| Bionic
Ear
Caroline
Nassour
Daniel Yazbek
Vatsla Nagpaul
Amanda Bolzan
Susannah Ng
Executive
Summary
The Bionic Ear is a biotechnological device that is designed
to be implanted into deaf people, to facilitate hearing.
The report gives an introduction on how the Bionic Ear
operates, and presents an analyses and discussion of the
social and ethical implications connected to the Bionic
Ear.
The Bionic
Ear is quite advantages for the post-lingually deaf as
it increases self-esteem, independence and social integration.
However for the pre-lingually deaf, long-term emotional
and social affects are experienced due to the patient
having an inferiority complex about themselves, and feeling
that technology is required to improve the quality of
life.
Two prime ethical
issues surrounding Bionic Ear technology include firstly
the implications that exist when parents make the decision
to implant a Bionic Ear in their deaf infant child. There
is no right or wrong decision. Parents make decisions
for their children based on the information they are provided
and their own morals, beliefs and ethics. Secondly the
future of bionic body parts, and their impact on society
if their development continues. Biotechnological development
needs to be controlled or moderated to avoid social identity
conflicts.
Introduction
Advancements in Information Technology have now made it
possible to restore hearing to the profoundly deaf by
inserting a prosthetic device called the Bionic Ear (also
known as the Cochlear Implant) in an individual’s inner
ear. The Bionic Ear technology is an example of design
and innovation combined with information processing, software
design and development. Since it was first devised, technology
advancements proceeded on a parallel track in terms of
miniaturisation and increasing sophistication of this
Bionic Ear technology. This particular technology operates
by delivering electrical stimuli to the auditory nerve
which then triggers auditory sensations to progressively
become closer to sounding like normal speech.
What
is the Bionic Ear?
The Bionic Ear, which is an artificial hearing device
intended to directly stimulate the implant recipient’s
auditory nerve. It is implanted surgically into the ear,
and is activated by a device that is worn outside of the
user’s body. The purpose of the Bionic Ear is to bypass
the normal hearing mechanism within the human ear and
convert speech and sounds into signals that are sent to
the hearing centres of the brain. This technology was
first researched and devised by Professor Graham Clark
in the 1960s to 1970s and since then, a range of implants
have been devised by the Nucleus® Cochlear division.
As opposed to the traditional hearing aid which makes
use of sound vibrations, the Bionic Ear converts these
vibrations into electrical stimuli that are picked up
by the auditory nerve and transmit them to the implant
recipient’s brain. (http://www.entnet.org/healthinfo/ears/cochlear-implant.cfm)
Who
is it catered for?
Many people
with hearing loss utilise hearing aids to intensify and
amplify sounds as well as to assist them in hearing. However,
for people with severe or profound deafness, these aids
do not provide any assistance. Hence, these individuals
require the use of the Bionic Ear. This technology is
designed especially for these people who receive little
or no assistance from the normal hearing aids. The device
can be implanted to aid two types of individuals:
- The Post-Lingually Deaf: individuals who have learnt
a spoken language before going deaf.
- The Profoundly Deaf: individuals who have lost their
hearing before they acquired language.
How
does the technology work?
The Bionic
Ear consists of two main components:
1. An electronic device, which is surgically implanted
under the skin behind the ear.
2. An external speech processor that is worn on a belt
or placed in a pocket. A microphone is also worn outside
of the body as a headpiece behind the ear to obtain sounds.
Sounds and
speech are captured by a microphone and sent to the external
speech processor. The processor then translates the sounds
into electrical signals, which are then sent to the transmitting
coil. These codes travel up a cable to the headpiece and
are transmitted across the skin through radio waves to
the implanted cochlea electrodes. The electrodes’ signals
then stimulate the auditory nerve fibres to send information
to the brain where it is interpreted as meaningful sound.
(http://www.entnet.org/healthinfo
/ears/cochlear-implant.cfm).
Social
Aspects
Advantages
The Bionic
Ear has revolutionised the lives of deaf individuals all
over the world, it is not only a great scientific achievement,
but also a great progression in a socio-cultural context
within the lives and communities of the deaf and hearing-impaired
individuals. The Bionic Ear with the aid of IT has provided
new capabilities and in turn gives individuals new choices
of action. This statement is supported by James Moor (T.
Bynum, 2000). He believes that the IT is the nearest thing
we have, to a universal tool, so its utilisation in cases
such as the Bionic Ear can only prove to be advantageous.
According to
Knutson JF -1998 (Advanced Bionics, 2005) within 54 months
of the implant, recipients go over a large psychological
change. In addition to an improved hearing performance,
the Bionic Ear users report that they do not feel as lonely,
have less social anxiety, and experience greater independence
than before they received their implant. Interpersonal
communication skills and social confidence are also found
to be enhanced, and after long-term use, marital satisfaction
and assertiveness have also been shown to improve between
adult users. Hence showing that recipients are able to
actively associate with members in society.
Furthermore
the Bionic Ear aids individuals by allowing them to hear,
which in turn prevents them from being labelled, teased
and isolated as a disabled person. It generally enables
post lingually deaf adult and child users to become more
aware of sounds in the surroundings around them. The utilisation
of this technology can help in alleviating some of the
barriers being faced by the deaf, and aids in social acceptance.
This has been found by 90-100 percent of post-lingually
deaf recipients demonstrating significantly enhanced speech
reading capabilities (M.Greco, 2005).
The Bionic
Ear therefore is quite advantageous, especially for the
post-lingually deaf, as recipients can benefit by an increase
in self-esteem, independence, social integration, and
vocational prospects. Furthermore, it provides a renewed
curiosity about the experience of hearing and the phenomena
of sound. In some cases the experience of implantation
becomes an integral part of the individual's identity,
leading implant users to even participate and share experiences
in self-interest and advocacy groups.
Disadvantages
The detriments
of the bionic ear must be known to the implant recipient
prior to receiving the technology.
Firstly it
is found that the Bionic Ear works better for the Post-Lingually
deaf individuals as they have previously acquired a language
before becoming deaf (Omer Zak, 1996). So the profoundly
deaf may not benefit as much from the surgery, making
them feel like social outcasts as they have yet to acquire
a language prior to becoming deaf.
Secondly, according
to a ‘Sound Decision’ paper by Dr. Susan Williamson (S.Williamson,
1999) in the first few years of life, the human brain
is highly plastic, this gives it the potential to grow
and form many complex neural connections. The reason why
an implant done on children is more successful is due
to the easy manipulation of the neural connectivity in
nerves. However if a neural connection is not used it
will degenerate as time goes by hence making it difficult
for a deaf adult. An adult’s brain is no longer as plastic
and the auditory nerve often degenerates as a result of
disuse, which also leads to major surgical complications.
Therefore the longer a person has been deaf, the less
likely it is for them to gain meaningful information from
a cochlear implant. So even if the surgery is successful,
full social activity may not be experienced, which could
lead to social anxiety and frustration by the recipient.
Additionally
the surgical procedure of the implant itself could cause
social hesitance for the recipient as major complications
may occur. For instance those requiring revision surgery,
include flap problems, device migration or extrusion,
and device failure. Facial palsy is also considered a
major complication that can lead to patient suffering
from damaged facial tissues and nerves, as well as various
abnormalities such as drooping cheeks. According to results
of the in-depth Questionnaire by a number of various Bionic
Ear recipients, at the Congressional Hearing Health Caucus
these negative effects can lead to the recipient gaining
a complex and feeling like a social outcast, (M. Greco,
2005).
These negative
social impacts of the Bionic Ear can have a large effect
on both children and adults. As a result of the implant,
children may get teased and isolated due to the additional
signal processor accessories that need to be utilised
in order for the technology to function. This can be used
as a basis for a child suffering from long-term emotional
and social affects (C.Splona, 2003) due to the child having
an unhealthy self-belief that there is something wrong
with his/her body. Common social insecurities, for children
and adults, may result from the difficulty of hearing
amidst background noise, and from unreasonable expectations
of aural-only benefit on the part of the implant user
or his/her family and friends. These negative aspects
of the Bionic Ear technology support the theory of Donald
Gotterban that failure to see one’s responsibility has
significant consequences (D. Gotterban, 2004). Showing
that though IT has advanced in the form of the Bionic
Ear it has not proven to be problem free, resulting in
problems and consequences impacting implant recipients
on a social level.
Ethical
Aspects
There are numerous ethical implications related to the
cochlear implant technology. This section will discuss
two prime ethical issues surrounding the technology:
3. Is it ethical for parents to make the decision on behalf
of their child to receive the Bionic Ear implant?
4. The ethics regarding the social and future developments
of the technology.
Parents
making the decision
The largest
ethical implication that exists is whether or not the
parents of a deaf child have the right to make a major
life changing decision for their child (in this case,
to receive the implant), who is incapable of making his
or her own decisions (Zak, 1996). There is a fairly large
amount of controversy surrounding this ethical dilemma
as parents are making a major life-altering decision on
behalf of their deaf child before the child is too old
to successfully receive the implant.
This decision
may seem trivial as cochlear implants are most of the
time successful and being able to hear is a sense that
is vital for quality living according to those who are
not deaf. However, the result of this ethical dilemma
can have serious repercussions for the child. The key
dilemma being that as the child grows, they will begin
to analyse the differences in living life with and without
the implant. They may blame their parents for making a
wrong, ill-informed decision (Hyde & Power, 2002).
Forcing a human being into something as life-altering
as this is a violation of human rights at any age, although
it is legal to make this decision. (Refer to Section 4.3
The decision to receive the Bionic Ear technology).
Since the Bionic
Ear is a relatively new technology, the long-term impacts
of the IT are still quite unknown. Parents making the
decision on behalf of their children always fail to consider
this issue, hence possibly sentencing their child to a
future of uncertainty. (Hyde et al. 2002) Ethically, it
is inappropriate to make a decision for others where the
outcomes are not clearly defined. On the contrary, parents
are also concerned about the quality of life their child
will experience, and believe that the best decision is
that their child should be able to hear just like the
majority of the population can.
What gives parents the right to make a major life changing
decision on behalf of the child? Some parents believe
that they are only trying to provide the best opportunities
possible for their child; others believe that deafness
is a disability and their child cannot live life being
“disabled”. Parents making this decision for their deaf
child fail to consider the quality of life the child would
have if it were to remain deaf. Parents are often not
informed of the culture and heritage of members of the
deaf community, so fail to consider the alternative which
is allowing the child to live their life deaf. Removing
a deaf child from their culture is a sign of intolerance
and aggression.
Most children
who have received implants are mainstreamed into society.
After receiving the implant, children are sent to normal
schools after some brief post-implant therapy. Unfortunately,
most implanted children attending normal schools do not
perform at “grade level” and fall behind the majority
of the class. It is proven that people with a disability
in one of their senses tend to develop superior quality
in their other senses. Thus, the child can be considered
to be unfairly disadvantaged by receiving the cochlear
implant because the superior development of the other
senses would not take place (Christiansen, Leigh &
Clerc, 2002).
Personal religious
beliefs of parents can also influence decisions related
to acquiring such technologies. People with a strong Catholic
faith believe that the body should not be altered, and
the way you are is the way God intended. Religious parents
contemplating cochlear implants for their children often
face moral and ethical dilemmas in this domain (House,
1995). Should they allow the technology to be used on
their child in an attempt to improve their child’s quality
of life, or should the follow their firm religious beliefs
which potentially results in the child not having the
opportunity to hear.
Children of
parents that made the decision to proceed with the implant
surgery cannot have the cochlear implant removed (Hyde
et al., 2002). The surgery is irreversible; hence they
are forced to live the rest of their lives with an implant
that was forced onto them, even if they disagree with
the decision their parents made for them.
As discussed, parents are faced with many ethical issues
when contemplating the decision to give the implant to
their deaf child. The deaf child is unable to make a decision
so the parents ultimately make this life altering decision
for them. Receiving the technology is a life altering
decision and unfortunately, there is no right or wrong
decision; parents will ultimately make their own decision
based on their morals, beliefs and ethics.
Ethics and Technology
Additional
to the ethical implications faced by parents when contemplating
to perform cochlear implant surgery on their child, the
technology itself poses many ethical implications on society,
culture and future biotechnological developments.
The only way
to test the quality and development of the cochlear implant
is to insert it into a deaf child and monitor how he or
she reacts (Zak, 1996). Continual development must be
trialled on human patients, as testing on animals will
not provide accurate results as they will not be able
to respond to humans like children will. This issue poses
many ethical implications. It is not acceptable to test
such technology on children when the long-term impacts
are still not known. However, if the technology is not
tested, continual development and improvement could not
be possible and the quality of technology that current
patients receive would not be as state of the art, as
it is today.
If scientists,
IT professionals and engineers can work together to create
such remarkable technology as the Bionic Ear, what else
can these professionals create? Further research and development
into biotechnology can lead to other “bionic” body parts,
such as a bionic eye. Research and development has already
gone into the bionic eye, which operates by feeding video
signals coming from a tiny camera mounted on reading glasses
into the nerves behind the retina (Sandhana, 2003). If
more and more of these “bionic” technologies are developed,
it could lead to social chaos. Wealthier people would
be able to afford such bionic devices to enhance their
quality of life to an ultimate goal of living longer.
However poorer people of society will not be able to afford
medical treatment and thus be unfairly disadvantaged.
Further development into bionic body parts will lead to
social divides and clashes. Rules and regulations must
be put into place to prevent such events from occurring.
Conclusion
While the
Bionic Ear technology offers the deaf community many advantages
in all areas of their lives, it raises many social, legal
and ethical issues. On a social level, the provision of
the Bionic Ear technology can be advantageous; however
the surgery can also lead to negative impacts for an individual
if it fails. Current laws also exist to state that the
IT manufacturer and surgeon are professionally responsible
for the technology and its installation. On an ethical
level, there are many implications related to the Bionic
Ear technology as the majority of patients receiving implants
are profoundly deaf children. Hence, they are not able
to voice their opinions, leaving the parents in control
of a large, life altering decision for their child. Moreover,
the Bionic Ear technology itself poses many ethical implications
on society, culture and future biotechnological developments,
including the affects of testing and trialling the technology
on human patients.
While parents
realise that their implanted children are still children
who are deaf, they see the implant as enhancing their
child's quality of life. A lot of parents are making decisions
for their children when they are often poorly informed
about the culture and quality of life of a deaf person,
so they fail to consider the possibility of leaving their
child to live the rest of their live being deaf. Children
should therefore not be forced to undergo the implant
surgery and parents should consider accepting their child
as being deaf. They should also consider that the great
amount of money that goes towards the financing of their
child’s cochlear implant could be used in other ways,
such as improving the education and literacy amongst the
deaf and hearing-impaired.
From our research,
we can also conclude that with the use of this technology
to further society and the wellbeing of people from all
around the world, the motivation of IT professionals is
not only for money in this growing and dynamic industry.
What also motivates them is their underlying interest
and passion in finding ways to apply IT to the current
and changing needs of society and make meaningful contributions
to the way we live. In considering whether it is easy
to make a difference in society through the use of IT,
it can be concluded that the Bionic Ear should not be
viewed as a threat to society, but rather a choice that
is available for those who wish to experience the effects
of the technology in their lives. We should be aware that
there will always be challenges that will arise due to
the conflicting interests of the stakeholders affected
by the technology.
In future,
the Bionic Ear will lower power consumption, biocompatibility,
miniaturization as well as manufacturing automation. These
Bionic Ear technology advancements will continue to make
an impact on society as IT professionals continue to work
for the betterment of humanity. The Bionic Ear will continue
to provide many great advantages to the deaf and if implanted
and used correctly, become one of the greatest beneficiaries
to humanity.
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