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.
Mr. Montañez was contracted to interpret for Mr. Colón at his doctor’s appointment. Upon arriving, he greets the patient and introduces himself. While waiting to be called in, the patient, Mr. Colon, asked the interpreter if he had any kids. This leads to a lively conversation about each other’s families. By the time the patient was called, they felt like they knew each other for years.
Once called in, the doctor delivers some bad news, “Mr. Colon, I’m sorry to tell you that there is no more I can do for you. We have tried physical therapy, shots, and surgery. At this point You have reached MMI. Therefore, I am going to calculate your impairment rating and close your case.” Both the patient and the interpreter are visibly stunned.
When the doctor stepped out, the patient, Mr. Colon looks over and comments to his interpreter, “I don’t think this is right! He is my doctor; he should do more! He’s in with the insurance company! What do you think? Does that make sense to you? Do you think I should see another doctor? Should I fight this? You have lots of experience working around doctors, what should I do?’
Believe it or not, this scenario is very common and happens often. The interpreter might feel impelled to try and help the patient by sharing his opinions. However, there are some very important ethical reasons why he should not. Below are the ethical guidelines dictating role boundaries.
The objective in the NCIHC National Standards of Practice for Interpreters in Health Care in this case is to clarify the scope and limits of the interpreting role, in order to avoid conflicts of interest. Interpreter must maintain the boundaries of the professional role, refraining from personal involvement.
The interpreter limits personal involvement with all parties during the interpreting assignment. For example:
- Interpreter should not share overly personal information in conversations with a patient.
- Nor should they elicit such information by asking personal questions unrelated to the assignment.
The interpreter limits his or her professional activity to interpreting within an encounter. For example:
- The interpreter should never give advice to a patient on health care or legal questions.
- The interpreter should redirect the patient to ask the provider.
The interpreter with an additional role adheres to all interpreting standards of practice while interpreting. For example:
- An interpreter who is also a nurse does not confer with another provider in the patient’s presence, without reporting what is said. Their role at that moment is to interpret.
In example 7, the interpreter went beyond his role boundaries. By becoming overly familiar with the patient in the beginning of the encounter, he opened himself up to a conflict of interest. Often when patients are given bad news, they are desperate and haven’t yet come to terms with their reality. They will seek out and hold on to anyone who can give them the hope that they desperately crave. By becoming overly friendly, the interpreter became emotionally compromised and also desperately wanted better results for the patient. This is called compassion. However, contradicting the doctor and giving false hope to the patient is not only harmful, it can lead to a lawsuit against the interpreter.
It is important for the professional healthcare interpreter to be friendly and respectful while at the same time respecting ethical role boundaries designed to best serve the patient while protecting the interpreter.
Untrained bilingual people, although well-meaning, are typically fall right into this trap. They have been overheard talking bad about doctors, recommending lawyers and giving other advice they are not qualified to give. Role boundaries are evident with every professional interpreter.
Future posts will consider other circumstances where good people can be unethical without even knowing it.