Communication through Interpreters in Healthcare: Ethical Dilemmas Arising from Differences in Class, Culture, Language, and Power

Abstract

In this article, we will consider the problems faced by medical interpreters as they facilitate communication between individual patients, healthcare providers, and family members. After we consider day-to-day workplace pressures and ethical dilemmas, we will focus on informed consent and end-of-life decisions. We will examine the roles interpreters may play when differences in cultural beliefs and frameworks cause participants to disagree. We will discuss cultural conflicts as well as power relationships between participants. Problems arise when the participants in healthcare settings have different interpretations of illness and treatment, hold disparate values in relation to death and dying, and use language or decision-making frameworks differently. We will illustrate these problems by cases drawn from our ethnographic research on the roles of Aboriginal health interpreters in Winnipeg, Canada and observations of healthcare interpreters and healthcare providers in Seattle in which interpreters deal with questions of clarifying values, the mediation of cultural differences, autonomy in consent agreements, and truth-telling in end-of-life decisions. Finally, we will discuss the ethical dimension of the work of interpreters, and consider the evolution and regulation of the role of the healthcare interpreter and their relationships with other healthcare providers.