Medical Interpreter Ethics

Code of Ethics

Set of principles or values that govern the conduct of members of a profession while they are engaged in the enactment of that profession. Guidelines for making judgments about what is acceptable and desirable behavior in a given context or particular relationship. (NCIHC, 6)

Core Duty

To make possible the communication between two parties - patient & provider - who do not speak the same language in order to achieve the goal of the encounter - the health and well-being of the patient. (NCIHC, 8)

Ethos

Moral custom

Ethic

Principle of good conduct

6 Tenets of Code of Ethics

Confidentiality, Accuracy, Professionalism, Impartiality, Use Advocacy and Cultural Interface Roles Appropriately, Professional Development

Confidentiality, Confidencialidad

The interpreter treats as confidential, within the treating team, all information learned in the performance of their professional duties, while observing relevant requirements regarding disclosure. (NCIHC, 10)

Confidentiality, Confidencialidad

Interpreters will maintain confidentiality of all assignment-related information. Do not disclose assignment-related information unless with the expressed permission of all parties or if required by law. (IMIA, 1)

"Right to Know"

The norms of the U.S. medical system value and protect the autonomy of the individual. It is with the individual that the right to know rests unless the patient has explicitly or implicitly indicated otherwise.

When is it justifiable to break the Code of Confidentiality?

(1) The patient has communicated the desire to hurt self or others. (2) There are statements of child, domestic, or elderly abuse.

HIPAA, year?

Health Insurance Portability and Accountability Act of 1996.

What Colleagues are doing to Ensure Confidentiality?

(1) Avoid discussing sensitive medical information in hallways, elevators, etc. (2) Shred medical notes after assignment or shift. (3) Disclose to both parties that you are bound by a Code of Ethics to maintain information confidential. (4) Do not volunteer health information about a patient to family members. (5) Do not share the name of the patient or other identifying information when discussing case studies. (6) Do not leave any document with the patient's name in a public area.

The 3 Core Values of the Code of Ethics for HCIs

(1) Beneficence (2) Fidelity (3) Respect for the importance of culture and cultural differences

Beneficence

Core value that is shared with other health care professions. Essential obligation and duty to support the health and well-being of the patient and their system of support and to do no harm.

Fidelity

Interpreters vow to remain faithful to the original message as they convert utterances from one language into another without adding to, omitting from, or distorting the original message.

Respect for the importance of culture and cultural differences

Understanding speaker's cultural frame of reference and being aware that cultural differences in perspectives and alternative views of the world can lead to critical misunderstandings and miscommunication.

Sapir-Whorf Hypothesis

Language serves as an expression of the ways that a culture organizes reality.

The 9 Principles of the National Code of Ethics for Interpreters in Health Care (NCIHC)

1. Confidentiality 2. Fidelity 3. Impartiality 4. Boundaries (Transparency, Conflicts of Interest) 5. Scope of Practice 6. Professional Courtesy 7. Advocacy 8. Professional Development 9. Professional & Ethical Manner (NCIHC, 21)

Accuracy & Completeness

Precisión & Completud

The principle of fidelity. The interpreter strives to render the message accurately, conveying the content and spirit of the original message, taking into consideration its cultural context.

Impartiality

Imparcialidad

The interpreter strives to maintain impartiality and refrains from counseling, advising, or projecting personal biases or beliefs.

Conflict of Interest

Conflicto de intereses

The interpreter maintains the boundaries of the professional role, refraining from personal involvement.

Scope of Practice

Àmbito de práctica

The interpreter continually strives to develop awareness of their own and other (ex. biomedical) cultures encountered in the performance of their professional duties. Cultural Competency.

Disqualification/Impediments to Performance

Descalificación/impedimentos al desempeño

Interpreters will refrain from accepting assignments beyond their professional skills, language fluency, or level of training.

Responsibility to withdraw from assignment if language or content keeps interpreter from enacting role in accordance with the principle of fidelity.

Responsibility Toward Ensuring Adequate Working Conditions (ex. interpreter fatigue, 20 minute rule, requesting complex materials ahead of time.)

Professional Courtesy

Cortesía profesional

The interpreter treats all parties with respect

Professional Development

Desarrollo profesional

The interpreter strives to continually further his/her knowledge and skills.

Interpreters will

Guidelines to the Conduit Role

- interprets in the first person

- interprets pauses, sighs, meaningful gestures, etc

- interpreter gives an accurate interpretation, not a literal interpretation

- the interpreter reflects tone, inflection, and volume

Clarifying: when intervention is necessary

- the interpreter needs to have the speaker repeat what they said

- the interpreter needs to ask the speaker to use shorter sentences

- the speaker is not pausing enough to allow for interpretation

- use of language that the interpreter does not understand

- the interpreter suspects, due to non-verbal clues, that the patient does not understand

- anyone uses a term that must be explained or put in a cultural context to be understood

- a cultural difference is causing a misunderstanding

Exceptions to using first person interpreting

- if the patient is disoriented, mentally ill, etc.

- if the patient speaks a language whose grammatical structure makes it inappropriate to use first person