Ethics in Healthcare

The case study selected for this assessment deals with a grandmother (Elena) who does not speak English, and faces a deteriorating memory as potential side effects from the grief she experienced after losing her spouse just five years prior. Elena’s doctor only speaks English, with a thick Indian accent, therefore it is her granddaughter that must translate the information understood to Elena, which she does not. This then leaves Elena without communication from the doctor, and without knowledge of the tests she is about to undergo. The ethical issue in this case is the lack of translation and interpretation to the patient. This is a fault of the healthcare provider, as they should require an interpreter be present. The responsibility of translation and interpretation set on the family’s shoulders can be stressful, and having to make difficult healthcare decisions for the family member may leave the patient in the dark as far as what is occurring. The hospital needs to ensure proper translation and interpretation is provided, and is not the responsibility of a stressed-out family member.

Professional standards that point toward solutions could be translating all medical documents provided to patients. Translators working to translate medical information would have sufficient medical training and knowledge to understand the definitions of medical terminology to give an accurate translation—this would also ensure that the peculiar characteristics of medical jargon is placed in the correct contexts; and it could be ensuring that healthcare workers are not using language that is above the patients or translators understanding level (Bhatt, 2022). Additionally, healthcare does have a code of ethics that they abide by. In these situations, the professional standards set forth in the code of ethics requires them to ensure that they remain current on best practices and industry trends, they are also required to ensure patient safety, and much more (National Association for Healthcare Quality, 2023). According to the National Association for Healthcare Quality (2023), it is the healthcare providers responsibility to ensure that each patient is well taken care of, and any potential risk is minimized. If translation and interpreter services are not properly utilized, then there has been documented studies stating that 30% of patients had difficulty understanding medical instructions, and 15.8% of patients had a negative reaction to a medication due to lack of understanding the instructions, or wrong medication prescribed because the patient and doctor could not communicate properly (Shamsi et al, 2020). This can relate to larger societal problems as patients can lose trust in the healthcare system, because they are unable or unwilling to provide everything that the patient needs to understand their treatment. Lack of proper translation in healthcare for doctors and patient’s communication could additionally take part in the spreading of diseases, if the patient is not able to explain all of their symptoms to the doctor and have them properly understood.

Applied Ethical Principles and Standards

According to the APA Ethical Principles of Psychologists and Code of Conduct (2023), there are a variety of principles and standards that relate to this particular ethical issue in healthcare. 1.03 of the Ethical Principles of Psychologists and Code of Conduct (2023), states that if an organizational demand presents a conflict between the demands of the organization and ethics, then a psychologist must take steps to resolve the conflict, and it is under no circumstances an excuse for violating human rights. I could directly link to this the healthcare field, as the doctor is responsible for ensuring each patient is seen in a timely manner, however if a patient requires translation the process can take much longer—regardless of the length of time it takes, this is no reason for the doctor to cut the appointment short.

2.01(b) from the Ethical Principles of Psychologists and Code of Conduct (2023) would additionally play a role in this ethical dilemma as well. 2.01(b) states that where scientific or professional knowledge on a given subject is to be given to another individual all demographic factors must be understood first. In order for a psychologist to ensure that this is properly handled they are required to know the boundaries of their competence. They must have proper supervision when necessary, provide competent services or consultations for their patient, or receive the training and education to provide the additional services themselves across multiple fields of diversity. This directly relates to the ethical issue being studied, because of the fact that the doctor did not provide a translator or interpreter, could not interpret themselves, and did not have proper supervision in this situation while discussing healthcare needs with a family member.

An additional section of the Ethical Principles of Psychologists and Code of Conduct (2023) that would apply to this case, would be 3.04(a). Stating that psychologists must take all reasonable steps to avoid harm. The lack of proper translation in a healthcare setting, can have very negative and harmful repercussions. This is directly related, because if a doctor questions their ability to completely understand the patient, they must make absolute certain before prescribing medications, or determining a plan of care to avoid harm.

Alternative Solutions

If an interpreter was not available, an alternative to resolving this ethical dilemma could be to reschedule the appointment for when those services are more readily available. It would also be wise to ensure that the interpreter is given a schedule of the patient’s appointments to avoid scheduling conflicts that would require additional appointment cancelations. However, in the case of an emergency this may be unavoidable. A possible ramification of this situation could cause a lack of trust in the healthcare facility, as the patient does not feel that they are being put in priority. The patient could attempt to seek care from other places, and possibly switch doctors due to the lack of care provided at one facility.

Another alternative, is because the granddaughter does speak English, the doctor could reinforce the translation provided by a family member before requiring that a translator is brought in. This lets the family member know that she has a responsibility to ensure that her grandmother gets the proper communication from the doctor, from a trusted source. However, a possible ramification is that if the granddaughter does not fully understand the English spoken by the doctor, it could be hard for her to provide interpretation. This could provide misinformation to be interpreted, making it hard to make a proper decision on a care plan.

The last alternative for resolving this ethical dilemma, is to change doctors. The hospital should take responsibility in ensuring that patients are matched up with doctors that would best fit their needs, and backgrounds. This would not provide bias, but would instead provide proper communication and services be administered to patients without the need for additional services to be brought in—or it would not be needed as often. The patient would receive the proper care, and the hospital and doctors would minimize any potential risks. A possible ramification could be that it would potentially overload certain doctors over others, depending on the location you live in. However, more culturally diverse doctors could be hired, ensuring that everyone receives proper treatment and the case load is properly dispersed over each doctor.

Choosing a course of action, adding more bilingual doctors would be the most practical as interpreters can be few and far between, and they can also be pulled for multiple other responsibilities throughout the hospital. While having interpreters in the healthcare setting is vital, ensuring that more bilingual physicians is also essential. Interpreters can be a stranger that a patient would need to bear their private health information to, which can make the care plan harder to assess because maybe the patient withholds information because they are not comfortable speaking with an interpreter (Kent State University, 2017). “When patients can speak to healthcare workers in their own languages, they feel more comfortable with their treatment,” (Ivan Novation Language Movement, 2022).

According to the Ivan Novation Language Movement (2022) it has been analyzed that most all medical information for patients to assess and help determine a plan of care, is geared toward individuals who are English-speaking adults. They may not fully grasp what is being offered or explained, and may decide on a plan of care based on the very limited information which they have. It was found that multilingual physicians in the healthcare field can create better relationships with their patients. It would be of ethical importance for the physicians to understand the boundaries of the competence though, and know when to seek outside support.

Research

Data addressed in a recent study analyzed the characteristics of physicians that varied when they did not speak the patient’s language, and were forced to find alternative means of reaching a conclusion with a patient (Center for Medicare and Medicaid Services, 2017, pg. 17). This also forced patients to seek alternative means to understand the physician, all of which could harm a patient if the communication was not interpreted correctly. Therefore, it was determined through the course of this study, through utilization of a questionnaire which is appropriate to allow proper translation, that if the physician needed the training, the healthcare facility would be responsible for providing additional language training for physicians (Center for Medicare and Medicaid Services, 2017, pg. 17). 70% of respondents in this study indicated that their place of employment provided formal language services for physicians and patients, however it was determined through the questionnaire that nearly 20% of employers did not have a plan in place whatsoever for language services (Center for Medicare and Medicaid Services, 2017, pg. 17). The studies limitations were that few respondents participated in the survey, compared to the number of surveys sent out, and it did not collect any demographic data. The appropriateness of this survey would be limited to the information it was able to gain, and what it also lacked.

One research study assesses through categorical and continuous approaches to defining how effective bilingualism across different participants (Kremin and Byers-Heinlein, 2021). Some of the ways in which individuals from both monolingual and bilingual backgrounds were analyzed for the course of this study was through the use of questionnaires—which is appropriate to allow proper translation for each participant, which can then be assessed for late-learning bilingualism compared to early-learning and their varying levels of empirical support (Kremin and Byers-Heinlein, 2021). Late learning was considered after the age of 15, and early learning was considered before the age of 13. This is compared to the continuous model selected as well, where it was believed to be more beneficial to assess an individual’s bilingualism abilities on a continuous model (Kremin and Byers-Heinlein, 2021). These methods of study have been found to be effective and appropriate for assessing whether it is of benefit to teach physicians a new language while in medical school, or whether to hire an interpreter that has been speaking multiple languages for many years now. Which could also be supported by an additional research study that analyzed how the differences in context across languages can affect bilingual speakers, and how the languages can influence interpretation by patients (Inbal et al, 2017). It could then be noted that early-learning bilingualism was found to lack the emotional foundations for the language, creating a potential dilemma in the interpretation of the language (Kremin and Byers-Heinlein, 2021). Emotionality was a common factor for misunderstandings across languages, and brain imaging utilized in the study found that when certain words were stated when using a functional magnetic resonance imaging (fMRI) individuals who were English native speakers would have different brain reactivity to a word, compared to a bilingual whose first language is not English (Inbal et al, 2017). This concluded that while an individual may be able to understand a secondary language, the potential for misunderstanding is still possible through emotions and personality (Inbal et al, 2017). Being trained in this information can make healthcare providers more equipped to understand potential ways the languages may be misperceived or misjudged.

An additional research study conducted through the World Economic Forum, and was used to assess the culture diversity among populations from 27 different countries, which included 30,133 individuals, and it proved that on average 69% of the individuals who participated were from a different country than where they were currently living—meaning they also spoke a different language than the country where the resided home language was (Fon, 2023). The study then compared Individual Bilingualism and Official Bilingualism. While it would be ethically more challenging to mandate individual bilingualism, countries with varying languages spoken could reinforce official bilingualism ethically through the legal term ‘officialization,’ which would provide legal framework and guidelines for entities wishing to mandate bilingualism throughout their healthcare facilities (Fon, 2023). Official bilingualism is practiced in 34 countries currently, and this study specifically analyzed Canada as one of the countries. Canada has successfully utilized official bilingualism, reinforcing that French and English are the two official languages spoken in the country (Fon, 2023). Ethically, the appropriateness of this study is limited to the languages mostly spoken in those countries, however, by creating two native languages for a country through official bilingualism the ability for individuals of lower classes of socioeconomic stand points, would be able to learn multiple languages—possibly raising their socioeconomic stands. Based upon the ethical codes and standards addressed earlier, and the plan of action stated above, research studies have reviewed phenomena found in a study, utilizing questionnaires, concerning health literacy and multilingualism, multiple things were considered, (1) potential for words and conflict to be shared across languages; (2) lexical properties that can influence an individual’s ability to decode documents; (3) emotional valence of words across languages; (4) any other type of discourse-level of texts that could potentially influence an individual’s reading difficulty. In conclusion, having multilingual health literacy is of vital importance, and could be extended to include multilingual doctors to help enforce the ethical principles necessary in healthcare (Esteban et al, 2022). Individuals for this study were selected through stratified random sampling. Individuals were divided into groups based on their native languages, and then selected at random from there. This method of study was appropriate because it did not hold a bias or judgement over anyone, they were equally utilized. This research study aligns with and supports my plan of action in

Conclusion

When addressing patient and physician language barriers, it is important to analyze the possible ramifications of not providing proper interpretation services for both the physician and the patient. A misunderstanding of the care plan can have severe ramifications of the mentality of a patient going into an appointment. If a patient is not able to properly address their concerns, then it is possible for the wrong medication to be administered as well as the wrong dosage, which could have life threatening consequences if not addressed properly. The need for bilingual physicians is becoming ever more a necessity as the United States expands the wealth of languages spoken. Hiring physicians who are bilingual or offering training for physicians that are not bilingual can not only increase the physicians personal demand, making their resume more appealing, but also can allow them to facilitate better relationships with their patients and ensuring that they meet all of the ethical standards and codes of conduct through proper care and minimizing harm to anyone they treat.

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