Ethical dimension of paediatric cochlear implantation.

In congenitally or prelingually deaf children cochlear implantation is open to serious ethical challenge. The ethical dimension of this technology is closely related to both a social standard of quality of life and to the uncertainty of the overall results of cochlear implantation. Uncertainty with regards the acquisition of oral communicative skills. However, in the western world, available data suggest that deafness is associated with the lowest educational level and the lowest family income. Notwithstanding the existence of a Deaf-World, deafness should be considered as a handicap. Therefore, society should provide the means for the fulfilment of a deaf child's specific needs. For the time being there is no definitive answer with regard the best way to rehabilitate a particular deaf child. Therefore, communitarian values may be acceptable. If the deaf child parents' decide not to implant, their decision should be respected. Guardians are entitled to determine which standard of best interest to use in a specific circumstance. They are the proper judges of what (re)habilitation process is best for their deaf child. However, most deaf children are born to two hearing parents. Probably, they will not be acculturated in the Deaf-World. It follows that cochlear implantation is a welcomed (re)habilitation technology. If auditory (re)habilitation will in the future provide the necessary communicative skills, in particular oral language acquisition, customs, values and attitudes of the hearing world should be regarded as necessary to accomplish a deaf child's right to an open future. If cochlear implantation technology will provide all deaf children with the capacity to develop acceptable oral communicative skills--whatever the hearing status of the family and the cultural environment--then auditory (re)habilitation will be an ethical imperative.