Book Review

Title:  Cochlear Implants in Children: Ethics and Choices 
Authors: John B. Christiansen & Irene W. Leigh 
Publisher: Gallaudet University Press, 2002
Cost: $49.95, hardcover
ISBN: 1-56368-116-1 
Title: Ethics in Mental Health and Deafness
Author: Virginia Gutman (editor)
Publisher: Gallaudet University Press, 2002
Cost: $65.00, hardcover
ISBN: 1-56368-120-X
Reviewer: Simo Vehmas 

  These two recent books treat ethical issues of immense importance related to working with deaf 
clients in mental health practice, and to the facts and controversies associated with cochlear 
implants. The titles of these books may be misleading though since the actual ethical discussion 
found in these books is scarce and shallow. The focus regarding ethics in these books is very 
practical. They deal with issues that professionals, parents and deaf people themselves may confront 
in different stages of life. In both books the ethics part is more an introduction to various ethical 
questions, rather than scrutinizing them and finding sound bases for ethical judgments. 

  The authors do not discuss the issues philosophically.  Gutman, for example, mentions in Ethics in 
Mental Health and Deafness, that her focus is not on providing the Òright answersÓ but on helping 
readers ask the right questions leading to ethically sound clinical decisions (p. 12). This may reflect 
a conscious methodological approach to examining ethics where the point is to enlighten moral 
philosophical reasoning to people unfamiliar with it. But presenting questions in itself is not very 
helpful if they are not discussed properly. To help readers make their own conclusions, one should 
provide them with arguments of the strengths and weaknesses of various possible normative 
judgments. In this sense, the ethical argument in Ethics in Mental Health and Deafness seems to 
cease before it has even properly begun. 

  Christiansen and Leigh fortunately present the ethical dimensions related to cochlear implants in a 
more versatile manner. They provide readers with at least one possible tool for solving ethical 
problems: the four-principles approach developed by Tom Beauchamp and James Childress.  
However, the principles of autonomy, justice, beneficence and nonmaleficence do not in any manner 
constitute an unproblematic, indisputable foundation for resolving ethical dilemmas. The theory of 
four principles has been strongly criticized. Whether one finds it plausible is not the issue. The ideal 
in books like Cochlear Implants in Children is to give readers alternative ways to solve ethical 
issues. When only one philosophical tool is presented, the ethical reasoning is limited.

  Thus, from the viewpoint of philosophical ethics, these books do not seem to have too much to 
offer. However, one crucial element in applied ethics is the consideration of empirical knowledge. 
The use of empirical data gives a framework to the normative arguments and directs the conclusions. 
In this sense, these books provide some invaluable material to both academics and lay people. Many 
academics and professionals may not have even thought about many of the issues related to cochlear 
implants, deaf people in mental health care, the Deaf culture and so on. Regarding the awareness of 
the ethical issues related to deafness, these books give a useful overview of the field (this applies 
especially to Cochlear Implants in Children). Since many professionals, like the general public, do 
not have much time for complicated philosophical arguments, these books may be very useful to 
parents and professionals who have not encountered deafness and the related ethical issues.

Simo Vehmas, Ph.D. in Education, specializes in ethical issues related to disability. The subjects of 
his publications include practical topics such as the morality of selective abortion, as well as more 
general theorization about the concept of disability. He may be contacted at Dept. of Moral and 
Social Philosophy, PO Box 9, 00014 University of Helsinki, Finland, or simo.vehmas@helsinki.fi; 
njet.net/users/vehmas