ABSTRACT In Power Without Knowledge, Jeffrey Friedman develops a critique of technocracy and in doing so makes an epistemic case for exit over voice. He argues that a technocracy that fails to take people’s ideational heterogeneity into account is unlikely to possess the knowledge required to solve social problems, and that the alternative of “exitocracy” may, in some cases, overcome these limits. By creating the conditions under which individuals can exit from undesirable social situations, an exitocracy may allow people (...) to escape their social ills without knowing their society-wide causes or solutions. As Friedman recognizes, however, an exitocracy still requires technocratic knowledge, and this paper explores these requirements in further detail. First, it investigates the limits of exit as a solution to social problems, and the extent to which technocratic policies can be substituted for exit. Second, it considers the need for technocratic knowledge in the promotion of exit opportunities, and how this undermines Friedman’s defense of exitocracy. (shrink)

Hirschman's (1970) exit, voice, and loyalty framework draws attention to both economic and political behavior as instruments for organizational change. The framework is simple but powerful; it has stimulated much cross-disciplinary analysis and debate. This paper extends this analysis by examining normative implications of Hirschman's basic premise: that exit and voice are primarily mechanisms for enhancing organizational (vs. individual) well-being.

Over fifty years ago, Albert Hirschman argued that dissatisfied consumers could either voice complaint or exit when they were dissatisfied with goods or services. Loyal consumers would voice rather than exit. Hirschman argued that making exit easier from publicly provided services, such as health or education, would reduce voice, taking the richest and most articulate away and this would lead to the deterioration of public services. This book provides the first thorough empirical study of these ideas. Using (...) a modified version of Hirschman's account, examining private and collective voice, and viewing loyalty as a form of social investment, it is grounded on a dedicated five-year panel study of British citizens. Given government policies over the past decade or more which make exit easier from public providers, this is a timely publication for all those who care about the quality of government services. (shrink)

Are there worthwhile values and ideals which flourish in the procedures of the state but wither in the transactions of the market? Are there equitable and fulfilling social relationships which are nurtured in the economic sphere but crumble in the political world? There is clearly some truth in the claim that at least in certain circumstances market systems inculcate in people not only ‘honesty and diligence, but also sensitivity to the needs and preferences of others’ . On the other hand, (...) it is difficult to deny the appeal of a tradition of thought which attaches moral superiority to the non-market ideals and values epitomised in the gift relationship. Titmuss , for example, objected to treating blood as a commodity in part because it undermined the sense of fraternity or community which a system of voluntary blood donors enhanced. A contemporary statement of this position holds that gift values differ from commodity values in being ‘tokens of love, admiration, respect, honor, and so forth, and consequently lose their value when they are provided for merely self-interested reasons’. (shrink)

Disputes over agriculture and foodproduction have occurred against a background ofdisputed authority with regard to governments,experts, and single issue pressure groups. Consumershave intervened in quite significant ways with manyaltering their buying patterns. The conventionalassessment of consumer ``preferences'''' throughaggregated purchases fails to reflect the ethicalnature of significant numbers of purchase decisions.Nevertheless, consumers seem to offer a wider basis onwhich to consider ethical issues. The author proposesthat a valuable inclusion of consumer opinion in thedebates would require a move away from neo-classicaleconomics and (...) the selective inclusion of consumeropinion to unravel the complexity of (aggregated)consumer behavior. It is argued that Hirschman''sframework of ``exit, voice, and loyalty'''' is a moreappropriate tool for the understanding of ethics infood consumption. (shrink)

This essay addresses tensions within political philosophy between group rights, which allow historically marginalized communities some self-governance in determining its own rules and norms, and the rights of marginalized subgroups, such as women, within these communities. Community norms frequently uphold patriarchal structures that define women as inferior to men, assign them a subordinate status within the community, and cut them off from the individual rights enjoyed by women in other sections of society. As feminists point out, the capacity for (...) class='Hi'>voice and exit cannot be taken for granted, for community norms may be organized in ways that deny women any voice in its decision-making forums as well as the resources they would need to survive outside the community. This essay draws on research among the Gond, an indigenous community in India, to explore this debate. Given the strength of the forces within the community militating against women’s capacity for voice or exit, the question motivating our research is: Can external organizations make a difference? We explore the impacts of two external development organizations that sought to work with women within these communities in order to answer this question. (shrink)

The essay proposes an unexpected alliance between two of the figures assembled in the impressive intellectual constellation Benhabib presents in her new book: Albert O. Hirschman and Judith Butler. Hirschman’s model of ‘exit, voice, loyalty’ is used to interpret and justify the Palestinian call for Boycott, Divestment and Sanctions against Israel.

To shield stakeholders from exploitation, society increasingly expects organizations to engage with stakeholders. While exploitation of stakeholders is of great concern, economic literature points to the costly nature of stakeholder engagement vis-à-vis alternative mechanisms that protect stakeholders, such as competitive markets. When the costs of stakeholder engagement outweigh the benefits, why would organizations engage with stakeholders? Through an analysis of the cooperative enterprise and a comparison with its capitalist counterpart, we theorize two additional reasons why stakeholder engagement is beneficial. First, (...) we explain how stakeholder engagement facilitates long-term organizational resilience and protection of stakeholders in times of crisis, and second, we show how engagement is a decisive ingredient in answering non-economic value requirements of stakeholders. To conclude, we contribute to the broader stakeholder engagement and cooperative literature by stressing that engagement practices, and particularly democratic governance arrangements, are subject to design principles that sometimes favor stakeholders in capitalist firms. (shrink)

Investors concerned about the social and environmental impact of the companies they invest in are increasingly choosing to use voice over exit as a strategy. This article addresses the question of how and why the voice and exit options (Hirschman 1970) are used in social shareholder engagement (SSE) by religious organisations. Using an inductive case study approach, we examine seven engagements by three religious organisations considered to be at the forefront of SSE. We analyse the full engagement process (...) rather than focusing on particular tools or on outcomes. We map the key stages of the engagement processes and the influences on the decisions made at each stage to develop a model of the dynamics of voice and exit in SSE. This study finds that religious organisations divest for political rather than economic motives using exit as a form of voice. The silent exit option is not used by religious organisations in SSE, exit is not always the consequence of unsatisfactory voice outcomes, and voice can continue after exit. We discuss the implications of these dynamics and influences on decisions for further research in engagement. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 27.2 (2003) 456-470 [Access article in PDF] Ethics without Exit:Levinas and Murdoch Bob Plant Hearts open very easily to the working class, wallets with more difficulty. What opens with the most difficulty of all are the doors of our own homes. —Emmanuel Levinas, Nine Talmudic Readings... there is no debt to acquit. From the outset, I am not exonerated. I am originally in default. —Emmanuel (...) Levinas, God, Death, and TimeIN HIS RECENT ARTICLE "Emmanuel Levinas and Iris Murdoch: Ethics as Exit?," C. Fred Alford highlights a number of insightful comparisons—and many important contrasts—between the respective conceptions of ethics proffered by Levinas and Murdoch. Alford's avowed objective is to "criticize Levinas sympathetically," or to "disrupt" what has come to be known as "the Levinas Effect" and the tendency of many commentators to make Levinas "become everything to everyone." 1 Given what one commentator calls "the facile 'postmodern' temptation to lump together all differences under the general rubric of the 'Other,'" 2 Alford's objective is, I believe, wholly commendable. (As Arthur Schopenhauer pithily remarks: "the man who is everyone's friend is no one's friend." 3) Nevertheless, in the following discussion I want to "disrupt" Alford's own reading of Levinas; not, I hope, to make the latter simply a conduit for saying "whatever.... [I] wanted to say in the first place" (p. 24), but to present a fuller picture of Levinas's singularly difficult, evocative and often puzzling philosophy. I shall do this by critically responding to and developing a number of points [End Page 456] Alford explicitly raises. To what extent my reading of Levinas aligns him with Murdoch, I leave for others far better qualified to assess.Let us be clear from the start, Levinas is—as Hilary Putnam rightly notes—a "moral perfectionist." 4 But this is not to say that Levinas's work is "otherworldly." Although Alford does not use this latter term, it is clearly implied in his analysis. Thus, contrasting Levinas and Murdoch, he remarks that, "like Levinas, Murdoch's goal is to go beyond the limits of the self. Unlike Levinas, Murdoch is content to remain within a world of beings" (p. 37), and likewise, that Murdoch wants us to "climb the ladder of love only high enough to be free of their vanity and egoism, but never so high as to leave the world behind" (p. 38). According to Alford, "the other is an abstraction for Levinas.... Only at a distance is the other abstract enough to remind us of infinity" (p. 25)—indeed, a "barely contained passion for otherness, exit, and transcendence runs through Levinas" (p. 40). In a similar vein we are told that, for Levinas, "the self is remarkably real, a tangible fleshy thing.... and a barrier to infinity," and it is "for this reason,... a shattering experience is necessary, like that of Saul on the road to Damascus, an experience that does not bring me closer to my deliverer.... Only this can open me up—not to reality, but to infinity" (p. 38). More pointedly still, Alford asserts: "Levinas was never interested in the concrete reality of the other person, whose fleshy reality can only get in the way of transcendence" (p. 37). Thus, although he acknowledges that Levinas "often writes about ethical relationships as though they were real relationships with real people" ("what is not true is that Levinas is talking about some Other more august and transcendent than real other people.... we know the infinite only through other people"), Alford nevertheless defends his own "turning to Murdoch" on the grounds that she is "a theorist who remains strictly within the realm of everyday life, finding there subtleties of knowing, caring, and being that Levinas believes come only by way of the infinite" (p. 34).While Levinas's attitude toward the "everyday" or "ordinary" is hardly transparent (after all, the imperative of the other's face is said to come "from most high outside the world" 5 ), Alford overstates the "otherworldly" aspect of the former's ethics. Against the allegation that Levinas... (shrink)

What do we owe participants in collective pension plans in terms of socially responsible investment (SRI)? This paper draws into question current conventional wisdom on SRI, which considers investor engagement a more effective strategy than divestment to change morally problematic corporate behaviour. More fundamentally, in light of reasonable disagreement about the objective of SRI, the paper argues that participants in collective pension plans are owed some kind of control over their investments. The final section considers four different institutional arrangements to (...) respect this requirement in practice, ranging from democratic decision procedures to the availability of SRI alternatives. (shrink)

What can Hannah Arendt's writings offer to current thinking on the environment? Although there are some obvious connections between her work and current issues in environmental ethics, not very much has been written on the topic. This article argues that Arendt's philosophy is particularly fruitful for environmental thinking because she explicitly links the material and biological conditions of human existence with the political conditions of human freedom. This is articulated in the article as the requirement of both constrained consumption and (...) unconstrained deliberation. The article elaborates these notions before concluding that Arendt's philosophy uniquely combines the existential task of self-understanding with the practical task of confronting our environmental challenges. (shrink)

This article is about knowledge and argument. The purpose is to dramatize certain questions of knowledge: how and why does the better knowledge not become the better argument; what are the voices access ible to the claiming of new knowledge; what are the limits and destinies of contemporary expertise? The article is also an experiment in aca demic and intellectual forms, an experiment which corresponds to the central inquiry: how should knowledge speak now? There are three parts. The first (...) part tells a story about enlightenment and persuasion. The second part is a dialogue between two voices which speak for the argumentative ethos of knowledge - Newtonian is a voice of the centre, and Paracelsan speaks from and for the margins. The third part is a dia logue between Critic and Speculator, a dialogue about the fate of know ledge in postmodernity. Throughout, the text includes a range of quotations, synchronized with its arguments. The continuous source of excerpts is the BSE news, which is taken to represent aspects of know ledge in our time. There is a strong association made between questions of contemporary knowledge and ecological crisis. Major reference points include: Beck; Baudrillard; Blanchot; Jabes. (shrink)

The paper is a response to Russell Daylight’s “In the Name of Democracy”. I argue that Daylight’s postmodernist approach to the question of democracy is flawed in several respects. First, he interprets the claim that the meaning of democracy is open to entail that there can be no closure when democratic norms are in dispute. I argue that normative closure is not only essential but also necessary to democratic practice, in particular for democratic legitimacy. I reject the claim that normative (...) closure requires transcendental truths or dubious metaphysical commitments. Second, I critically examine Daylight’s positive proposal for “language-citizens.” I end by offering a sketch of a theory of democratic legitimacy that I believe evades the charges that Daylight and postmodernists offer against normative democratic theory. (shrink)

This book argues for moral contractarianism, the view that moral justification rests on the idea of agreement. It critically appraises the views of contemporary contractarians such as John Rawls, David Gauthier, and Thomas Scanlon. It argues for a theory of moral justification that is based on a hypothetical agreement of restricted scope between strangers in the circumstances of justice and that is bound by historical place and circumstance.

The meaning of privacy has been frequently disputed in the philosophical and -/- legal literature since Warren and Brandeis first argued for it as a distinct and -/- important personal and social value. Nevertheless, while the meaning of privacy -/- is held to be vague, there is general agreement that Warren and Brandeis were -/- correct in their assessment of its value. Theorists of democracy, on the other hand, -/- have been ambivalent towards the realm of the private. This paper (...) interrogates the -/- intersection between privacy and democracy, questioning the place of privacy as a -/- distinctly democratic value. (shrink)

Drone warfare disrupts the generally understood experience of war, and drone operators’ distance from the battlefield has called into question the authenticity of their experiences as participants in conflict. This article examines the autobiographies of three US military drone operators, analysing how the narration is discursively oriented to particular spatial and ideological perspectives. It argues that the linguistic construction of point of view in each text reflects a dynamic and sometimes paradoxical relationship between drone operators and their distance from the (...) battlefield. Observing the position and shifting of deictic centres, the analysis draws parallels between spatial perspective, ideology, and the social identities of drone operators and victims of drone strikes. It concludes by reflecting on the variety of discursive strategies employed across these texts, and considers this variation itself to be an emerging trend in the discourse of drone warfare. (shrink)

In this paper I argue that David Gauthier’s answer to the Why be moral? question fails. My argument concedes the possibility of constrained maximization in all the senses Gauthier intends and does not rely on the claim that it is better to masquerade as a constrained maximizer than to be one. Instead, I argue that once a constrained maximizer in the guise of "economic man" is transformed through an affective commitment to morality into a constrained maximizer in the guise of (...) the "liberal individual," then a purely rational justification for morality must become invisible to the latter. If I can show this, then I can show that rational justification can have no motivational power for the "liberal individual" and that Gauthier fails to answer the problem of moral motivation. (shrink)

This article analyses the recent controversy over single and lesbian women’s right to access reproductive technology. It focuses on the McBain case in relation to the Sex Discrimination Act. As well, it attempts to bring voices that have been ignored into the debate, and reflect on the values that they express.

Is there a principled way to understand what liberal democratic states owe, as a matter of justice, to the victims of disasters? This article shows what is normatively special and distinctive about disasters and argues for the view that there are substantial duties of justice for liberal democratic states. The article rejects both a libertarian and a utilitarian approach to this question and, based on broadly Rawlsian principles, argues for a ‘political definition’ of disasters that is concerned with the restoration (...) of citizens' dignity and their capacities for effective citizenship. (shrink)

This paper argues that the categorical authority of love’s imperatives is derived from a sentimental contract. The problem is defined and the paper argues against two recent attempts to explain the authority of love’s demands by Velleman and Frankfurt. An argument is then set out in which it is shown that a constructivist approach to the problem explains the sources of love’s justifications. The paper distinguishes between the moral and the romantic case but argues that the sources of authority are (...) paralleled in each. The paper ends by asking what we are to say when the demands of morality and the demands of love conflict. (shrink)

In this paper I argue that noise is a significant source of social harm and those harmed by noise often suffer not merely a misfortune but an injustice. I argue that noise is a problem of justice in two ways; firstly, noise is a burden of social cooperation and so the question of the distribution of this burden arises. And, secondly, some noises, although burdensome, are nevertheless just because they arise from practices that are ‘reasonable’. I offer a number of (...) distinctions, between necessary and unnecessary noise, between public and private noise and between reasonable and unreasonable noise. What justice requires will differ according to what kind of noise we consider. My purpose is to give normative urgency to the problem of noise by understanding certain instances of it as not merely annoyances and nuisances but instances of injustice. (shrink)

In this paper I argue that noise is a significant source of social harm and thoseharmed by noise often suffer not merely a misfortune but an injustice. I arguethat noise is a problem of justice in two ways; firstly, noise is a burden of socialcooperation and so the question of the distribution of this burden arises. And,secondly, some noises, although burdensome, are nevertheless just becausethey arise from practices that are ‘reasonable’. I offer a number of distinctions,between necessary and unnecessary noise, (...) between public and private noiseand between reasonable and unreasonable noise. What justice requires willdiffer according to what kind of noise we consider. My purpose is to give normativeurgency to the problem of noise by understanding certain instances ofit as not merely annoyances and nuisances but instances of injustice. (shrink)

Is there any ethical justification for limiting the reproductive autonomy and not make assisted reproductive technologies available to certain prospective parents? We present and discuss the results of an interdisciplinary clinical ethics study concerning access to assisted reproductive technologies (ART) in situations which are considered as ethically problematic in France (overage or sick parents, surrogate motherhood). The study focused on the arguments that people in these situations put forward when requesting access to ART. It shows that requester’s arguments (...) are based on sound ethical values, and that their legitimacy is at least as strong as that of those used by doctors to question access to ART. Results reveal that the three implicit normative arguments that founded the law in 1994, which are still in force after the bioethics law revision in July 2011—the welfare of the child, the illegitimacy of a “right to a child,” and the defense of the so called “social order”—are challenged on several grounds by requesters as reasons for limiting their reproductive autonomy. Although these results are limited to exceptional situations, they are of special interest insofar as they give voice to the requesters’ own ethical concerns in the ongoing political debate over access to ART. (shrink)

We introduce the concept of “organizational terrorism” to describe dysfunctional leaders who are abusive and who treat organizational members with contempt and disregard. After identifying the moral duties of leaders in organizations, we explain how organization members respond to their dissatisfaction with organizations through Exit, Voice, Loyalty, or Neglect. We explain why exercising voice is the most effective moral choice in dealing with dysfunctional leaders.

This article deals with nurses’ ethical concerns raised by the consequences of changes in governmental and institutional policies on nursing practice and patient care. The aims of this project were to explore perspectives of registered nurses who provide or manage direct patient care on policies that affect nursing and patient care, and to provide input to policy makers for the development of more patient-centred policies. Four focus groups were conducted with a total of 36 registered nurse participants. The project team (...) identified major themes that emerged in the analysis of transcripts of the focus group discussions. The four major themes were: effects of policy focused on cost containment, effects on quality of care, effects on patient education and access to needed services, and effects on nurses and nursing. The participants identified primarily negative effects of changes in national health policy and legislation that influence institutional policies on patient care and nursing practice. The effects of identified policy changes raised concerns about meeting nurses’ ethical obligations to patients and families. Participants specified key points for consideration by legislators and other policy makers. They viewed nurses who are involved in direct patient care as a critical resource for legislators and other policy makers in the development of public and institutional policies that affect nursing and patient care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 26.1 (2002) 24-42 [Access article in PDF] Emmanuel Levinas and Iris Murdoch: Ethics as Exit? C. Fred Alford THE LEVINAS EFFECT it has been called, the ability of Emmanuel Levinas's texts to say anything the reader wants to hear, so that Levinas becomes a deconstructionist, theologian, proto-feminist, or even the reconciler of postmodern ethics and rabbinic Judaism. Talmudic scholar and postmodern philosopher, Levinas has become (...) everything to everyone. Abstract and evocative, writing in what can only be described as the language of prophecy, we pretend we understand what he is talking about, writing in much the same style, so as to say whatever we wanted to say in the first place. Even those who disagree with Levinas generally criticize him from within the framework of his project, sharing his assumptions while trying to make Levinas more Levinassian. 1How might one disrupt the Levinas Effect? By disrupt, I mean criticize Levinas sympathetically, from a perspective outside his "system," but not outside his world. Levinas's world is one in which the self is the enemy not only of the other, but of authentic existence. Iris Murdoch shares this view with Levinas. Like Levinas, Murdoch sees the self as the enemy. "Unselfing," as she calls it, is the means; the end is to overcome totality, which means the subjection of the other to my categories and my experience. Levinas means much the same thing by totality. It is his philosophical idée maîtresse, the troubling tendency of Western thought from Plato to Hegel and beyond."What breaks the drive of consciousness to totality is not an appeal to an abstract social or linguistic whole, but an encounter with the concrete other person." Levinas did not say this, nor did Iris Murdoch. Maria Antonaccio says it in a book about Murdoch, in which she compares Murdoch's views to those of Levinas. What they share, says [End Page 24] Antonaccio, is this critique of totality, even if "Murdoch would reject the language of command, lordship and accusation that pervade Levinas's account." 2Certainly Levinas's language of persecution is one of the most striking aspects of his account, and I will not ignore it. But it is not the most important thing that distinguishes him from Murdoch. One might argue that it is the "concrete other person" that distinguishes Levinas from Murdoch, for in many respects the other is an abstraction for Levinas. "The best way of encountering the Other is not even to notice the color of his eyes!" says Levinas. 3 Only at a distance is the other abstract enough to remind us of infinity.This distinction comes closer to capturing the difference between them. Even more important, Levinas shares Sartre's nausea at the thingyness of the world. Levinas calls it the il y a, the "there is." It is this that makes his account closer to Sartre's than one might imagine, and more distant from Murdoch. This does not, of course, make Levinas wrong. The comparison with Murdoch is a way of getting out from under the Levinas Effect.My goal is to better understand Levinas by comparing him with Murdoch. This requires that Murdoch's philosophy be seriously considered, but perhaps not as seriously as that of Levinas. Murdoch is the other, Levinas the subject. Possibly we will end up understanding the other better than the subject. I The outlines of Levinas's philosophy will be familiar to many readers. I will elaborate upon a story told by Levinas to recount it. 4 Imagine that someone rings your doorbell and disturbs your work. As you walk to the door you are distracted, still thinking about your latest project. It takes you a moment to recognize your neighbor at the door, the one who lives upstairs; as soon as you recognize his face you invite him in. You talk for a while. He tells you his problem, you tell him what you might do to help him. You share some pleasant conversation, and soon enough your neighbor leaves. What you originally experienced... (shrink)

We introduce the concept of "organizational terrorism" to describe dysfunctional leaders who are abusive and who treat organizational members with contempt and disregard. After identifying the moral duties of leaders in organizations, we explain how organization members respond to their dissatisfaction with organizations through Exit, Voice, Loyalty, or Neglect. We explain why exercising voice is the most effective moral choice in dealing with dysfunctional leaders.

This comprehensive educational history of public schools in Hawai'i shows and analyzes how dominant cultural and educational policy have affected the education experiences of Native Hawaiians. Drawing on institutional theory as a scholarly lens, the authors focus on four historical cases representing over 150 years of contact with the West. They carefully link historical events, significant people, educational policy, and law to cultural and social consequences for Native Hawaiian children and youth. The authors argue that since the early 1800s, educational (...) policy in Hawai'i emphasizing efficiency has resulted in institutional structures that have degenerated Hawaiian culture, self-image, and sovereignty. Native Hawaiians have often been denied equal access to quality schools and resulting increased economic and social status. These policies were often overtly, or covertly, racist and reflected wider cultural views prevalent across the United States regarding the assimilation of groups into the American mainstream culture. The case of education in Hawai'i is used to initiate a broader discussion of similar historical trends in assimilating children of different backgrounds into the American system of education. The scholarly analysis presented in this book draws out historical, political, cultural, and organizational implications that can be employed to understand other Native and non-Native contexts. Given the increasing cultural diversity of the United States and the perceived failure of the American educational system in light of these changes, this book provides an exceptionally appropriate starting point to begin a discussion about past, present, and future schooling for our nation's children. Because it is written and comes from a Native perspective, the value of the "insider" view is illuminated. This underlying reminder of the Native eye is woven throughout the book in _Ha'awina No'ono'o_--the sharing of thoughts from the Native Hawaiian author. With its primary focus on the education of native groups, this book is an extraordinary and useful work for scholars, thoughtful practitioners, policymakers, and those interested in Hawai'i, Hawaiian education, and educational policy and theory. (shrink)

This anthology takes a broad approach to ethics, incorporating traditional topics and texts while bringing in voices and themes that are too often excluded. A substantial section on ethical theory is provided, as are readings on topics such as oppression, sex, identity, the environment, life and death, war and terror, and caring for others. Accessible introductions and discussion questions are included throughout to contextualize material for the student reader without playing favorites among the positions at issue.

Around 96 percent of children with hearing loss are born to parents with intact hearing, who may initially know little about deafness or sign language. Therefore, such parents will need information and support in making decisions about the medical, linguistic, and educational management of their child. Some of these decisions are time-sensitive and irreversible and come at a moment of emotional turmoil and vulnerability (when some parents grieve the loss of a normally hearing child). Clinical research indicates that a deaf (...) child’s poor communication skills can be made worse by increased level of parental depression. Given this, the importance of reliable and up-to-date support for parents’ decisions is critical to the overall well-being of their child. In raising and educating a child, parents are often offered an exclusive choice between an oral environment (including assistive technology, speech reading, and voicing) and a signing environment. A heated controversy surrounds this choice, and has since at least the late 19th century, beginning with the International Congress on the Education of the Deaf in Milan, held in 1880. While families seek advice from many sources, including, increasingly, the internet, the primary care physician (PCP) is the professional medical figure the family interacts with repeatedly.The present article aims to help family advisors, particularly the PCP and other medical advisors in this regard. We argue that deaf children need to be exposed regularly and frequently to good language models in both visual and auditory modalities from the time hearing loss is detected and continued throughout their education to ensure proper cognitive, psychological, and educational development. Since there is, unfortunately, a dearth of empirical studies on many of the issues families must confront, professional opinions, backed by what studies do exist, are the only option. We here give our strongly held professional opinions and stress the need for improved research studies in these areas. (shrink)