How Ethics Consultants Can Support Medical Interpretation to Improve Decision-Making

Adele Dinicola, PhD – Bioethics Fellow, Center for Bioethics, Cleveland Clinic; Ryan Felder, PhD – Assistant Staff Bioethicist, Center for Bioethics, Cleveland Clinic; Jane Jankowski, DPS, MSW – Director, Center for Bioethics, Center for Bioethics, Cleveland Clinic; Jeffrey Pannekoek, PhD – Assistant Staff Bioethicist, Center for Bioethics, Cleveland Clinic

Abstract: When a patient’s language differs from that of their healthcare team, the parties may struggle to adequately share relevant clinical information and values. Interpreter services is standardly consulted to mitigate this challenge. However, variation in availability and use of interpreters puts patients and their surrogates/families at risk of missing critical medical information and of having their values and preferences misunderstood or left unstated. For example, the use of family members or friends as interpreters raises worries about the adequacy of information conveyed by the treating team, a concern compounded when patients or families also decline to work with interpreter services. Similarly, the use of translation technology by patients and families, such as cell phone applications, risks achieving mere replication, and potentially misses critical cultural connotations and norms of communication that would be understood by a skilled interpreter.

In this presentation, we argue that these ethical challenges remain unaddressed by current guidelines and policies regarding the use of medical interpreters. We then argue that ethics consultants can partner with care teams and medical interpreters to better promote informed consent and shared decision-making processes when patients or their surrogates do not speak the team’s language. We address how to help set interpreters’ expectations regarding ethical aspects of the conversation, how to navigate cultural or family preferences regarding care communication, how to respond to patient or family requests to decline to work with these services, and how to advocate for expanded access to in-person interpreters, especially for high-stakes decisions.

Keywords: interpreter services, ethics consultation