The Ethics of Using Clinical Interpreters

The ability of a clinician to provide excellent clinical services to a patient is dependent partly on the information the clinician receives about a patient, and partly on how well the clinician can communicate information to the patient/family. When a language interpreter is necessary to assist with patient care because the clinician does not speak the patient’s or family’s language, this adds an additional challenge to providing services. How does the clinician know the interpretation is accurate? How does he or she know the message the patient is receiving is the one being communicated? What is the effect of the patient’s culture on the interaction?

These questions and others were raised in a recent Ethics Program consultation involving programs that provide services to patients who are deaf or hard of hearing. Dr. Jennifer Reesman, of the Neuropsychology Department’s Deafness-Related Evaluations and More (DREAM) Clinic, and Elizabeth Campbell, of the Unity Clinic at the Center for Child and Family Traumatic Stress, shared their experiences providing care to members of that community. Dr. Reesman, who is fluent in American Sign Language (ASL), explained that there are nuances involved in the culture of the community of individuals who are deaf or hard of hearing that go beyond a medical view of hearing loss. Though there is certification for language interpretation, she explained, there are no regulations or laws that guarantee accurate interpretation.

Members of the Ethics Program recognized that the discussion involving interpreters for ASL was also relevant for interpreters of other languages. Clinician members acknowledged having had experiences in which their ability to understand and communicate with patients was affected by an interpreter’s level of competence, sometimes having a negative impact on patient care. What is the ethical obligation to ensure that interpreters are providing accurate information, and how can clinicians know if their words are being interpreted correctly? Beyond language, how can a clinician respond to other aspects of interpretation, such as culture, clinical boundaries and interpersonal factors? The answers to these questions reflect the basic bioethical principles of “Autonomy,” “Doing Good,” “Doing No Harm” and “Justice (Equity).”

Ethics Program members developed three recommendations to help support excellent services in cases in which interpretation services are used: 1.) Provide more opportunities within Kennedy Krieger Institute to educate clinicians on the use of interpreters. 2.) Increase communication with language communities served at the Institute, including developing a patient advisory panel that includes speakers of other languages. 3.) Look at ways of enhancing the interpretation services currently used, some of which are arranged through The Johns Hopkins Hospital. Suggestions included creating an efficient feedback process about the performance of interpreters, and exploring the possibility of employing “master interpreters” to provide interpretation services and assess the level of interpretation being offered at Kennedy Krieger appointments.