interpretation of “I love you” through sign language mean less than the vibrations of air particles in time and space? If we truly consider ASL (American Sign Language) a true language, why not consider its “speakers” the same as anyone else that doesn’t speak English? It is not a disability; it is a linguistic minority (Bramwell). With other technology such as texting, closed caption and voice-to-text software available at our fingertips, why push for surgery or even consider deafness a disability?  Audiologists are right behind the general public in making these changes and giving families a more equal choice. 

Sincerely,

A medical student with an understanding of Deaf culture.

Explanation:

The reason I chose the abrupt, short sentence suggestion style for my conclusion is to remain effective in my argument while creating coherence.  This is a short paper so I also don’t summarize much at all.  In the bulk of my paper, I could not reasonably make my goal to suggest getting rid of a procedure that has been scientifically tested and implemented in hundreds of thousands (if not millions) of patients without taking into account the authority of my scholarly audience. Instead, I attempted to appeal to the emotions by providing real situations (how a parent might react and the inclusion of the viral video examples) in order to make a sound argument. However, I did attempt to offer persuasive takeaways and methods of thinking that could easily be implemented by doctors and the casual reader and thereby unite a common interest.  Early on, I decided that attempting to make an effective claim to doctors that goes against some of those basic scientific assumptions is very difficult without having lots of data or significant compromise.  In order to be more effective to both my intended audiences (audiologists and the casual reader), I decided that I would suggest a change in vocabulary and mindset instead of displacing the relevance of cochlear implant procedures in order to be more effective.

             

Works Cited

Bramwell, Ros, Harrington, Frank, and Harris, Jennifer. “Deafness – disability or linguistic minority?”  British Journal of Midwifery, vol 8., no. 4. 2013.

Mauldin, Laura. “Precarious Plasticity: Neuropolitics, Cochlear Implants, and the Redefinition of Deafness.” Science, Technology & Human Values, vol. 39, no. 1, 2014, pp. 130-156

O’Donoghue, Gerard. “Cochlear implants – science, serendipity, and success.” N Engl J Med. 2013. Pp. 1190 – 1193. \

Wrigley, Owen. The politics of deafness. Washington, D.C.: Gallaudet University Press, 1996.