In this concluding article of an "American Annals of the Deaf" Special Issue, we draw on Vygotsky's "Fundamentals of Defectology" to argue that the essence of deaf pedagogy is not centered on constructing deaf students' hearing abilities but on a biosocial orientation that considers the whole multimodal child with unfettered access to natural signed languages. In alignment with this biosocial view, we recognize and resist the overarching influence of biomedical professionals and systems on deaf education. Such biomedical influence comes with convenient detachment from accountability in education systems while arguably causing at least significant, if not maximal, harm to the optimal developmental outcomes of deaf children. The article ties together the articles of the Annals Special Issue, along with additional Vygotskian perspectives, to bring forth the emergence and exploration of biosocial accountability in deaf education.