Bioethics and medical/legal considerations on cochlear implants in children.

UNLABELLED: Cochlear implants are the best treatment for congenital profound deafness. Pediatric candidates to implantation are seen as vulnerable citizens, and the decision of implanting cochlear devices is ultimately in the hands of their parents/guardians. The Brazilian Penal Code dictates that deaf people may enjoy diminished criminal capacity. Many are the bioethical controversies around cochlear implants, as representatives from the deaf community have seen in them a means of decimating their culture and intrinsic values. OBJECTIVE: This paper aims to discuss, in bioethical terms, the validity of implanting cochlear hearing aids in children by analyzing their vulnerability and the social/cultural implications of the procedure itself, aside from looking into the medical/legal aspects connected to their criminal capacity. MATERIALS AND METHODS: The topic was searched on databases Medline and Lilacs; ethical analysis was done based on principialist bioethics. RESULTS: Cochlear implants are the best therapeutic option for people with profound deafness and are morally justified. The level of criminal capacity attributed to deaf people requires careful analysis of the subject's degree of understanding and determination when carrying out the acts for which he/she has been charged. CONCLUSION: Cochlear implants are morally valid. Implantations must be analyzed on an each case basis. ENT physicians bear the ethical responsibility for indicating cochlear implants and must properly inform the child's parents/guardians and get their written consent before performing the procedure.

Aspectos bioéticos e médico-legais do implante coclear em crianças / Bioethics and medical/legal considerations on cochlear implants in children

Implante coclear é a melhor forma de correção da surdez profunda nas formas congênitas. As crianças "implantáveis" são tidas como "vulneráveis", recaindo a decisão de se implantar sobre os responsáveis. Pelo Código Penal Brasileiro, o surdo-mudo pode ter sua imputabilidade reduzida. Existem controvérsias bioéticas a respeito do implante, pois parcela dos representantes da chamada "comunidade de surdos" vê nele uma maneira de "dizimar" sua cultura e valores intrínsecos. OBJETIVOS: Discutir em termos bioéticos a validade de se realizar implante coclear em criança, analisando a sua vulnerabilidade e os aspectos socioculturais do problema, e discutir aspectos médico-legais a respeito da imputabilidade do surdo-mudo. MATERIAL E MÉTODOS: Forma de estudo: pesquisou-se o tema nas bases de dados Medline e Lilacs e a análise ética foi baseada na Bioética Principialista. RESULTADOS: O implante coclear é a melhor opção terapêutica para correção da surdez profunda, estando moralmente justificado. Quanto à imputabilidade penal do surdo-mudo é necessário analisar seu grau de entendimento e autodeterminação à época dos fatos a ele imputados. CONCLUSÕES: O implante coclear é moralmente válido. Sua aplicação deverá ser analisada em cada caso, cabendo ao otorrinolaringologista a responsabilidade ética pela indicação, após assinatura de termo de consentimento pelos responsáveis pela criança.

Cochlear implants are the best treatment for congenital profound deafness. Pediatric candidates to implantation are seen as vulnerable citizens, and the decision of implanting cochlear devices is ultimately in the hands of their parents/guardians. The Brazilian Penal Code dictates that deaf people may enjoy diminished criminal capacity. Many are the bioethical controversies around cochlear implants, as representatives from the deaf community have seen in them a means of decimating their culture and intrinsic values. OBJECTIVE: This paper aims to discuss, in bioethical terms, the validity of implanting cochlear hearing aids in children by analyzing their vulnerability and the social/cultural implications of the procedure itself, aside from looking into the medical/legal aspects connected to their criminal capacity. MATERIALS AND METHODS: The topic was searched on databases Medline and Lilacs; ethical analysis was done based on principialist bioethics. RESULTS: Cochlear implants are the best therapeutic option for people with profound deafness and are morally justified. The level of criminal capacity attributed to deaf people requires careful analysis of the subject's degree of understanding and determination when carrying out the acts for which he/she has been charged. CONCLUSION: Cochlear implants are morally valid. Implantations must be analyzed on an each case basis. ENT physicians bear the ethical responsibility for indicating cochlear implants and must properly inform the child's parents/guardians and get their written consent before performing the procedure.