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Can a deaf child be operated against the will of the parents?

Can a deaf child be operated against the will of the parents?

A deaf child could learn to hear and speak through a cochlear implant. Because his parents disagree with the procedure, the doctor has turned on the youth welfare office.

 It’s about a decision that will fundamentally shape the life of a young child: the one and a half year old boy is deaf. With the help of a so-called cochlear implant, which takes over the function of the injured inner ear, he would have the chance to hear and speak more easily.

That the boy implanted such an implant, considers the ENT chief physician of the city hospital Braunschweig necessary. However, he did not convince the parents of the child, they refuse their consent to the procedure. Therefore, the doctor has turned on the youth welfare office, which has forwarded the case to the Family Court Goslar. The responsible judge must now decide.

It has to find answers to difficult questions that are in the room: is a deaf child worse off than a child with hearing? Because if a deaf child has to be implanted with a cochlear implant, it suggests that his life would be worse without the implant. But is it really like that? And how can that be evaluated?

“I can not teach him to speak”

The father and mother have a number of reasons why they do not want surgery for their son:

  • The parents of the boy and his siblings are deaf or severely hearing impaired. “As a deaf person, I can not teach him to speak anyway,” says the mother in sign language in a television report by Norddeutscher Rundfunk. “I can not control what pitches he produces.”
  • The operation carries dangers: Although it is now a routine procedure, but a residual risk such as by infection or by anesthesia is always.
  • Children with a cochlear implant (CI) do not hear as normal hearing. The CI, which includes a microphone, a digital voice processor and electrodes, takes over the work of the inner ear: it picks up the sounds from the environment, translates them into electrical impulses and forwards them to the brain. In order to perceive the transmitted sounds in the brain as normal hearing, it needs regular training. Nevertheless, a certain deficit persists, often in the area of deafness. Therefore, there are also often problems with language acquisition.

The deficiencies of the CI are among the reasons why the German Deaf Association in a statement has expressed to the case against forced implantation: “This makes them particularly concerned that this attempt is made especially for parents who better deaf as a self-concerned about the situation of their In particular, deaf parents can provide their deaf child with more and better tools of life, including sign language.

A question of belonging

What many listeners underestimate: A cochlear implant can bring a deaf person into an identity conflict. The victim is stuck through the device between two worlds and is neither in those of the deaf at home nor in the world of the hearing.

Ines Helke is Including Ambassador of the advocacy group “Selbstbestimmt Leben in Deutschland” and active in the German Association of the Deaf. She has been wearing a hearing aid since she was seven months old and has grown up with spoken language, but she is also proficient in sign language. By her own admission she knows “all three worlds”, the deaf, the hard of hearing and the hearing.

 “It’s important that you feel comfortable in the communication,” says Helke. “This is just as possible in the diverse and self-confident sign language community as among hearing people.” That does not mean that a cochlear implant may not be the way to go. “But the court is now negotiating a forced implantation is a scandal,” says Helke.

Deprive the child of a world

But the image of the different worlds also speaks for an implant: The CI would open the child’s access to a world that would otherwise remain closed to him. “If everyone supports the child, why should it not be possible for him to grow up bilingually and to be granted all opportunities?” Asks Jochen Vollmann, Director of the Institute for Medical Ethics and History of Medicine at the Ruhr University Bochum.

For many hearing people, the situation may therefore seem clear: denying the child the chance to hear is wrong.

So who is right? From a legal point of view, at least the decision-making priorities are clear. “Right at the forefront is the well-being of the child,” says Britta Konradt, a doctor and lawyer specializing in medical law in Berlin. “Before that all other interests have to stand back, including the parents’ well-being.”

Out of concern for the boy?

Therefore, it is crucial to find out what exactly the parents are all about in their decision to reject the operation, says Georg Marckmann, Professor of Medical Ethics at the LMU Munich. In other words, above all, do parents want to defend their principles and maintain a homogeneous family in terms of deafness? Or does the well-being of her child come first?

“This can not be clarified with ultimate certainty,” says Marckmann, “but if the parents at least appreciate the counter-arguments, then that’s a sign that the concern for their child is in the foreground.” How this situation looks in the current case, however, can not be judged without a detailed conversation with the parents.

Usually much better for everyone – even for the affected children – according to Marckmann in such cases, however, if an agreement can be reached out of court. “Conflict resolution is delegated by those who are familiar with the child and their medical situation, ie parents and physicians, to a judge who, although fully informed, hardly knows the boy and his situation first hand,” says Marckmann. But this is exactly what happens in the case of the one-and-a-half-year-old boy from the Goslar area.

Precedent for Germany

“If such conflicts end up in court, that, in my experience, is often an expression of failed communication,” says Jochen Vollmann. The parents felt taken by surprise and pressured to restrict the doctors in their duty of care. “In such cases, a clinical ethics consultation should be used so that the arguments of the other side really arrive at the opponent,” says Vollmann. This opens up the possibility of talking to one another on an equal footing and working together to find a solution for the affected child.

But this opportunity for mediation and out of court settlement seems to have passed. In court, a precedent should now be created in Germany. If the verdict against the parents should fail, then not all deaf children, for which a cochlear implant would be considered, have to be surgically operated? The lawyer of the family has already announced that in this case they want to move to the next instance.

Advocates of implantation are running out of time

The decision of the court may replace the consent of the parents. But the advocates of an implantation are running out of time: the earlier the boy gets the cochlear implant, the better his chances of learning to hear and speak well.

 However, this raises the question of implementation: how can hearing and speech support measures be realized after the operation if the parents do not support them? One can wrest the parents the child so badly several times a week, to bring it to speaking exercises, says the lawyer Britta Konradt.

Whatever the court’s ruling, precedent could influence the welfare of thousands of deaf children.

Editor’s note: We removed the testimony from an earlier version of the text that the child could not learn to speak because of his deafness.

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