The Couch

The Couch – Guidance required: Guidelines for Medical Interpreters

The Couch is a learning place, not only for its contributors but also for our readers who engage in the ensuing discussions. Our colleague is curious about what is expected of her as a medical interpreter due to a conflicting situation she heard about. Are you ready?

I hope to learn something positive about the next step I want to take in my career. My concern stems from some stories I have heard of people getting fired for… Well, I am getting ahead of myself.
I really want to become a medical interpreter, but a colleague told me she was fired after refusing to interpret for something that went against her religious beliefs. At the same time, I hear that I am supposed to recuse myself if I can’t be impartial in specific situations. These two concepts go against each other: the agency can fire someone for refusing to interpret in a situation s/he can’t be impartial and the Code of Ethics says medical interpreters should recuse themselves in situations where impartiality is in question. Which one is it?
I really want to make a good decision and before going further into becoming a medical interpreter. I am researching, planning to make this my next move next year: take courses, get certified and start working. Can you help me?
Thank you.

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18 thoughts on “The Couch – Guidance required: Guidelines for Medical Interpreters”

  1. Rosemary says:

    As an interpreter you MUST abide by the code of ethics. You have an obligation to interpret everything that is being said, not filter, add or omit.

    As far as your colleague getting fired after refusing to interpret something that went against her religious beliefs….. Had she had the proper training and had been aware of the code of ethics she wouldn’t have had any problems. It is not her dialog, it is the dialog of the provider and the patient, not hers.

    The lack of emphasis on the code of ethics in Medical Interpreter Training is the real culprit. For some reason this is the area where novices as well as seasoned interpreters goes awry.

    Interpreters completely forget the standards of practice and then wonder what happened. Medical Interpreting will never reach the pay, recognition and status of the real profession it deserves to be with this kind of indifference to the code of ethics.

  2. Helen Eby says:

    In medical settings, interpreters often work with chaplains. You have to be able to interpret for chaplains of all faiths. You may also find that medical procedures that go against your personal beliefs are a topic of conversation. Both parties deserve an impartial rendition of the conversation. Recusing yourself at that point makes your bias very clear, so you really need to just keep going. It is pretty much the only course of option for a professional interpreter.

    Now… it is always fair to ask, before the appointment, what the topic is. That is where you can make a decision regarding whether you are comfortable showing up. Once you are there, you just have to go with the flow.

    When medical interpreters provide this level of service, their pay will catch up to the pay of court interpreters.

    1. Lidia T. Pines says:

      Thank you.

    2. Alma says:

      Great response Helen!

  3. MariaFernanda Bravo says:

    If you can keep in mind that interpreting is never about you, you might make a very good interpreter. We are not there to sanction the choices made by the medical providers or the patients. You can recuse yourself in advance from certain scenarios- I know some people can’t stand the sight of blood and will only be assigned in-office visits and the like. But the reality is you can’t always expect to get any information in advance, because of patient confidentiality rules. This is a profession of service, where we ideally only become instruments of communication.

  4. Janis Palma says:

    The question is a very valid one. You should be able to refuse an assignment for any reason, not just religious beliefs. Of course, knowing you cannot remain impartial is definitely a reason to recuse yourself from an assignment, or refuse it when it is offered. But this is not even an ethics issue, it is a choice you have as an independent contractor: “what jobs do I really want to accept?” Even staff interpreters can refuse certain types of assignments, not necessarily for lack of competence—another good reason to recuse yourself—but because they cannot detach emotionally from the subject matter. I would not necessarily call it bias. If I cannot “stomach” a scenario in which a child is dying, it does not mean my interpreting will be tainted. It just means I will be that much more impacted by that child’s trauma—and the child’s family—than I would be if it were, say, a gangbanger bleeding to death. Be aware, however, that once you agree to work for an agency—or maybe a full-time employer—you should be absolutely honest and transparent: “there are certain types of cases I will not accept.” Be very clear about which cases, for example, rape, or child abuse. For medical interpreters, the boundary could be the emergency room in a hospital versus a doctor’s office. If the agency employing your services is not willing to accept your conditions, it is their right to hire someone else who does not have those limitations. If you were not clear from the onset, then it is their right to let you go. It is a 2-way street.

  5. Hello, it’s good that this issue has come up for you in general, before it hits you specifically. I agree with the comments of Rosemary, Helen and Maria Fernanda. I’d just add that one more consideration to keep in mind is: when the interpreter decided suddenly that s/he could not interpret the encounter, she probably left the healthcare provider and the patient high and dry, frustrated and angry and in general feeling little respect for that specific interpreter and possibly for all future interpreters they may encounter, Maybe even left them in the middle of a procedure that had already started… possibly having to recur to someone allegedly less professional. It’s not surprising that she was fired. I’m imagining that she was working for an agency, since there are many more of those types of contracting positions rather than staff. Unfortunate for all involved.

  6. Marcella Alohalani Boido says:

    The crucial issue raised here is whether an interpreter can and should recuse themselves from a situation when the interpreter believes that she or he cannot do their work impartially. The answer to that specific question, which is about impartiality, is “Yes.”

    It does not have to be a situation where the patient is doing something that the interpreter’s religion does not approve of. It could be that the interpreter knows that he or she cannot interpret impartially for a rape victim, because the interpreter or someone close to the interpreter has been raped. Interpreting for a rape victim may simply stir up too much emotional trauma for the interpreter. That trauma may make it difficult for the interpreter to do a good job.

    Having said that, there is a matter of logistics. If at all possible, an interpreter can try to find out in advance what the specific topic of the medical interview will be. That will aid the interpreter in preparing appropriate vocabulary, and also prepare themselves emotionally for what may be a difficult situation. For example, if an interpreter knows that the patient is going through a series of medical procedures for cancer, that will help the interpreter prepare emotionally as well as intellectually. Again, if the interpreter knows that a cancer patient interview is going to stir up a lot of trauma for the interpreter, then the interpreter might best recuse themselves in advance.

    If there are situations for which the interpreter thinks she or he cannot interpret impartially, then perhaps the agency should be informed of that. The interpreter may prefer to deal with these situations on a case-by-case basis, depending on their perception of the agency and how it treats interpreters.

    It is interesting that although most interpreters are freelancers, there are agencies and even interpreters themselves who believe and act as if interpreters are employees. Being a freelancer has many disadvantages. One of the advantages is that the freelancer is entitled to turn down work assignments in advance, and to do so without giving any explanation.

    The difficulty probably arises where the interpreter has accepted an assignment, not knowing the subject matter, and then finds themselves in a situaioin where they cannot be impartial. It may be in the best interests of everyone, including the patient, for the interpreter to recuse themselves.

    The interpreter needs to consider this: OK, I have an opinion. I do not like X procedure, I think it is wrong. But…Can I do my job properly? Can I provide medical interpreter services in this situation without letting any hint of my feelings come through? Can I do my job at an appropriate professional level?

    To use an example from legal interpreting: Court interpreters are unlikely to approve of murder, rape, drug dealing, etc. But if we do not go in and interpret for the alleged murderer, rapist, or drug dealer, then what happens to the justice system? Most interpreters probably do not approve of people driving under the influence. Should we therefore recuse ourselves from interpreting for people facing these kinds of charges?

    My personal answer is that I will interpret as long as I think I can do my job impartially, to an appropriate professional standard. Judgement is something I leave to the judges, and where applicable, to the jury, as much as possible.

  7. Alfredo Babler says:

    Wow, this is a tough one indeed. I’m just going to let the spirit write now. Bear with me. You get called in to a Planned Parenthood clinic to interpret at a late-term abortion. The patient is being asked to sign informed consents about keeping her 8-month-old “fetus” alive to harvest the organs and parts, to be sold to third parties for medical research, in exchange for the free “family planning” procedure. You are a firm supporter of women’s right to choose, but you have an epiphany when you read for yourself all the forms and see with your own eyes how insanely sick and evil this “medical procedure” has become. You’re torn apart between your liberal indoctrination and your moral compass. You don’t want to let politics get in the way of you doing your job, but you know in your heart that you hate Trump and the Republicans for what the mainstream media has told you over and over again is a violation of women’s right to choose to abort a fetus at any stage, because “a fetus isn’t a child.” But when you see the instruments on the stainless steel table and the mechanical approach taken by the doctor and staff at the abortion clinic, and realize it is a for profit operation peddled as a choice, you decide you want nothing to do with what you now consider infanticide and wish to avoid the burden your participation in it will put on your soul. But you are a professional. You don’t have any skin in the game. You might as well be a mechanical transmitter/receiver devoid of emotion or bias, and you also have to pay your bills. If you don’t do this assignment, somebody else will. Right? Sorry for the raw stuff, but life is complicated. This is just one horrible thing you will witness in the medical establishment. I don’t have all the answers, but I certainly know my limitations. There’s a clear line I will not cross. Some people can participate in that kind of stuff and go enjoy their lunch. Statistically speaking, 10% of the population are sociopaths and 2% are psychopaths, so I’m sure there’s an interpreter or two somewhere out there that can do the “yeaaaayyyy, an abortion!” assignment and eat a burrito when it is done. Some of us… you couldn’t ever pay us enough to even consider doing that job. I don’t have any answers to this “ethics” dilemma, but In the end, I‘d just recommend that you pray for guidance, follow your heart, and never compromise and participate in evil by lying to yourself saying that you won’t bring your work home. You might not want to, but it’s always going to come home with you. Nothing beats a guilt-free conscience and a good night sleep. Good luck.

  8. Jeanine Roybal says:

    As an interpreter, in any situation, you must be faithful to the message. Just as a telephone line doesn’t disconnect when something questionable pops up, neither does the interpreter. That’s the job! It’s not your thoughts. It’s not your words. The lens is theirs. Not the INTERPRETERS.

  9. A Del says:

    I worked as a medical interpreter in a major pediatric hospital. It was difficult, often traumatic, but always rewarding because I felt that I was helping someone in their hour of need. As far as the question posed here; the interpreter is a voice. The content of what is being interpreted is not ours, we’re simply conveying information. To insert your beliefs in this scenario is making the situation about yourself and this is not what you’re being paid to do. If you have such limitations, you have no business being a medical interpreter.

  10. Alfredo Babler says:

    Aren’t we, as “professionals,” past the point of circular reasoning? By this standard (it’s their words, not the interpreter’s, so anything goes), you could be the next accomplice to a ruthless physician found guilty of manslaughter and medical malpractice, or the interpreter between the High-Profile American Narcotics Buyer and the Mexican Cartel Boss, and it would be perfectly fine for you to have participated in either scenario because they are the ones doing something that is horribly wrong and you’re just a “professional.” Circular logic is kind of a lazy approach to intellectual reasoning and a disconnect from that “gut feeling” or spiritual guidance that gives us the free will to choose between right and wrong. Sorry for getting all preachy-like. I promise I am just trying to help, because there are certain things one just can’t undo. After all, we don’t want to be so complacent in our pride of being impartial observers hired to improve communication, no matter what the situation at hand, because we are “professionals,” and then end up like the world’s worst translator. That would be awful. Look at this example.

    PS. To the Blog moderator: Sorry, I just can’t help myself. LOL

  11. Having worked as a trauma nurse specialist in a trauma center before I became a medical interpreter my personal issue with this subject is this: if I as an ER nurse could pick and choose who I took care of depending on my “feelings” or past bad experiences, I would not last long as an ER nurse. I see interpreters as part of the health care team and therefore, if working in a hospital, one must be ready for anything that comes your way without prejudice. Many facilities have stress debrienfing teams to handle very difficult situations and help the employee. I train medical intepreters and a big part of my course is talking about what challengers there are working in the medical field, In my textbook, I have a chapter on how to work with a chaplain which was written by our chaplain. So I hope that my students feel very well prepared for what is out there with few surprises. Maybe we as trainers can concentrate more on these issues to better prepare the interpreters of the future.

  12. The questions begs understanding of all the factors involved aside from the legal regulatory directives. The law does not address nor regulates individual conscience.
    1. Where the communication of entire procedure goes past a single individual.
    2. Where that individual is there, singularly prompted by his/her conscience to facilitate all communication thus the procedure.
    3 . Where the in-depth understanding of the procedure for all parties, especially the pivot point for all communication, the interpreter
    4. It stands to reason that as all parties that are there for the procedure are of one agreement, it’s the pivot point: the interpreter whose conscience puts him in that very position, TO FACILITATE the procedure, MUST be in agreement with other aspects such as the morality of the procedure.
    5. The law in United States, so far, does not regulate nor squelches the morality of acts thus the individual continues to have complete expression of his/her conscience to dictate his agreement or lack of.
    6. The written law cannot be rationalized one way or the other, It’s a clear directive of expectations.

    Therefore, if the interpreter had not previous knowledge of the nature of the procedure, he/she is totally in the right to facilitate or recluse him/herself from the position where the violation of his/her conscience is unavoidable. .

  13. read the code of ehtics by the IMIA, may clarify some things, very specific about when you can recuse from an assigment:
    . Interpreters will refrain from accepting assignments beyond their professional skills, language fluency, or level of training.

    4. Interpreters will refrain from accepting an assignment when family or close personal relationships affect impartiality.
    Says nothing about personal feelings about emotional situations such as interpreting for a murderer, religious beliefs, prejudices, etc.

  14. Excellent point, Maria Schweitzer! The beginning of your career is when you want to ask yourself this question and be honest with yourself. You should know: Interpreters are needed wherever healthcare takes place. Interpreters are part of the healthcare team. Interpreter’s respect patient/provider autonomy, in order to do so, they remain impartial. You know what your personal values are, as you learn more about the healthcare interpreting profession you should also learn about where it takes place and how, so that you can decide if it’s a job you are willing to perform. Can you recuse yourself from assignments? The answer is yes. When should you? A previous post cited IMIA’s guidelines of when an interpreter should. But I think the question some interpreters struggle with is not “can I recuse myself?” The real question is, “Can I recuse myself if something personally bothers me so much that I feel I can’t do a good job because this thing makes me so uncomfortable that I don’t want to do it?” In that case I would say NO, barring extenuating circumstances, (will return to this).. Things like blood transfusions, abortion, elective surgeries, some life sustaining therapies, end of life options, etc. are things that cause strong opinions, they are also things that take place in healthcare.
    Ok, so speaking practically, here is an example: I really, really want to be an interpreter in healthcare, but I am not comfortable interpreting in assignments that involve abortion. Knowing my code of ethics and standards or practice, I know that this is not an acceptable reason for recusing myself, so I know I am limited to where I can complete assignments. I can seek work in hospitals/clinics where it is not practiced for example faith based organizations. If I’m a contractor, I can state this in my contract. Another example: I am an interpreter and I have never had trouble with being impartial, but a close family member just lost his battle with cancer I am at an assignment where a patient is receiving news about their prognosis related to a cancer diagnosis, I find that I am having trouble focusing and am emotionally impacted to the point where I can’t continue, I choose to recuse myself. To make this acceptable, I must inform someone so I don’t abandon patient and provider, I must then debrief with the correct person about the situation, I should employ my self-care plan, I should take any possible steps to not commit to assignments that involve similar situations.

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