31 May 2016 AEST
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Policy on Cochlear Implants

Policy current from 3 November 2006
Deaf Australia represents the Deaf community of Australia. This community is largely composed of those who have been deaf from an early age, and who use Auslan (Australian Sign Language) as their native or preferred language.

Deaf Australia's views on the cochlear implant should be seen in the context of the socio-cultural perspective on Deaf people's lives. Deaf people do not see deafness as something that needs to be 'cured'. Cochlear implant programs, however, tend to see deafness as a pathological condition which is open to medical and technological intervention. The disparity between the two views of deafness has led to much of the debate about the cochlear implant.

Deaf Australia is aware that there are many adults who become deaf at a later age through illness or accident or who for other reasons may not identify with the Deaf Community and who wish to regain some hearing. Deaf Australia fully recognises their right to choose devices such as cochlear implants, provided their choice is made freely and is based on full and accurate information.

Deaf Australia is conscious of Australia's leading role in the development and export of the cochlear implant device. However, it is also acutely aware of the feelings of most Deaf people about this issue. This policy has been prepared to reflect the attitudes of Deaf people about a procedure that is portrayed as a major international success for Australian science and as providing much needed relief for Deaf people.

Deaf Australia views the cochlear implant procedure with deep concern. Not only is it seen as invasive and unnecessary surgery, but it also raises many other issues that impact on Deaf people's lives. Some of these issues are addressed below.

Publicity

Many Deaf people and their families have been disturbed by misleading publicity and information about the cochlear implant, either through the mass media or other sources. This publicity implies that Deaf people are ill or incomplete individuals, are lonely and unhappy, cannot communicate effectively with others, and are all desperately searching for a cure for their condition.

Such publicity is highly inaccurate. It also demeans Deaf people, belittles their culture and language, and makes no acknowledgment of the diversity of lives Deaf people lead, or their many achievements. It is stressful for hearing parents of deaf children who are already struggling to come to terms with their child's deafness and are given a false impression that the implant will 'cure' their child.

Deaf Australia believes that such misleading publicity should be challenged, not only by Deaf people themselves, but by spokespersons for cochlear implant programs. Deaf Australia condemns in the strongest possible terms any cochlear implant program that uses such damaging publicity for its own ends.

Cochlear Implants in Children

Deaf Australia feels great concern about the fact that deaf children are undergoing cochlear implant surgery at a very young age. The decision to implant such children is usually made by parents and guardians and Deaf Australia has long believed that parents and guardians do not have access to full and accurate information about the implication of deafness for their children's lives. Parents are usually led to see their children as pathologically deficient and little information is available to them about the history, culture and language of Deaf people, or the possible lives of Deaf people in our society.

Until such time as more complete information is available for parents, and more productive associations develop between parents of deaf children and adult Deaf people, Deaf Australia feels that decisions to implant young deaf children are questionable. It should also be kept in mind that the implantation procedure effectively destroys the cochlea, and makes it unsuitable for future technological developments that may be less invasive.

Deaf Australia believes that medical ethics and socio-emotional implications of such surgery on young children need to be discussed and researched in much greater depth.

Until such time as the ethical issues have been addressed and more comprehensive information about Deaf people's lives is available to care givers and professionals, Deaf Australia remains uneasy about the use of cochlear implants for children and cautions parents and guardians to research all of the issues thoroughly before making a decision.

Deaf Australia supports all parents considering an implant for their child. We provide clear, factual information, encourage honest and open discussion of the key issues of which parents need to be aware and that professionals need to address. We provide opportunities for parents to contact other parents, Deaf adults and professionals.

One such key issue that needs to be considered carefully is that the present surgical procedure means that any residual hearing in the implanted ear will be destroyed.

For a profoundly deaf child with very little or no residual hearing in either ear, the issue to implant can be seen as a less complex one, when considering the destruction of their residual hearing. However, this is not the case for children with 'usable' residual hearing. As increasing numbers of children are being implanted, who can obtain some benefit from appropriate high-powered hearing aids, it is even more essential that parents understand the effect that present surgical procedures can have.

In general Deaf Australia does not endorse bilateral (in both ears) implantation due to the fact that any residual hearing a child has will be totally destroyed by the procedure and there is currently no evidence to show significant additional benefit from two implants. In addition, rapid changes in related technology mean that, by leaving one ear intact, the child has the potential to benefit from future developments.

Deaf Australia advocates that cochlear implant teams working with children, and others who are able to influence their lives, should:

  • develop clear, consistent criteria about which children they consider suitable for implantation;
  • involve experts from all relevant professions, ensuring a true multi-disciplinary approach;
  • develop surgical procedures that minimise the impact and trauma;
  • provide parents and children with effective counselling and support, whether or not the child receives an implant;
  • give parents realistic information about the potential outcomes for their child;
  • ensure that parents considering an implant understand that their child will always be a deaf child even with an implant;
  • ensure parents are provided with the safety guidelines appropriate to cochlear implantation and of particular relevance to children;
  • provide opportunities for families considering an implant for their child to meet other deaf children, with and without an implant, and provide the opportunity to meet a variety of deaf adults;
  • ensure the child is, wherever possible, fully involved in the decision making process and procedure; and
  • ensure that children with an implant receive the highest possible standards of life long care, with smooth transition to the adult cochlear implant service.

As children's educational progress after implantation will often depend upon teachers and speech therapists in the school in which the child is placed, Deaf Australia believes that these professionals must have adequate training and support in order to work effectively with children with a cochlear implant.

Deaf Australia believes that all deaf children need to develop fluent language skills (whether the language is Auslan or English or both), and that it is crucial for parents, care givers and professionals to understand that language and speech are distinctly different things. The ability to speak English does not necessarily mean a person is fluent in the English language. Decisions about communication methods and educational placements post-implantation must be made with this in mind.

Deaf Australia also believes that all deaf children, with and without an implant, should have the opportunity to access and learn Auslan and to become bilingual in Auslan and English. Contrary to information often given to parents, there is no evidence to support the claim that learning Auslan interferes with learning speech. We condemn cochlear implant programs that do not allow children in their programs to use Auslan.

Deaf Australia believes that research is essential to assess the effect of short, medium and longer term implantation, not only in relation to audiometric measures and spoken language skills, but also in relation to educational performance and opportunities, and to social and emotional well being. As cochlear implantation in children in Australia is now well advanced, such research is crucial to determine the longer-term effects on the psychological, emotional, social and long term development of deaf children with a cochlear implant.

Funding for Cochlear Implant Programs

The development of the cochlear implant device, the establishment of clinics for performing implant surgery itself and pre- and post-operative care are all enormously expensive. Huge amounts of funding have been allocated to this over the years, from both private and government sources and through health insurance schemes.

The needs of Deaf people are many and diverse: special education services, provisions for access such as interpreters and notetakers, and technology such as TTYs all enable Deaf people to lead comparatively 'normal' lives and to contribute to society. A cochlear implant does not necessarily remove the need for such services and technology.

Deaf Australia believes that cochlear implants receive a disproportionate amount of public funding, and that other services are more essential and serve a far greater number of Deaf people, often including the implantees themselves.

Deaf Australia suggests that greater consultation should take place with users of services to ensure a more equitable distribution of funds.

Conclusion

Deaf Australia, in line with promoting greater community awareness of deafness and the diversity of Deaf people's lives in our society, calls for further research into the cochlear implant and its impact on deaf people and their families.

This policy was adopted by members at Deaf Australia's 20th Annual General Meeting on 3rd November 2006.


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