When Good People Are Unethical: Respect

Imagine this.  Instead of hiring a professional interpreter who is familiar with and cognizant of the code of ethics, an untrained bilingual person is hired to simply cover the assignment.   Without proper knowledge and training, the bilingual person serving as an “interpreter” will most likely unconsciously commit serious ethical violations while at the same time thinking he is doing a good deed.

Example 6

Mr. Jacob Moran was contracted to interpret for Ms. Lucy Rubio at her doctor’s appointment. Mr. Moran is fluent in both languages and felt inspired to interpret as a way to serve his community. He has no formal training or experience, but an agency hired him because of his availability at the right price.

When he arrives to the appointment, right away he greets the patient and introduces himself. They hit it off right away because it just so happens that Ms. Rubio is from the same region from which he hails. Immediately, the patient tells the interpreter all about her medical condition so that he can explain it all to the doctor.

When the doctor enters the examination room, he greets everyone.  He then looks at the interpreter and says “Ask her why she is here. What is her problem?” The interpreter looks at the patient and says “Lucy, the doctor wants to know what your problem is!” Ms. Rubio, astonished by the question, then mutters “What a rude doctor! I’m here so he can tell me what is wrong with me. He’s the expert! I don’t know, just tell him what I told you about my back when we were in the waiting room.” At this moment, the interpreter looks back at the doctor and says “Lucy says that she has pain in her lower back and it is radiating down.”

When the appointment is over, the patient realizes that she failed to call for a ride back home. She asks the interpreter if he would be kind enough to take her home. She even offered to treat him to lunch for his troubles.

Believe it or not, this scenario is very common and happens often when the following ethical guidelines are ignored.

Respect:

The objective in the NCIHC National Standards of Practice for Interpreters in Health Care is to acknowledge the inherent dignity of all parties in the interpreted encounter. For this reason, interpreters treat all parties with respect.

The interpreter uses professional, culturally appropriate ways of showing respect. For example, in greetings, an interpreter uses appropriate titles for:

• patient
• provider
• interpreter

The interpreter promotes direct communication among all parties in the encounter. For example:

• The interpreter will inform the patient and provider to address each other directly, rather than the interpreter.

The interpreter promotes patient autonomy. For example:

• An interpreter directs a patient who solicits a ride home to appropriate resources within the institution.

In this example, the interpreter treads in very dangerous waters. Before I even bring up the respect issues, this interpreter could be held legally liable for failing to interpret everything being said and not admitting his mistakes. Failure could cause greater harm to the patient and foment distrust among the patient, the doctor, and insurance company. Often, untrained interpreters with little or no knowledge of the code of ethics will often fall into the traps presented above.

The interpreter should have shown proper respect by addressing the patient as Ms. Rubio and never becoming unduly familiar with patient on a first-name basis. When the doctor first looked at the interpreter and spoke to him, the interpreter should have kindly requested that the doctor look at and address the patient, at the same time assuring him everything would be interpreted.

For instance, I often avoid making eye contact with the doctor while he is talking and instead look at the patient. This body language subconsciously directs the doctor to the patient. Then when the patient is talking, I look at the doctor.

Finally, a well-intentioned person might think he is doing a kind favor by taking the patient home. However, this can make the interpreter appear overly friendly and biased toward the patient. It is also common for people to become dependent on the interpreter and begin to ask for regular favors. Respect for the patient then would mean that the interpreter would set limits and promote patient autonomy.

Untrained bilingual people, although well-meaning, are typically unqualified to interpret complex medical terminology. Respect is the quickest way to tell the difference between a professional and a dangerous well-meaning bilingual person.

Future posts will consider other circumstances where good people can be unethical without even knowing it.