Learn how to apply the National Council on Interpreting in Health Care (NCIHC) code of ethics to worse case scenarios encountered by real medical interpreters.

1. Death Threats,
Interfering Daughters,
and Other Worst-Case Scenarios
2010 CCHMC Conference on Medical Interpreting
21-22 August 2010
Terena Bell, CEO

2. Or,
The National Council on Interpreting in
Health Care Code of Ethics:
Daily Application

3. Getting the Legalities out of the Way
DISCLAIMER:
Terena Bell does not work for the National Council on
Interpreting in Health Care, nor does she speak on its behalf.
The following presentation is simply a user’s fresh look at how to
apply the NCIHC’s Code of Ethics while interpreting in difficult
or unusual situations. It has not been endorsed by the NCIHC
accordingly. A full copy of the NCIHC code of ethics may be
downloaded at http://data.memberclicks.com/site/ncihc/
NCIHC%20National%20Code%20of%20Ethics.pdf.
All of the case examples provided in this presentation are real-life
situations in which professional interpreters have found
themselves while on-the-job. Examples are being used with
interpreter and/or client permission.

4. Thanks To
“A Health Care Interpreter’s Best Friend: The National Code of
Ethics for Interpreters in Health Care”
Shiva Bidar-Sielaff & Karin Ruschke
Presented by Jorge U Ungo
American Translators Association 49th Annual Conference

5. 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.
Complete Code of Ethics document available at http://data.memberclicks.com/site/ncihc/NCIHC%20National%20Code%20of%20Ethics.pdf.

6. Code of Ethics for
Interpreters in Health Care, Cont.
• 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 patient’s 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.
Complete Code of Ethics document available at http://data.memberclicks.com/site/ncihc/NCIHC%20National%20Code%20of%20Ethics.pdf.

7. In a word…
Original Language
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.
Summarization
CONFIDENTIALITY

8. In a word…
Original Language
The interpreter strives to
render the message
accurately, conveying the
content and spirit of the
original message, taking
into consideration its
cultural context.
Summarization
ACCURACY

9. In a word…
Original Language
The interpreter strives to
maintain impartiality and
refrains from counseling,
advising or projecting
personal biases or beliefs.
Summarization
IMPARTIALITY

10. In a word…
Original Language
The interpreter maintains
the boundaries of the
professional role, refraining
from personal involvement.
Summarization
NEUTRALITY

11. In a word…
Original Language
The interpreter
continuously strives to
develop awareness of
his/her own and other
(including biomedical)
cultures encountered in the
performance of their
professional duties.
Summarization
CULTURAL-AWARENESS

12. In a word…
Original Language
The interpreter treats all
parties with respect.
Summarization
RESPECT

13. In a word…
Original Language
When the patient’s 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.
Summarization
ADVOCACY

14. In a word…
Original Language
The interpreter strives to
continually further his/her
knowledge and skills.
Summarization
SELF-IMPROVEMENT

15. In a word…
Original Language
The interpreter must at all
times act in a professional
and ethical manner.
Summarization
PROFESSIONALISM

16. • 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 patient’s 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.
CONFIDENTIALITY
ACCURACY
IMPARTIALITY
NEUTRALITY
CULTURAL-AWARENESS
RESPECT
ADVOCACY
SELF-IMPROVEMENT
PROFESSIONALISM

17. Points to Keep in Mind
Which part of the code applies?
Could this situation have been prevented?
How would you handle it?

18. And now for the death threats,
interfering daughters, and other
worst-case scenarios.

19. Hospital - Louisville, Ky
You’re interpreting for a
man who may or may not
have cancer. While waiting
for the test results, the
man’s son approaches you
and, leaning in closely,
whispers that no matter
what the results say, if you
tell his father that he has
cancer, he will follow you
home and kill you.
CONFIDENTIALITY
ACCURACY
IMPARTIALITY
NEUTRALITY
CULTURAL-AWARENESS
RESPECT
ADVOCACY
SELF-IMPROVEMENT
PROFESSIONALISM

20. Hospital - Louisville, Ky
You are consecutive interpreting in a
language whose culture considers
interrupting to be very offensive. After
the doctor has spoken, you turn to
interpret, but before you have the
chance, the patient’s daughter jumps in
and does the interpreting on her own.
Knowing that the patient has requested
a professional interpreter and does not
want his daughter interpreting, you try
to speak sooner next time. Now,
however, the daughter is interrupting
you as you interpret, simply acting as
though you are not there and speaking
so loudly that only she can be heard.
CONFIDENTIALITY
ACCURACY
IMPARTIALITY
NEUTRALITY
CULTURAL-AWARENESS
RESPECT
ADVOCACY
SELF-IMPROVEMENT
PROFESSIONALISM

21. Private Practice - Louisville, Ky
You are a Spanish interpreter in a
city where many trained, Spanish
interpreters are available. After
arriving on-site for your
appointment, you realize that while
you did not recognize the patient’s
name before, you do happen to
know him after all. His child and
your child are friends.
CONFIDENTIALITY
ACCURACY
IMPARTIALITY
NEUTRALITY
CULTURAL-AWARENESS
RESPECT
ADVOCACY
SELF-IMPROVEMENT
PROFESSIONALISM

22. Health Clinic - Louisville, Ky
As an individual, you are pro-life.
Your personal religious
views do not advocate or allow
you to help or otherwise aid in
any abortion-related activities.
Very quickly, however, you
learn that an assignment you
have arrived to interpret for is,
in fact, a pre-abortion
counseling session.
CONFIDENTIALITY
ACCURACY
IMPARTIALITY
NEUTRALITY
CULTURAL-AWARENESS
RESPECT
ADVOCACY
SELF-IMPROVEMENT
PROFESSIONALISM

23. Home Visit- Rural South Carolina
A little girl with developmental issues
desperately needs corrective surgery. But
despite the doctor’s urging, the father says
he doesn’t want her to have the operation.
The doctor keeps asking why, but the father
won’t answer. Upset, the doctor steps
outside to calm down, leaving you alone
with the family. While the doctor is out, the
father and mother have a private
conversation you can easily hear. The
mother wants the girl to have the surgery;
however, the father is ordering her to keep
quiet, because if the girl has the surgery,
she will heal and the family will lose the
government assistance and disability
benefits that they receive for the child.
CONFIDENTIALITY
ACCURACY
IMPARTIALITY
NEUTRALITY
CULTURAL-AWARENESS
RESPECT
ADVOCACY
SELF-IMPROVEMENT
PROFESSIONALISM

24. Private Practice - Bardstown,
Ky
The patient needs a ride home.
His ride hasn’t shown and you
are in a rural town without
public transit.
CONFIDENTIALITY
ACCURACY
IMPARTIALITY
NEUTRALITY
CULTURAL-AWARENESS
RESPECT
ADVOCACY
SELF-IMPROVEMENT
PROFESSIONALISM

25. Hospital - Chicago, Illinois
You are working in a pediatric facility with a
family that has just lost their only child. You
know from working with the family during
prior appointments that religious burial is
necessary for the child to enter their
heaven. But during the session where you
are interpreting, the mother declines burial
information offered by the hospital and
agrees that the hospital may dispense of
the body as it sees fit. The mother seems
discontent with her decision, however, and
you strongly suspect that the family does
not have the financial means to pay for
burial. From your previous job, you are
familiar with an area program which
provides free or low-cost burials to lower
SES families.
CONFIDENTIALITY
ACCURACY
IMPARTIALITY
NEUTRALITY
CULTURAL-AWARENESS
RESPECT
ADVOCACY
SELF-IMPROVEMENT
PROFESSIONALISM

26. Health Clinic - Raleigh, North Carolina
An elderly lady has been diagnosed with
skin cancer and is embarrassed to go
out in public because of what the cancer
has done to her appearance. The family
wants the doctor to fix it. While the
doctor does not have anything he can
give her as a cancer cure, he does have
some cream he can give her that would
help with her appearance. He’s afraid,
however, that the family will
misunderstand and think that this
cream is also a cure. Not sure how to
handle the situation, the doctor asks
you if he should give it to her.
CONFIDENTIALITY
ACCURACY
IMPARTIALITY
NEUTRALITY
CULTURAL-AWARENESS
RESPECT
ADVOCACY
SELF-IMPROVEMENT
PROFESSIONALISM

27. Health Clinic - Louisville, Ky
During a well-child
checkup, the nurse on duty
asks you to help her
physically restrain a child
so that she can give the
child a booster shot.
CONFIDENTIALITY
ACCURACY
IMPARTIALITY
NEUTRALITY
CULTURAL-AWARENESS
RESPECT
ADVOCACY
SELF-IMPROVEMENT
PROFESSIONALISM

28. Hospital - Bensalem, PA
You are interpreting for a
woman who is waiting to hear if
she has cancer. The doctor
comes into the room and says, “I
have your results.” As a gut
reaction, the patient reaches out
and grabs your hand. Do you
hold it or do you let it go? What
if she were waiting for AIDS
results instead?
CONFIDENTIALITY
ACCURACY
IMPARTIALITY
NEUTRALITY
CULTURAL-AWARENESS
RESPECT
ADVOCACY
SELF-IMPROVEMENT
PROFESSIONALISM

29. Physical Therapy Center - Louisville, Ky
After completing an assignment for a
patient injured on the job, you receive a
phone call from the patient’s insurance
company. The company believes their
insured is committing insurance fraud
and that a friend of the insured is
attending the appointments instead.
Their representative asks you to
complete a single page form with
questions such as “How tall was the
patient,” “What kind of car did the
patient drive,” and “What color eyes
does the patient have?”
CONFIDENTIALITY
ACCURACY
IMPARTIALITY
NEUTRALITY
CULTURAL-AWARENESS
RESPECT
ADVOCACY
SELF-IMPROVEMENT
PROFESSIONALISM

30. Health Clinic - Kansas City, Mo
You are an interpreter working in a language of limited
diffusion and the only professionally-trained interpreter for
your language pair in town. In your home culture, all family
concerns must be reported directly to the father for him to
make all decisions. You are interpreting for a single woman in
her early 20’s who has contracted an STD. In this culture, sex
before marriage is punishable by stoning. Knowing his
daughter is ill, the father has taken her to the doctor; however,
provider regulations do not allow him to be in the room while
the examination is taking place. When the patient learns she
has an STD, he is therefore not in the room and she begs you
not to tell him. You know her father is going to press you for
information about her condition because he feels he has a
cultural right to know and he is particularly strict. In fact,
earlier that day, while you took a bathroom break, you had to
walk by the father and he stopped you. At that time, he told
you that he thought his daughter was having sex and that he
wanted you to find out if this was true. If you did not tell him,
as an elder, he swore to have you socially outcast from the
community. He promised that he would personally see to it
that no one in the community ever spoke to you again. His
exact words, translated, were “You will be dead to us.”
CONFIDENTIALITY
ACCURACY
IMPARTIALITY
NEUTRALITY
CULTURAL-AWARENESS
RESPECT
ADVOCACY
SELF-IMPROVEMENT
PROFESSIONALISM

31. For More Information
www.ncihc.org
www.ineverylanguage.com