TrIn 3101: Introduction to Interpreting

Unit 6: Cultural Aspects of Interpreting Situations Part 1: Ethical CodesPart 2: Ethical Model for Decision-making

Nov. 3 & 10, 2004

2

Assignments (due 11/03) 1. Thought questions for:

Jackson pp. 158-164Haffner pp. 150-154

2. Weekly Assignment 3: Transcript and Error Summary (30 pts)

(due 11/10) 1. Weekly Assignment 4: Internal

Thought Process 2. Please read attached handout

Ethics and Medical Interpretation: The Value of a Pre-Session

3

Unit 6: Cultural aspects of interpreting situations

Goals: Ethics and Ethical Codes 1. Define ethics and give examples of

ethical principles2. Explain the importance of ethical

codes for various professions3. Describe how one’s own personal

values and beliefs can influence one’s ethical principles

4. Compare and contrast various ethical codes and identify similarities and differences

4

Goals

5. Define and discuss 5 approaches to ethics

6. List the steps of the model for ethical decision-making

7. Apply the model for ethical decision-making to situations presented in class

8. Videotaping of prepared role-play introductions on Nov. 10 and 17.

5

What is ETHICS?

• Read aloud and discuss article entitled “What is Ethics?”

6

Discussion questions

1) What are ethical codes?2) Which professions have them and why?3) Why are ethical codes important?4) How has community interpreting been

practiced? 5) What are the ramifications of having/not

having ethical standards in a profession?6) How do one’s own personal values and

beliefs influence ethical decisions?7) What factors might influence the ethical

decisions an interpreter is faced with?

7

1. What are ethical codes?

•A text document of a framework of standards with universal principles acknowledged and accepted by all practitioners within a field.

8

2. Which professions have them and why?

•Legal, medical, educational, etc.

•To establish and uphold a standard of conduct and professionalism in each field

9

3. Why are ethical codes important?

•These are professional guidelines to standardize the norms and behaviors expected in each field.

10

4. How has community interpreting been practiced?

• Ad hoc interpreters or non-professional bilingual coworkers, family members, any bilingual person available

11

5. What are the ramifications of having/not

having ethical standards in a profession?

• Inconsistent and irresponsible work

•Lack of accuracy, integrity, confidentiality

•Confusion•Liability issues

12

6. How do one’s own personal values and beliefs influence

ethical decisions?

•Previous experiences (positive or negative) affect all ethical decisions and so cannot be completely impartial and neutral.

13

7. What factors might influence the ethical decisions an interpreter

is faced with?

•Emotions•Previous experiences•Cultural factors•Personality factors of all

parties•Physical surroundings

14

Review: Basic principles of the Code of Ethics (legal and

medical)

1.Confidentiality

2. Impartiality3. Integrity4. Accuracy

1. Respecting the privacy of others

2. Not taking sides in a transaction

3. Being honest about one’s own skill level and qualifications for a job

4. Ensuring that the message is faithful to the original utterance, appropriate to the original context

15

Similarities in Codes of Ethics

1. Accuracy and completeness

2. Confidentiality3. Impartiality4. Role

boundaries

5. Professional demeanor

6. Cultural bridging

7. Continued competence

8. Accountability

16

Differences in Codes

Legal considerations:1. Representation of qualifications2. Impartiality and avoidance of

conflict of interests3. Assessing and reporting

impediments to performance4. Duty to report ethical violations5. Considerable knowledge of legal

systems, laws and legal procedures in the societies concerned

17

Six Ethical Standards

• These ethical standards are based on the Massachusetts Medical Interpreters' Association Standards of Practice.

• Professional ethics are rules that help maintain a professional relationship with the people you work with and for. A medical interpreter must maintain a professional relationship with both the patient and the provider in a health care encounter.

18

1. Maintains confidentiality

• Information exchanged in any interpreter exchange--for example, between a patient and a health care provider--is private. The interpreter does not intentionally reveal confidential information.

• Interpreters must treat all information learned during the interpretation as confidential, divulging nothing without the full approval of the client and his/her provider.

19

2. Interprets accurately and completely

• Interpreters must transmit the message in a thorough and faithful manner, giving consideration to linguistic variations in both languages and conveying the tone and spirit of the original message. Interpreters must interpret everything that is said by all people in the interaction, without omitting, adding, condensing or changing anything. If the content to be interpreted might be perceived as offensive, insensitive or otherwise harmful to the dignity and well-being of the patient, the interpreter should advise the health professional of this before interpreting.

20

3. Maintains impartiality • The interpreter withdraws from assignments

where personal ties or beliefs may affect impartiality and refrains from interjecting personal opinions or biases into the interview.

• The interpreter should strive to develop a relationship of trust and respect with the client by adopting a caring, attentive, yet discreet and impartial attitude toward the patient, toward his or her questions, concerns and needs. The interpreter shall treat each patient equally with dignity and respect regardless of race, color, gender, religion, nationality, political persuasion or life-style choice.

21

4. Maintains professional distance

• The interpreter understands the boundaries of the professional role and monitors her own personal agenda, refraining from becoming personally involved in a client's life. For example, the interpreter should refrain from providing services to family members or close personal friends except in emergencies. In personal relationships, it is difficult to remain unbiased or non-judgmental.

22

5. Knows own limits

The interpreter refrains from interpreting beyond his training, level of experience and skills. Interpreters should disclose any real or perceived conflict of interest that could affect their objectivity. In emergency situations, interpreters may be asked to do interpretations for which they are not qualified. The interpreter may consent only as long as all parties understand the limitations and no other interpreter is available.

23

6. Demonstrates professionalism

• The interpreter clearly understands his/her role and refrains from delivering services that are not part of that role. Interpreters shall be punctual, prepared and dressed in an appropriate manner. The trained interpreter maintains professional behavior at all times while assisting clients and seeks to further knowledge and skills through continuing studies and training. The interpreter shall explain cultural differences or practices to health care providers and clients when appropriate.

24

Activity: Standards

• In groups of 3-4, each student will take turns briefly summarizing the standards associated with the eight principles found in the textbook on pp. 269-272.

25

Mayo Clinic Language Department

Medical Interpreter Code of Ethics  • Introduction

• A medical interpreter is a specially trained professional who has proficient knowledge and skills in two or more languages and uses that training in a health-related setting in order to facilitate communication between the health care provider and patient who do not speak the same language. The following standards for ethical behavior exemplify the duties and responsibilities of the Mayo Medical Interpreter.

26

Mayo Clinic Language Department

Medical Interpreter Code of Ethics1. Maintains confidentiality.

• Information divulged in any interpreted exchange, for example, between a patient and a health care provider, is private. The interpreter does not intentionally reveal confidential information. 

• Mayo Confidentiality Policy: 

http://mayoweb.mayo.edu/hr-epm/General/confidentiality.html 

2. Interprets accurately and completely. • The interpreter is committed to transmitting the

content and spirit of the original message into the other language without omitting, modifying, condensing or adding. 

27

Mayo Clinic Language Department

Medical Interpreter Code of Ethics3. Maintains impartiality.

• The interpreter withdraws from assignments where personal ties or beliefs may affect impartiality, and refrains from interjecting personal opinions or biases into the exchange. 

4. Demonstrates professionalism.  • The interpreter clearly understands his/her role

and refrains from delivering services that are not part of that role.  The interpreter conducts his/herself in dress, posture and speech in a manner appropriate to the situation, and is respectful, courteous and honest. 

28

Mayo Clinic Language Department

Medical Interpreter Code of Ethics5. Conveys cultural practices.  

• The interpreter explains cultural differences or practices to health care providers and patients when appropriate. 

6. Knows own limits. • The interpreter declines to interpret beyond

his/her training, level of experience and skills.  In addition, he/she avoids situations that may represent a conflict of interest or may lead to personal or professional gain. 

29

Mayo Clinic Language Department

Medical Interpreter Code of Ethics7. Maintains professional distance.

• The interpreter understands the boundaries of the professional role and monitors his/her own personal agenda, refraining from becoming personally involved in a patient’s life. 

8. Pursues professional development. • The interpreter continually endeavors to

improve his/her interpreting skills by pursuing further relevant study and experience. 

• January 2002

30

Mayo Clinic Language Department

Medical Interpreter Code of Ethics• Read aloud and discuss article:

Working with Interpreters

31

Video: Cross-Cultural Communication in Health

Care1) What is happening in the video?2) What is the interpreter doing that is

appropriate to her role and what is inappropriate?

3) Is the interpreter following the ethical guidelines?

4) How does the interpreter influence the situation?

5) What are some possible outcomes of the situation based on the way the interpreter handled the interviews?

32

Thinking Ethically: A Framework for

Moral Decision-Making

I. Lecture/discussion:• Utilitarian Approach• Rights Approach• Fairness or Justice

Approach• Common-Good Approach• Virtue Approach

33

Application Activity: Ethical Situation

1. Groups of 2: Each group will be assigned one of the five approaches.

2. Based on the principles defined by the specific approach (details in handout Thinking Ethically: A Framework for Moral Decision Making), the group defines the ethical problem and decides what course of action to take to resolve it.

3. Class discussion

34

Application of 5 approaches on an ethical situation

You find a billfold with $500 and change. You have been laid off your job recently and your house mortgage is past due. How do you decide what ethical thing to do based on each of the five approaches? What specific questions do you ask yourself?

35

1. Utilitarian• What courses of action are

available to me?• Who will be affected and

what benefit or harm will be derived from each course of action?

• Choose the action that will produce the greatest benefit and the least harm. It will provide the greatest good for the greatest number.

36

2. RightsWe have the right:

– to the truth– of privacy– not to be injured– to what is agreed

Does the action respect the moral rights of everyone?

37

3. Fairness or Justice

• How fair is an action?

• Does it treat everyone in the same way, or does it show favoritism and discrimination?

• Both favoritism and discrimination are unjust and wrong.

38

4. Common-Good• The common good

consists primarily of having the social systems, institutions and environments on which we all depend work in a manner that benefits all people.

• How does a course of action benefit all people?

39

5. Virtue• What kind of person

should I be? Honest, courageous, generous, compassionate, faithful, fair, self-controlled, prudent, etc.

• What will promote the development of character within myself and my community?

40

Approaching Ethics

• Label the 5 approaches in the boxes on the follow-up handout. Answers will be discussed.

41

Ethical decision-making in a cultural context

Situational ethics and decision-making identify the steps of a decision-making process that can be used when faced with an ethical dilemma or problematic situation. Consider factors that may influence an interpreter’s response: familiarity with the client, the setting, the seriousness of the situation or outcome, the subject or topic, and beliefs and values.

42

Model for Ethical Decision-Making in a Cultural

Context1. State the

situation/problem2. State the ethical

dilemma3. State the cultural

factors involved4. State the factors

that affect the interpreter

5. State all the options of behavior/action

6. State the consequences of each option

7. Determine the best solution

8. Implement the solution

9. Evaluate the outcome

43

Application Activity 6-4

• Each group of 3-4 will be assigned a situation to resolve using the 9 step ethical decision-making model discussed.– One group member will facilitate the

discussion– Another will record (write) the discussion

results– Another will give an oral summary of the

group’s discussion to the class

44

Activity 6-5

• Problem-solving activities: In groups of 3-4, discuss how you would ethically handle each situation. All take brief notes to share with the class.

45

Weekly Assignment #4: Internal Thought Analysis

• Due by week 11/10/04• In 3+ paragraphs, describe your internal

thought process for 2 ethical situations (not necessarily related to interpreting) and one belief (i.e. goodness of wo/man, or one related to abortion, cloning, drugs, non/violence, etc.) Situations:

• Describe your situations (may be real or not)• Analyze your thinking as you consider various

options and courses of action you could take. How did you make your final decision?

Belief: • State exactly what you personally believe.• How and why do you believe what you do?

46

Weekly Assignment #5 for Nov. 17

• Forced Choice (20 pts.): Choose which situation is more contrary to your values. Write 2-3 paragraphs responding to the situations and describe how they conflict with your values.

If you have time, discuss your first reaction to each situation with a classmate.

• Situation 1: The patient becomes very angry with the doctor when the doctor tells him he is ready to go back to work. The patient uses profanity and insults the doctor.

• Situation 2: During a physical exam, the doctor asks the patient if she is sexually active. Since the patient is not married, she is embarrassed and uncomfortable to be asked such a question and does not respond.

47

Guidelines for Introductions 1. Give your name and language.2. Ask whether the provider/client has worked with

a professional interpreter before and tailor information to that answer.

3. Explain the role, including the goal of facilitating communication, confidentiality, accuracy, and completeness, and use of the first person form.

4. Find out the goal of the encounter—for both the provider and the client.

5. Ask if there are any questions about the interpreter’s role.

6. Answer questions about interpreting, not about the particular provider/client.

7. Include any necessary cultural information.

48

Assignment #8: Preparation (Bring your blank videotape on Nov. 10 & 17)

– Please write a 2 minute statement that you would give as part of your introductions in both languages A and B.

– Compare any differences in your introductions within the context of a medical setting and/or a legal setting.

– Discuss your statement(s) with 2 other classmates.

• If you have time, practice your role play as interpreter with a “provider” and a “patient/client”.

49

Video Assignment #8 • Each student should be prepared to

introduce him/herself in a simulated role-play at the next class session (11/10/04). These introductions will be video-taped in small groups in the context of a “role-play”. Two other students will act as the provider and the patient/client.

• Each student should view the videotape at home and complete a study guide assessing his/her performance. The study guide and videotape will be submitted by 12/8/04.

50

Until we meet again . . .