A National Code of Ethics For Interpreters in Health Care

2004 National Council on Interpreting in Health Care, Inc., All Rights Reserved.
The NCIHC National Code of Ethics is in the

public domain and may be reproduced as is in its current format under the copyright law of fair use. No changes may be made to the
document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact the
NCIHC.

The National Council on Interpreting in Health Care

A NATIONAL CODE OF ETHICS FOR
INTERPRETERS IN HEALTH CARE

The National Council on Interpreting in Health Care
http://www.ncihc.org
J uly 2004

A National Code of Ethics for Interpreters in Health Care J uly 2004 Page 2 of 25
2004 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Code of Ethics is in the
document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact
NCIHC.

Acknowledgements
This work would not have been possible without the vital input of interpreters and others who
dedicated their time and knowledge to further the health care interpreter profession. The
financial support given by the U.S. Department of Health and Human Services Office
of Minority Health, Guadalupe Pacheco, Program Officer, was essential in getting this project
started.

We would like to acknowledge Maria Paz Avery for her work as primary author of
"Understanding the National Code of Ethics for Interpreters in Health Care" working paper. We
would also like to take this opportunity to thank the members of the NCIHC Standards, Training
and Certification Committee: Karin Ruschke, M.A., Co-Chair; Shiva Bidar-Sielaff, M.A., Co-
Chair 2003-2005; Linda Haffner, Co-Chair 2001-2003, current committee member; Maria Paz
Avery, Ph.D.; Bruce Downing, Ph.D.; Carola Green. A special thank you to Susan Kocher for
meticulously collating the hundreds of survey responses we received and Patricia Ohmans for
her insightful recommendations on how to best analyze the data. Lastly, we are grateful to Esther
Diaz for her help in the final months of this project.

NCIHC Board
Wilma Alvarado Little, MA, Co-Chair of the Board
Maria Michalczyk, RN, MA, Co-Chair of the Board
Elaine Quinn, RN, MBA, CST, DSA, Treasurer
Lisa Morris, MSTD, Secretary
Cynthia E. Roat, MPH, Chair of the Advisory Committee
Karin Ruschke, MA, Co-chair of the Standards, Training and Certification Committee
Shiva Bidar Sielaff, MA, Co-chair of the Standards, Training and Certification Committee
Elizabeth Jacobs, MD, Co-chair of the Research and Policy Committee
Alice Chen, MD, Co-chair of the Research and Policy Committee
Joy Connell, Co-chair of the Organizational Development Committee
Esther Diaz, M Ed, Co-chair of the Organizational Development Committee
Julie Burns, M Ed, Co-chair of the Membership and Outreach Committee
Susy Martorell, MPH, Co-chair of the Membership and Outreach Committee

Disclaimer for the Code of Ethics:
The National Code of Ethics for Interpreters in Health Care, produced by the National Council on
Interpreting in Health Care (NCIHC), Inc., is the result of a systematic, deliberate, and reflective process.
The NCIHC is confident that this Code represents the principles that working interpreters believe are
important to ensure the ethical practice of their profession. These principles are the ones that working
interpreters throughout the US have said merit serious consideration when faced with a dilemma or
difficult choice and to which they agree to be held accountable. The NCIHC regrets any inadvertent result
which may arise from the application of this Code. The Code is designed as a guide for both interpreters
and the health care systems in which they work, and is not meant to supplant or expand policy or
regulations pertinent to the provision of competent interpreter services.

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Code of Ethics for Interpreters in Health Care

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.

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

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

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

The interpreter continuously strives to develop awareness of his/her own and other
(including biomedical) cultures encountered in the performance of their professional
duties.

The interpreter treats all parties with respect.

When the patients health, well-being, or dignity is at risk, the interpreter may be
justified in acting as an advocate. Advocacy is understood as an action taken on behalf
of an individual that goes beyond facilitating communication, with the intention of
supporting good health outcomes. Advocacy must only be undertaken after careful and
thoughtful analysis of the situation and if other less intrusive actions have not resolved
the problem.

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

The interpreter must at all times act in a professional and ethical manner.

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Understanding the National Code of Ethics for Interpreters
in Health Care

The role of interpreter is a tightrope balancing act: A code of ethics is a good guide for the bar carried on such a
walk on the tightrope. It offers balance, some security and especially is a comfortable way to face the unknown
risks faced on the interpreters path. Anonymous Respondent to Code of Ethics Survey

Introduction

As the profession of health care interpreting in the United States matures and evolves, the
importance of creating shared understandings of what is considered high quality and ethically
appropriate principles and practices in the field becomes imperative. To this end, the National
Council on Interpreting in Health Care identified three steps that needed to take place on a
national level in order to standardize the expectations that the health care industry and patients
should have of interpreters and to raise the quality of health care interpreting. The first step was
to create and build support for a single Code of Ethics that would guide the practice of
interpreters working in health care venues. The second step was to develop a nationally
accepted, unified set of Standards of Practice based on the Code of Ethics that would define
competent practice in the field. The third step was to create a national certification process that
would set a standard for qualification as a professional health care interpreter. (NCIHC, 2004)

The Standards, Training and Certification (STC) Committee of the National Council on
Interpreting in Health Care (NCIHC) took on the task of bringing the first step to fruition. The
goal of the STC Committee was to create a national code of ethics that would provide the
growing profession with a set of shared, essential guiding principles expressing what are
considered morally appropriate behaviors for its practitioners as they perform their day-to-day
duties.

To achieve this goal, the STC Committee engaged in a systematic process of reviewing existing
codes of ethics, creating a draft code, conducting national focus groups to review the draft, and
eliciting feedback through a national survey. The challenge was to design a code that built on
and solidified existing work at the same time that it expanded upon this work to ensure its
relevance to all health care interpreters, irrespective of the languages or particular venue in
which they were working.

The STC Committee started by identifying and collecting existing codes of ethics in health care
and other related areas such as legal and sign language interpreting. This process surfaced a
number of codes that were already in use at the local level by state and national associations of
interpreters, institutions of health care, interpreter service organizations, and court programs in
the United States and Canada. The STC Committee then focused on ten codes that were
considered most relevant to their work and compared them in order to identify the elements that
were held in common and to analyze how each approached those issues that were most difficult
and controversial in the field. Based on its analysis, the STC Committee drafted a code that
included the elements shared across these existing codes as well as a few that were controversial

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but relevant. This draft also included a short commentary after each principle that further
explained and illustrated that principle.
In the fall of 2002, the STC Committee presented the draft code to working interpreters across
the country for review and comment. Focus groups were organized in nine localities across the
United States. Attention was paid to the composition of these focus groups to include a broad
representation of language groups and modes of service delivery (e.g. face to face and telephone
interpreting). The focus groups confirmed the need for a unified national code of ethics and
affirmed its development as a positive step for the profession. The feedback from the focus
groups also concluded that the draft code was fundamentally complete and appropriate although
some principles were seen as more or less controversial.

Based on the focus group feedback, a second draft of the code of ethics, including the
commentaries, was developed, incorporating consistently recommended changes. This second
draft was then introduced to a larger cross-section of working interpreters through a survey that
was disseminated through the NCIHC website and state associations of health care interpreters.
Approximately 2500 surveys were distributed, with a return rate of 20%. The STC Committee
then analyzed the data from the 500 returned surveys.

In analyzing these data, it became apparent to the Committee that there was strong agreement on
the principles as stated in the draft. It was mostly the commentaries that generated controversy
in the form of disagreement with the explanations and unresolved questions about
implementation. Therefore, in creating the final draft of the code, the STC Committee decided to
highlight the consensus there was on the principles themselves by publishing the code as a set of
principles without commentary. The STC Committee agreed that further explanation of the
principles would be better left to a companion document that could offer a more thorough
discussion of the issues raised and to the development of standards-of-practice that would
address the practical questions of implementation.

Having considered all the feedback it had received, the STC Committee created a final draft of
the code. However, before officially approving the code, the final draft was also sent to a select
number of health care providers and medical ethicists for comment.

The National Code of Ethics for Interpreters in Health Care is the result of this systematic,
deliberate, and reflective process. The STC Committee is confident that this code represents the
principles that working interpreters believe are important to ensure the ethical practice of their
profession. These principles are the ones that working interpreters have said merit serious
consideration when faced with a dilemma or difficult choice and to which they agree to be held
accountable.

This document provides a guide to understanding the National Code of Ethics for Interpreters in
Health Care. It was apparent from the responses to the survey that not everyone in the field had
the same understanding of the concept of ethics, what a code of ethics represented, what this
code meant in the course of professional practice, and what the difference was between a code of
ethics and standards of practice. Therefore, this document places the code in the context of
ethical behavior in general and then discusses each principle in the context of specific issues and

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dilemmas often faced by health care interpreters. It provides an elaboration and discussion of
each principle and the interrelationships among them, acknowledging that controversies still
exist while offering the working interpreter a way to think about these controversies.

This document is organized around three major sections. The first section offers an explanation
of ethics and ethical behavior in general as well as in the context of the profession of health care
interpreting. The second section describes the core values on which this code of ethics is
grounded. Finally, the third section presents a commentary on each of the principles that makes
up the National Code of Ethics for Interpreters in Health Care.

What is Ethics?

Human beings are ethical animals.
(Simon Blackburn, 2001)

From the earliest times of human consciousness, human beings have been concerned with
defining rules of conduct or setting expectations for what is considered appropriate or the right
behavior with respect to oneself, others, and ones environment. As Blackburn (2001) explains,
it is not so much that we, as human beings, always end up behaving exceptionally well, but
rather that we constantly compare and evaluate our own and others behavior in order to find
what the shared accepted principles of right and wrong are that govern the social group around
us. These shared governing principles of right or wrong have become formalized in a number of
ways. For example, cultures embody them in their norms and customs, religions in their moral
precepts, governments in their laws, and professions in their codes of ethics.

The term ethic derives from the Greek word ethos, meaning moral custom.
An ethic, therefore, is a principle of right or good conduct (The American Heritage Dictionary
of the English Language). Consequently, ethical behavior is behavior that corresponds to the
accepted and idealized principles expressing what is considered right and wrong.

As professions mature and become established, they begin to create an ethical environment of
shared expectations and norms for acceptable and appropriate behavior in the enactment of its
duties and obligations. In the words of Blackburn (2001) an ethical environment provides

. . . the surrounding climate of ideas about how to live. It determines
what we find acceptable or unacceptable, admirable or contemptible.
It determines our conception of when things are going well and when
they are going badly. It determines our conceptions of what is due to
us, and what is due from us, as we relate to others. It shapes our
emotional responses, determining what is a cause of pride or shame,
or anger or gratitude, or what can be forgiven and what cannot. It
gives us our standards our standards of behavior (p. 1).

For a profession, this ethical environment is embodied in its professional code of ethics. A code
of ethics, therefore, provides a set of principles or values that govern the conduct of members of

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a profession while they are engaged in the enactment of that profession. It provides guidelines
for making judgments about what is acceptable and desirable behavior in a given context or in a
particular relationship. (NCIHC, 2002) It creates consistency and lessens arbitrariness in our
choices when confronted with difficult dilemmas (Gonzales, et al., 1991).

The National Code of Ethics for Interpreters in Health Care sets the ethical environment for the
practice of health care interpreters in the United States. By formalizing a set of principles for
appropriate behavior into a code, an emerging profession begins to move away from the
confusion of personal preferences and opinions about what is acceptable and what is not, to
statements of preference that are shared and that, as a result, become demands on each other.
These demands form a cohesive network of rules or norms that serve to sustain the integrity
of the profession and its purpose.

It is important to understand, however, that the principles contained in a code of ethics are
abstract conceptions. A code of ethics, no matter how thorough or concise, cannot and does not
provide definitive answers to all possible dilemmas or choices an interpreter may face. It is not a
how to recipe nor is it an answer book for the many unique and problematic situations an
interpreter may face in the real world. In fact, codes of ethics inevitably contain within them the
seeds of conflict in the same way that our personal values in certain circumstances may conflict
with each other. How often, for example, do we find ourselves weighing the importance of two
values we hold dear in specific circumstances in our lives?

Why then have a code of ethics if it cannot provide definitive answers? To answer this question
we need to go back to the purpose of a code of ethics cited earlier, that is, to provide guidance
when making judgments about the right actions to take when faced with a difficult choice. Notice
that the purpose of a code of ethics is to assist in making judgments, that is, to assist in
evaluating the choices one has in a particular situation one is facing and then making a choice
based on a consideration of the appropriateness of each action.

But who decides what the principles that provide this guidance should be? Can any one person
or group arbitrarily make up the rules about right and wrong? Or can there be universal or
transcultural rules that are generally accepted by different peoples and that can stand the test of
time?

The challenge to create transcultural ethical principles is particularly salient in the field of health
care interpreting. This is a profession that, by its very nature, is made up of individuals who
represent a wide variety of cultural systems. Many have affiliations with other professions that
may have their own code of ethics. All bring to the job their own set of personal values and
beliefs that have been crafted out of their unique life experiences and circumstances. In addition,
they are faced with patients and providers who, themselves, bring into the health care encounter
a variety of ethical systems and expectations.

How, then, can a single code of ethics encompass all these ethical systems? Does it need to? Is
it possible to arrive at a transcultural set of principles that define what is appropriate and what

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is out of line for a given group of people, engaged in the same profession, at a given point in time
and place?

It is such a set of transcultural principles that the STC Committee set out to define as it listened
to what health care interpreters and those who work with them had to say about what was
important in how they performed their work. Through its discussions and review of the focus
group and survey information, the STC Committee sought to go beyond personal beliefs and
subjective opinions and, instead, distill those principles that were central to the role of health
care interpreter, principles that had to be taken seriously by all members of the profession if the
integrity of their core duty as health care interpreters was to be maintained, that is, their duty to
make possible the communication between two parties, the patient and the 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.

This core duty places the health care interpreter in a unique position. Unlike practitioners of
many other professions in which the performance of the duties are, at least to some extent,
transparent to the recipient of the services, health care interpreters are often the only ones present
in the encounter between the patient and the provider who are fully aware of what is going on.
For the most part, the interpreter is the only one who understands what each of the parties is
saying to the other. This places the health care interpreter in a tremendous position of power.
Both the patient and the provider have to be able to trust that the interpreter will not abuse this
power. They need to trust that the interpreter will transmit faithfully what it is they have to say
to each other (MMIA and EDC, 1996) without the interference of the interpreters own beliefs,
values, or opinions in the converted messages. They need to trust that the commitment to
confidentiality on which the provider-patient relationship is based will be maintained.

Therefore, It is the function of a code of ethics to guide the interpreter on how to wield that
power (Edwards, 1988, p.22). By adhering to the profession' s code of ethics, patients and
providers are reassured that the health care interpreter is someone who can be trusted to keep the
interests of the patient and the goals of the health care encounter in the forefront.

The Core Values of the Code of Ethics for Health Care Interpreters

The National Code of Ethics for Health Care Interpreters is grounded on three core values:
beneficence, fidelity
1
and respect for the importance of culture. These core values form an
overarching set of ideals that infuse the work of the health care interpreter and embody what
interpreters care about in their relationships with the patient and the provider.

1. Beneficence
A central value of the health care interpreting profession is the health and well-being of
the patient. This is a core value that is shared with other health care professions. It
means that the members of these professions have as their essential obligation and duty to

1
We would like to acknowledge Marjorie Clay, Ph.D., ethicist at University of Massachusetts Memorial Medical Center, who called to our
attention the core values of beneficence and fidelity in relation to the work of the health care interpreter.

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support the health and well-being of the patient and her/his family system of supports
(e.g., family and community) and to do no harm.

2. Fidelity
The essence of the interpreter role is encapsulated in the value of fidelity. The American
Heritage Dictionary of the English Language describes fidelity as involving the
unfailing fulfillment of ones duties and obligations and the keeping of ones word or
vows. In a related nonpersonal sense, it refers to faithfulness to an original . . . This
description accurately describes the quality of the interpreter's work and the attitude with
which interpreters should approach their work. In adhering to the essential function of
their role, interpreters make what amounts to a 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.

3. Respect for the importance of culture and cultural differences
Culture frames the way we interpret the world, our experiences in it, and our relationship
to ourselves and others. In the area of health, culture influences the meaning given to
symptoms, the diagnosis of those symptoms, the expectations regarding the course of the
related disease or illness, the desirability and efficacy of treatments or remedies, and the
prognosis. Language and culture are closely intertwined. Linguists such as Sapir (1956)
and Whorf (1978) have pointed out how language serves as an expression of the ways
that a culture organizes reality.

Health care interpreters have a twofold task in upholding their respect for the influence of
culture and cultural differences as they perform their essential duty of converting
messages from one language into another.

First, the interpreter . . . has the task not only of knowing the words that are being used
but of understanding the underlying, culturally based propositions that give them
meaning in the context in which they are spoken. (MMIA and EDC, 1996) Without
understanding that the cultural frame of reference of the speaker is an integral part of the
meaning system of that speaker, an interpreter may focus only on the surface meaning of
words and miss the essential message that the speaker is trying to convey. Second, the
interpreter has the task of always being aware that cultural differences in perspectives and
alternative views of the world can lead to critical misunderstandings and
miscommunication.

This value is one that should be shared with other health care providers. Currently, there
are more and more initiatives in health care facilities and educational programs for health
care professionals that include cultural competence as an essential skill. However, until
such time as all health care professionals are fully prepared to address cultural differences
in their practice, it falls upon the health care interpreter to be cognizant of and able to
alert both the patient and the provider to the impact of culture in the health care
encounter.

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Commentary on the Principles in the National
Code of Ethics for Interpreters in Health Care

In this section, a commentary on each of the principles in the National Code of Ethics for
Interpreters in Health Care will be provided. The commentary describes the intent of the
principle and offers a discussion of some of the major dilemmas that may arise in day-to-day
practice. The reader will note, however, that the commentaries do not offer answers to all
possible dilemmas. Instead, it offers a way of thinking about what would be important in making
ethical choices in difficult situations.

1. 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.

The primary intent of the principle of confidentiality is to honor the privacy of the patient and the
very personal nature of the health care encounter. It puts interpreters under the obligation not to
disclose information that has been learned during the performance of their duties to anyone
outside the medical team responsible for the care of the patient. It is an ethical principle that is
shared with other health care professions.

Matters of health and illness are intimate matters to the individual. As such, these are not
matters that a patient wants to have made known indiscriminately. Decisions as to when, where,
and to whom such intimate information is disclosed need to be left to the discretion of the
patient. In order for the patient to be forthcoming with the information that the provider needs
for the purpose of supporting or restoring their well-being, the patient has to trust that the health
care system (including the interpreter) will not indiscriminately share such information with
parties not associated with their care unless explicit permission has been given to do so.

The question of who comprises the treating team, however, is not as clear cut as it may seem
and may at times pose a dilemma for interpreters who may follow the same patient across
appointments and different providers or even across health care facilities as in the case of
freelance or contract interpreters. In the context of this principle, the treating team refers to all
those within a particular health care facility who have primary responsibility for the care and
treatment of a particular patient. Thus, when a patient is being followed within the same health
care facility by different providers, they are all considered part of the treating team and privy to
the information obtained about the patient. However, when the patient moves to a different
health care facility, there is now a new treating team. For legal and liability reasons, this new
treating team cannot access patient information held by the previous health care facility without
the express written permission of the patient. Interpreters who follow a patient to this other
health care facility are bound by the same need to obtain explicit permission from the patient
before disclosing any information.

A rule of thumb when it comes to issues of confidentiality would be to rely on the core value of
beneficence to determine who should know. In other words, might the patients life be
endangered if the provider of the moment is not given access to information that the interpreter

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already has? If the answer to this question is yes, then the first course of action that
interpreters should take is to encourage the patient to share this information directly with the
provider. Only if this is not possible or the patient refuses to do so should interpreters consider
disclosing the information themselves. There is a fine line, however, between respecting the
autonomy of the patient and ensuring that the provider has the necessary information to treat the
patient without harming them. Interpreters have an ethical obligation to deal with this fine line
and make a conscious choice that supports the well-being of the patient.

Given that staff interpreters are employed by the health care institution, they have more
flexibility when they feel it is necessary to disclose confidential information within their
institution. However, the amount of flexibility they have also depends on their role within the
health care institution.
Information sharing with family members

In many cultures, family members are considered an extension of the individual. In such cases,
it is often said that confidentiality within the family is a non-issue. The apparent presence of
such a cultural norm does not, however, allow the interpreter (or for that matter, any health care
provider) to unilaterally make the decision to share information with family members.
Knowledge about a particular cultural norm does not translate directly into knowledge about a
particular person or family system. Whether or not a particular individual or family system
adheres to certain norms is something that needs to be confirmed. But more importantly, the
decision to share information and with whom to share it is still always the prerogative of the
patient, and information sharing by any other party should first be discussed with the patient.

There are times, however, when the expectations regarding information sharing within the family
system are not clear. If the interpreter notices that this lack of clarity is causing communication
problems between the provider and the patient system, then the interpreter, acting within the
parameters of their role, may raise the issue with the patient and/or provider. But again, the final
decision regarding the sharing of information should rest with the patient and be negotiated with
the provider not with the interpreter.

In other cases, the family may request that information be withheld from the patient, thereby
circumventing the patients right to know. Some patients may, in fact, wish this to be the case,
either for personal reasons or because of cultural beliefs. Again, how, with whom, when, and
what information is shared should be negotiated with the patient. It is not the prerogative of the
interpreter or even of the provider to make this decision alone unless it is very clear that the
patient is unable to participate in their own health care. 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.

Confidentiality and the value of beneficence

There are circumstances when an interpreter may seriously have to weigh the seriousness and
importance of the principle of confidentiality against other values and principles. Such a
circumstance, as has already been mentioned, occurs when the value of beneficence the well-

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being of the patient and/or others comes into play. Situations in which there is a serious
possibility that withholding information will result in harm to the patient or to others can be an
exemption to the principle of confidentiality.

Two types of situation tend to arise for interpreters. One occurs when the interpreter has
information about a patient from a previous clinical encounter. For example, the interpreter may
know that the patient is allergic to a particular medication but the current attending provider is
unaware of this and is about to prescribe or administer the medication. Is it a breach of
confidentiality for the interpreter to intervene in this case?

Another situation occurs when the patient says something to the interpreter with the implicit or
explicit expectation that this will not be shared with the provider who may or may not be present.
Many interpreters have shared stories of sitting in the waiting room with the patient prior to
seeing the provider and having the patient share information that has serious consequences or
implications related to the health and well-being of the patient. At times, this information is
shared in passing and patients are unaware of the importance of what they have said. At other
times, patients may explicitly say to the interpreter that this information is shared in
confidence and that they do not want it conveyed to the provider. Such confidences have even
been reported as occurring while in the clinical encounter with the provider present. Examples
of the type of information that is shared ranges from statements of abuse, lack of compliance
with treatment regimens, or the presence of medical conditions or symptoms in the patient or
others around them. What is the interpreter to do in these situations?

First of all, interpreters have an ethical obligation to maintain transparency. The role of the
health care interpreter is still not widely understood by patients and providers alike. Therefore,
interpreters should be very clear, especially with patients, that their role is to interpret everything
that is said while in the presence of the provider. If there is anything that the patient does not
want to have known, then they should not say it. Secondly, interpreters should recognize that
their commitment to confidentially refers primarily to maintaining the privacy of the patient in
relation to those outside the treating team. This means that when the patient shares information
with an interpreter that is pertinent to his or her health care, the interpreter may have an ethical
obligation to make this known to an appropriate provider if there is danger that harm could come
to the patient or to others. In all cases, however, the first obligation of the interpreter is to
encourage patients to disclose the information themselves.

Information related to abuse, whether it is child abuse or elder abuse, as well as information
about direct threats of harm to the self or to others constitutes special cases under the principle of
confidentiality. Many states mandate the disclosure of information by designated persons such
as health care providers when the abuse of a person is at stake or when a person is threatening
harm to him- or herself or others. While there are no current national legal requirements
mandating reporting by interpreters in cases of abuse or potential harm, individual states may
have their own legal requirements for such disclosure. It is therefore, important for interpreters
to know who the mandated reporters are in their state. Beyond that, interpreters should follow
the same guidelines for disclosure of information as discussed above.

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In addition, in those cases, where the interpreter makes the ethical choice to disclose information
regarding abuse or potential harm, they also have the added responsibility to let those to whom
they report such information know when the signs of abuse or indicators of potential harm could
be confounded by cultural factors so that the proper investigation can be made in a way that
respects cultural differences. Not to do so could jeopardize the well-being of the patient who
may not be aware of the way their cultural practices could be misinterpreted.

The responsibilities of the interpreter when disclosure is necessary

The decision to disclose information should not be taken lightly. Such a decision should be
taken only after every effort has been made to persuade the party from whom the information
originates to make the disclosure themselves, explaining what information needs to be shared,
with whom it needs to be shared, and why it needs to be shared. If, for whatever reasons, the
patient refuses to do so and the interpreter then makes the ethical choice to disclose, it must be
done in a responsible and respectful manner.

If interpreters are unsure of the course of action to be taken and if there is time, they should
consult with their supervisor, the director of the interpreter service office or agency, or the ethics
division of the health care organization. When there is no time for consultation, interpreters may
have to make a decision based on their judgment as to what would be in the health care interest
of the patient but should later discuss the situation at a supervisory session or a professional
seminar. Such sharing of information for professional development purposes is not considered a
violation of the principle of confidentiality. In these situations, however, the interpreter has an
obligation to preserve the anonymity and, therefore, the privacy of the players by removing all
information that could identify who the parties are.

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

The intent of this ethical principle is to ensure that the interpreted encounter between the patient
and the provider approximates, as much as possible, what would be happening if the patient and
the provider spoke the same language and shared an essentially similar cultural frame of
reference. The ethical responsibility of the interpreter, therefore, is to convert messages rendered
in one language into another without losing the essence of the meaning that is being conveyed
and including all aspects of the message without making judgments as to what is relevant,
important, or acceptable.

In the case of direct communication between a patient and a provider, messages and the
meanings conveyed are not censored except by the parties themselves. It is, therefore, necessary
that the interpreter convey everything that is said by either party in its entirety and in the manner
in which the message is delivered, that is, without omitting from, adding to, or distorting the
message. In addition, when possible, interpreters should convey the meaning of those gestures,
body language, and tone of voice that add significantly to the content of the message, especially
when these might not be noted or might be misunderstood by the other party.

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The principle of fidelity requires that interpreters have the ability to detach themselves from the
content of the message. This is not always easy especially when the substance is difficult,
graphic, emotionally laden, or of a nature that elicits in the interpreter feelings of discomfort and
even pain. But in no instance should interpreters decide to omit or distort messages because
these are personally offensive to them or because they are uncomfortable with the language or
content of the message. If they are unable to enact their role in accordance with this ethical
principle, then interpreters should make this known to the parties and withdraw from the
assignment.

The language patients use to convey why they are consulting with the provider, to describe the
events (occurrences and symptoms) that led to the consultation, to communicate wishes and
desires for the future is a key source of data that providers use to arrive at an accurate and
mutually acceptable diagnosis and course of treatment (Woloshin, et. al., 1995). Interpreters are
there to make these data accessible to the provider by transforming the data transmitted in one
language into a format that the provider can understand. Providers use the interpreters
representation of what has been said as a diagnostic tool. Given this, interpreters need to be
mindful that any piece of information may be an important data source. To omit or distort any of
the information could, therefore, result in serious clinical consequences.
In the same way, the language the provider uses is a source of data for the patient. Through
language, providers convey their understanding of the patients concerns, negotiates an
appropriate diagnosis, and offers possible remedies and treatments. Through language, the
provider also builds a relationship with the patient, a relationship that can dramatically affect the
outcomes of the encounter. The patient, therefore, should be able to access both the technical
information and the information about the kind of relationship the provider is attempting to
establish in order to make decisions that will impact his or her health and well-being. The
patient can have full access to these data only if the interpreter faithfully transmits all messages
from the provider.

In both cases, the interpreter provides the essential channel for communication and as such has
the obligation to support the communication by rendering the content and spirit of the original
message as faithfully as possible.

Faithfulness of the message within its cultural context

So far, we have laid out the importance of ensuring that the content and spirit of the original
message is faithfully rendered in the other language. Why is there an additional qualifier to this
that states taking into consideration its cultural context? How does culture affect the
faithfulness of the rendering?

Many linguists, but most notably Sapir (1956) and Whorf (1978), have pointed out the
interrelationships between language and culture. According to them, a language is in many ways
an expression of culture and the way in which a culture organizes reality. Cultural experiences
infuse words with meaning. The interpreter, therefore has to understand not only the words that
are being used but also the underlying, culturally-based propositions that give them meaning in
the context in which they are spoken.

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One of the challenges interpreters often face is the appearance of untranslatable words, that is,
words that refer to experiences and concepts that have no comparable referent in the other
culture (Seleskovitch, 1978). In these instances, it is not enough for the interpreter to come up
with what appears to be an equivalent word or expression, because what is key to developing
communication or shared understanding is the conveyance of what the totality of that experience
or concept means in that culture to that individual.

Does this mean that interpreters have to know and convey every single cultural nuance contained
in every single utterance? Obviously not. But, what interpreters do have to know is that culture
affects meaning and if meaning is not shared miscommunication and misunderstanding occurs.
In the interest of faithfulness to the message, therefore, interpreters have an obligation to alert the
parties to the possibility of cultural barriers to communication and to assist the parties in
uncovering the hidden assumptions or unstated propositions in the message in order to arrive at a
mutual understanding of the meaning.

Faithfulness of the converted message and offensive content

A question that is often raised by interpreters with respect to accuracy and completeness is
whether the interpreter should immediately and fully convey discriminatory, prejudicial, or
derogatory remarks made by either party. Interpreters often find such remarks personally
offensive and some may be unwilling to utter them even when they are not speaking in their own
voice. This, however, is not an adequate or appropriate reason for interpreters to omit such
messages or to clean them up and make them nice.
Interpreters need to remember that everything that is said is a potential source of data. Offensive
language use by a patient may sometimes be part of their condition. If the interpreter omits such
language, the provider is losing a valuable piece of data that could lead to the appropriate
diagnosis.

There are occasions, however, when remarks are made that could inadvertently be perceived as
offensive by the other party and unwittingly affect the patient-provider relationship in a negative
way. In such cases, interpreters might consider choosing to speak in their own voice, alerting the
speaker to the possible negative effects of the remarks, remind the speaker that the interpreter is
obligated to convey everything that is said, and then allow the speaker to reframe or rephrase
their remarks if they wish to. For the most part, however, it is important for both the patient and
the provider to get the full sense of who each other is a sense that often comes through by the
manner in which parties speak to each other

Faithfulness to the message and interpreter errors

Health care interpreters work under stressful conditions. For this reason, even the most qualified
and competent interpreter will sometimes make an error in converting a message from one
language into another. What is the interpreters ethical obligation with respect to this?

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First of all, interpreters have the ethical obligation to monitor their own interpreting
performance. As has already been mentioned, an interpreter is in the unique position, in most
cases, of being the only person in the encounter who understands both languages. Therefore,
interpreters have a heightened responsibility to keep watch over their own performance and to
catch any inadvertent errors they may make. When they do, and the error is of a substantive
nature, it is then their ethical obligation to admit their error and correct it, not only in the interest
of faithfulness to the original message but especially in the interest of the well-being of the
patient.

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

The intent of this ethical principle is to ensure that the communication and relationship between
the patient and the provider remain at the center of the health care encounter.

What, then, does it mean for interpreters to act impartially? The dictionary offers the following
synonyms for impartial fair, equitable, unprejudiced, unbiased, objective. To be impartial,
therefore, is to act with an absence of favor or prejudice in making a judgment, free from favor
for any or either side. Impartiality applies primarily to the content of the messages that are being
conveyed by the parties in the health care encounter. In effect, it means that interpreters do not
judge the content of the messages in order to make decisions about what should be transmitted or
not, or how it should be transmitted. It also means that interpreters do not judge any of the
parties in the encounter. It means that interpreters respect the autonomy of each party in the
encounter and their right to speak for themselves in the manner they wish to. It means that
interpreters respect the right of the parties to make decisions for themselves; therefore,
interpreters should not take sides or attempt to persuade either party.

Interpreters in the health care encounter understand that they are not there as primary participants
in the interaction and, therefore, are not in a position to make decisions, to advise or counsel, or
to speak for the other participants. This means that interpreters have an obligation not to let their
personal biases and beliefs intrude into the patient-provider encounter either through direct
counseling or advice to either party or by injecting their biases and beliefs as if they belonged to
one of the speakers. When they do speak for themselves, they are fully aware that their function
in the encounter is that of a communication facilitator and as such their responsibility is to the
process of communication and the facilitation of a mutual understanding of meaning. Therefore,
it is not within the interpreters set of duties to give advice or to counsel either party with respect
to the goals of the health care encounter.

This is a principle that is misunderstood and misinterpreted by many to mean that interpreters
should be disinterested in or uncaring with regard to the patient. To the contrary, as was
discussed earlier, one of the overarching values of the health care interpreters code of ethics, a
value that is shared with other health care professionals, is the well-being and welfare of the
patient. In upholding this value, interpreters fully recognize and accept the humanity and the
human needs of the parties in the encounter. Responding with empathy to a patient who may
need comfort and reassurance is simply the response of a caring, human being.

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

The intent of this principle is twofold: 1) to provide transparency in the service that is being
provided, and 2) to avoid potential conflicts of interest.

Transparency

To maintain professional boundaries means that interpreters fulfill only the duties of a health
care interpreter while engaged in the performance of that role and do not assume any duties that
are outside that role. Therefore, interpreters, while in an encounter in which they have been
engaged to provide interpreting services, should not assume duties that pertain to other roles
whether they are qualified in those roles or not, unless there is an explicit understanding by all
parties that the interpreter will do so. This principle is especially important for those interpreters
who are cross-trained in other health care professions such as nursing. Individuals who are
trained in such dual roles have to be very transparent about which role they are engaging in at
any particular moment. If there is a need to take on their other roles or responsibilities for the
well-being of the patient, they should be transparent by letting the relevant parties know when
the shift occurs.

To work within the professional boundaries of the interpreter role also means that interpreters are
aware of the limitations of their duties as well as the limitations of their abilities as a health care
interpreter. Again, the element of transparency is key. There are times, for example, when an
interpreter may not have the desired qualifications for the particular setting in which they have
been called to interpret (e.g., a mental health interview) but is the only interpreter available. In
most cases where interpreters do not have the desired qualifications, the ethical obligation is to
withdraw. Where withdrawal from the assignment is not a practical option, interpreters may
continue but only after having made known to all parties concerned what their capabilities are
and, at the same time, committing to doing the best job they can.

Personal involvement and conflicts of interest

This principle also admonishes interpreters to refrain from becoming personally involved with
the people for whom they interpret. The status of a patient, especially when it is compounded by
the inability to speak the language of the provider or know how to negotiate the health care
system, places a person in a very vulnerable position. Interpreters should not exploit this
vulnerability to their advantage.

Personal relationships also carry different types of expectations and demands that could interfere
with the performance of the role of interpreter. Avoiding personal involvements minimizes the
risk of creating conflicts of interest between competing expectations and demands.

This does not mean that interpreters cannot be friendly and caring or that interpreters are
prevented from establishing rapport with both patient and provider, as can occur during a formal

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or informal pre-session. The development of rapport with patients and providers during a pre-
session is a part of the interpreters professional role and does not necessarily represent personal
involvement. Establishing rapport means that the interpreter interacts with the patient in a
respectful, culturally appropriate, and courteous manner, not only within the interpreted
encounter but also on other occasions. In fact, good rapport between the interpreter and the
patient can contribute to the development of a therapeutic relationship between the patient and
the provider. If the patient feels comfortable with the interpreter, it is likely that the patient will
transfer this feeling to the provider.
The question of maintaining professional boundaries that precludes personal involvement with
the patient can sometimes pose dilemmas for interpreters who come from the same small or
closely-knit cultural-linguistic community as the patient. In such communities, it is inevitable
that the interpreter will have some level of personal involvement with the patient outside the
world of the health care system. The responsibility of interpreters in these cases is to ensure that
any such personal relationships do not interfere with the ethical performance of their duties both
within the clinical encounter as well as outside the clinical encounter. For example, interpreters
are bound by the principle of confidentiality not to discuss what they may have learned about the
patient while in the clinical encounter with members in the community or even with family
members unless given explicit permission to do so by the patient. For interpreters who are part
of the social fabric of the community for whom they interpret, there is often a fine line between
information gathered only while in the performance of their interpreter duties and information
that might have been learned outside the encounter. Dealing with this fine line is not an easy
task, but the interpreter's ethical obligation is to make appropriate decisions in order to maintain
the privacy of the patient.

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5. The interpreter continually strives to develop awareness of her/his own and other
(including biomedical) cultures encountered in the performance of their professional
duties.

The intent of this principle is to acknowledge that culture is a central factor in the health care
encounter and is integral to the creation of meaning.

First and foremost, interpreters have to work at understanding the cultural basis of the way they
themselves make sense of the world. How we see the world influences the meaning we give to
experiences what we understand and what we remember. By developing awareness of their
own culturally based understandings and biases, interpreters are better able to focus on the
meaning of the messages expressed by others and refrain from unwittingly interjecting their own
perspectives or biases. This ethical principle actually assists interpreters in fulfilling their
obligations under another ethical principle, that of impartiality.

Secondarily, this principle also acknowledges that there are many cultures that interpreters may
encounter in the course of performing their duties. Does this mean that interpreters have to know
everything about the patients culture? Or the providers culture? Or the culture of
biomedicine? Obviously, this is impossible. No single interpreter, or provider for that matter, is
expected to know the particular cultural beliefs and values that may apply in any given situation.
Culture is an abstraction that is mediated in each individual by their unique circumstances and
experiences, such as their personality; family values and beliefs; class, gender, education and
other personal characteristics; and level of acculturation into another culture. Culture, therefore,
is manifested in each individual in a different way.

The ethical obligation of interpreters is to possess enough understanding of culture and cultural
practices and beliefs to be able to facilitate communication across cultural differences, seeking to
minimize, and, if possible, avoid, potential misunderstanding and miscommunication based on
cultural assumptions and/or stereotyping. Under certain conditions, such as clashing cultural
beliefs or practices, a lack of linguistic equivalency, or the inability of parties to articulate the
differences in their own words, the interpreter should assist (with the explicit consent of all
parties to this intervention) by sharing cultural information or helping develop an explanation
that can be understood by all.

Having background knowledge of the major cultural systems operating in the clinical encounter
provides interpreters with two central skills: 1) they are able to comprehend more fully the
meaning in the message of the speakers, and 2) they are able to generate hypotheses about how
cultural factors may be affecting a lack of communication between the two parties and assist the
parties in negotiating shared meaning.

Whose responsibility is it to be culturally competent?

With the tremendous increase in the number of patients from a variety of cultural and linguistic
backgrounds arriving in the health care system, health care professions and institutions have

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begun to implement policies, structures, and expectations for cultural competence. Given this,
some health care interpreters question why they have an obligation to be culturally competent.

The answer to this question is simple: cultural competence is a value and an ethical principle that
should be shared by all members of the medical team, including the interpreter. The reality,
however, is that in most instances, interpreters will still be the member of the team most likely to
have the knowledge and understanding of cultural factors that impinge on the process of
communication and the creation of meaning. Therefore, in keeping with the principle of fidelity
to the original message and in keeping with the goal of the clinical encounter the well-being of
the patient the interpreter has the obligation to develop their understanding of the cultures of
relevant others in the encounter and to bring this knowledge into their practice.

6. The interpreter treats all parties with respect.

The intent of this principle is to remind interpreters that they have an obligation to treat everyone
in the encounter with dignity and courtesy, respecting the rights and duties of each individual,
including their own.

An essential implication of this principle is that the interpreter respects the autonomy and
expertise that each party brings to the encounter. Patients have the right to decide what is best
for them after having received appropriate and relevant information. Providers have the duty to
present their knowledge clearly and objectively so that the patient is able to make informed
choices. Interpreters have the duty to convey all messages faithfully and completely. By
respecting the rights and duties of each party in the encounter and treating all parties equally and
with dignity, interpreters can help build mutual respect within the interpreted encounter.

7. When the patients health, well-being, or dignity is at risk, the interpreter may be justified
in acting as an advocate. Advocacy is understood as an action taken on behalf of an
individual that goes beyond facilitating communication, with the intention of supporting
good health outcomes. Advocacy must be undertaken only after careful and thoughtful
analysis of the situation and if other less intrusive actions have not resolved the problem.

Interpreters cannot help but be a witness
2
to what they have seen or experienced in the health
care encountergood or bad, right or wrong. Unfortunately, in the course of their practice,
interpreters will sometimes see injustices or ethically inappropriate behavior that may jeopardize
one or more persons in the encounter or that may negatively impact different groups within the
health care institution. In such cases, interpreters may find it ethically necessary to take an
advocacy role, that is, to speak out in their own voice in order to plead a cause or attempt to
right a wrong.

The idea of advocacy in relation to health care interpreting has been and continues to be a
controversial one. In the first draft of the code, the STC Committee had not included a principle

2
My thanks to Margarita Battle, former director of interpreter services at Massachusetts General Hospital for the introduction of the concept of
witness early on in the emergence of this profession to bring attention to the fact that interpreters often see and experience things that cannot
and should not be ignored.

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that addressed advocacy. Feedback from the focus groups, however, clearly indicated that
working interpreters were asking for guidance on advocacy. Many felt that they were being
asked to take on this role inappropriately while others felt constricted from doing certain things
because it would be considered advocacy.

A large part of the controversy, however, comes from the confusion that exists about the
meaning of advocacy and what its implications are in practice. On the surface, advocacy appears
to be a contradiction of the ethical principle of impartiality the obligation not to judge, take
sides, or express personal opinions and biases with respect to the content of the communication
in the clinical encounter. But these proscribed actions are clearly not examples of advocacy.
The act of advocacy should derive from clear and/or consistent observations that something is
not right and that action needs to be taken to right the wrong. On a deep level, advocacy goes to
the heart of ethical behavior for all those involved in health care to uphold the health and well-
being (social, emotional and physical) of patients and ensure that no harm is done.

Interpreters are seen in different ways by the parties. On the one hand, they are often said to be a
potentially intrusive presence, inhibiting the close, private relationship between patient and
provider. On the other hand, their presence is forgotten or considered inconsequential. In this
latter situation, a party may say or do things that go beyond the bounds of respectful
interpersonal interactions or ethical practice. When what the interpreter sees or experiences has
a significant likelihood of serious negative consequences for a patient or patients, or, for that
matter, for others in the system, and every effort to resolve the matter judiciously with the parties
involved has been unsuccessfully tried, interpreters have the ethical obligation like any other
professional in the same situation to take action and advocate on behalf of the wronged
individual or individuals. Essentially, they have an obligation to bear witness, that is, to bring
forth evidence of the wrongdoing to the appropriate parties in order to redress the wrong that has
been done.

Assuming an advocacy stance, however, should never be taken lightly. Interpreters should
undertake this action only after careful and thoughtful analysis of the situation. In coming to this
decision to advocate or not they may want to seek the advice of supervisors and colleagues in
the field, remembering, however, to preserve the anonymity of the parties involved when seeking
such advice. In some cases, they may want to consult an ethicist. In every case, they need to
find out what the appropriate mechanisms and protocols are for such action in the institution in
which they are interpreting and follow them. In every case, interpreters should conduct
themselves in ways that respect the privacy and rights of the parties involved.

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

The intent of this principle is to ensure that interpreters continue to develop their understanding
of the content and context in which they interpret and continue to sharpen their skills.

The ability to interpret accurately and completely is, to a large extent, dependent on how much
background knowledge the interpreter has of the content and the context of the communication
(Seleskovitch, 1978). In the field of health care interpreting, the areas of knowledge that are

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most salient include the medical context (e.g., the basic parts and functioning of the body and
common disease syndromes and their respective treatments) and the socio-cultural context of the
patient populations for whom the interpreter interprets (e.g., beliefs about wellness and illness,
folk illnesses and remedies, and the impact of assimilation and acculturation on the presentation
of illnesses). This does not mean that interpreters are expected to have the depth and breadth of
knowledge that health care professionals or anthropologist have in their respective fields.
However, the more background knowledge the interpreter has, the more likely it is that the
meaning of the messages will be fully understood and therefore, the more likely it is that the
conversion will be faithful to the original message.

Interpreters are also responsible for continuing to improve and enhance language skills and their
skills of interpretation. With respect to language skills, interpreters should strive to continually
improve their proficiency in both languages, including the use of appropriate syntax, fluidity of
expression, level of comprehensibility, and clarity of pronunciation. Because languages are
constantly changing, part of interpreter's responsibility is to keep up with new developments and
with varieties of each language with which they may be less familiar. With respect to the skills
of interpretation, interpreters should work to strengthen their ability to convert messages in either
direction accurately but also quickly and fluidly. Other skills of interpretation include improving
their ability to hold longer and denser chunks of meaning before having to interpret or using
mnemonic devices to assist their memory.

Professions are dynamic systems and adapt to changes in their environment. New knowledge is
created, different methodologies discovered, and new technologies created.
The ethical obligation to further their knowledge and skills resides in the individual interpreter,
not in their employers. There are many opportunities available to interpreters to continue their
professional development belonging to a professional organization, reading the current
literature, making good use of on-the-job training and supervision, and participating in
workshops and conferences to name a few.

9. The interpreter must at all times act in a professional and ethical manner.

The intent of this principle is to ensure that interpreters always strive to act in a manner that
maintains the integrity of their work and upholds the values and ethical principles of their
profession. This means that they perform their duties competently; monitor their own
performance and behavior, including knowing when to withdraw and when to admit and correct
an error; conduct themselves with dignity; respect other professionals at the same time that they
expect respect for their profession; and do not discriminate against anyone in the provision of
their services whether based on personal characteristics such as race, class, sexual orientation, or
ability to reward them for their services.

To behave ethically means that interpreters do not use the knowledge they gain about individuals
while in the enactment of their duties for their personal advantage. They do not withhold their
services in order to receive favors from the parties. They do not exploit the vulnerability of the
patient who depends on them in order to be able to receive the services they need for their well-
being.

NCIHC.

Professionalism and gifts from patients
3

What does this principle mean with respect to gifts from patients? Patients often bring gifts as an
expression of appreciation and gratitude for the services they have received. Such behavior is
also often a reflection of cultural traditions. Is accepting such gifts an ethical violation?

There are two rules of thumb that interpreters can use to decide whether accepting gifts would
constitute an ethical violation on their part. First of all, interpreters should know and adhere to
the policy of the health care institution in which they are interpreting with respect to the
acceptance of gifts. Many institutional policies acknowledge the human desire to show
appreciation, a desire that is often also embodied in cultural values and traditions. Such policies
recognize that a refusal to accept a gift may be construed as an insult that could destroy trust in
the relationship. Therefore, they offer guidelines as to what types of gifts are acceptable and
which are not. Second, and most importantly, the interpreter should try to determine whether the
act of gift giving is an attempt to influence the interpreter and secure preferential or special
treatment. A possible indicator of the motivation behind the gift giving is the value of the gift.
If the value is beyond what would normally be considered a token of appreciation, it should
raise questions as to the appropriateness of accepting the gift.

Whether the interpreter chooses to accept a personal gift, or to graciously decline the gift, or to
accept it only on behalf of the interpreting office, interpreters have the obligation to make clear
to the patient that their duty is to provide competent service in a fair manner to all patients
without added reward or compensation.

Concluding Remarks

As mentioned at the beginning of this document, a code of ethics is a guiding document, not a
how-to recipe. In the commentaries, you have seen that many of the principles are interrelated.
You have also seen that there are times when the principles may conflict with each other in a
specific situation. Conflict in ethical behavior is inevitable. What a code of ethics simply does
is offer those principles that a practitioner of the profession needs to seriously consider and
weigh as they make choices about their behavior.

Ethical principles are abstract, idealized concepts of what is appropriate. But these abstract
principles cannot answer the questions that arise out of the intersections of different people and
unique circumstances. Professionals have to evaluate the consequences of each course of action
they might take and ultimately make a choice. A code of ethics provides the professional with
those ideals and values they need to consider in making those choices so that the purpose of their
profession is furthered and its integrity maintained.

It is the hope of the NCIHC and the STC Committee that the National Code of Ethics for
Interpreters in Health Care will contribute to raising the quality of practice in the profession by

3
This section was patterned after the American Medical Associations Code of Ethics, principle E-10.017 Gifts fromPatients.

NCIHC.

providing clarity and consistency at the national level. At the same time, the NCIHC and the
STC Committee recognize that the National Code of Ethics is a living document that will
continue to evolve as the field develops and matures.

NCIHC.

References

Blackburn, Simon. Being Good. Oxford: Oxford University Press, 2001.

California Healthcare Interpreters Association Standards & Certification Committee. California
Standards for Healthcare Interpreters: Ethical Principles, Protocols and Guidance on Roles &
Intervention. 2002.

Edwards, A.B. Ethical Conduct for the Court Interpreter. The Court Manager, 3, No.2
(1988): 22-25.

Gonzalez, Roseann D., Victoria F. Vasquez, and Holly Mikkelson. Fundamentals of Court
Interpreting: Theory, Policy, and Practice. Durham, N.C.: Carolina Academic Press, 1991.

Massachusetts Medical Interpreters Association and Education Development Center, Inc.
Medical Interpreting Standards of Practice. Newton, MA: Education Development Center, Inc.
1996.

National Council on Interpreting in Health Care. A Code of Ethics for Health Care Interpreters:
A working paper for discussion. www.ncihc.org, 2004.

Sapir, Edward. Culture, Language, and Personality. Los Angeles: University of California
Press, 1956.

Seleskovitch, Danica. Interpreting for International Conferences. Translated by Stephanie
Dailey and E. Norman McMillan. Washington, D.C.: Pen and Booth, 1978.

Whorf, Benjamin Lee. The Retention of Habitual Thought and Behavior to Language. In
Language, Thought, and Reality. Edited by J ohn B. Carroll. Cambridge, Mass: M.I.T. Press,
1978.

Woloshin, Steven, Nina A. Bickell, Lisa M. Schwartz, Francesca Gany, and Gilbert Welch.
Language Barriers in Medicine in the United States. JAMA. 273, No.9, (1995): 724-728.

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