This document discusses the development of the National Code of Ethics for Interpreters in Health Care. It provides an overview of the National Council on Interpreting in Health Care (NCIHC), which led the process. A multi-step process was used that included reviewing existing codes of ethics, creating draft principles, conducting focus groups for feedback, revising the draft, surveying interpreters nationally, and finalizing the code. The code consists of 9 principles focused on accuracy, confidentiality, impartiality, professionalism and advocacy. Case studies are used to demonstrate how the principles apply in practice.

1. Shiva Bidar-Sielaff, M.A.
Karin Ruschke, M.A.
Presented by: Jorge U. Ungo
American Translators Association 49th Annual Conference
A Health CareA Health Care
Interpreter’s BestInterpreter’s Best
Friend: The NationalFriend: The National
Code of Ethics forCode of Ethics for
Interpreters in HealthInterpreters in Health
CareCare

2. Creating the National Code ofCreating the National Code of
Ethics for Interpreters in HealthEthics for Interpreters in Health
CareCare
 Overview of the NCIHC
 Review of the process used to develop the
Code of Ethics for Interpreters in Health Care
 Review the principles of Code of Ethics
 Case Studies

3. The National Council on InterpretingThe National Council on Interpreting
in Health Care (NCIHC)in Health Care (NCIHC)
 1994 - informal working group
 1998 - formally established
 Multidisciplinary membership:
 medical interpreters
 interpreter service coordinators and trainers
 clinicians
 policymakers
 advocates
 researchers
 Mission: to promote culturally competent professional
health care interpreting as a means to support equal access
to health services for individuals with limited English
proficiency
 Website: www.ncihc.org

4. Building a ProfessionBuilding a Profession
 Create and build support for a single Code of Ethics that will
guide the practice of interpreters working in health care
venues
 Develop a nationally accepted, unified set of Standards of
Practice based on the Code of Ethics that will define
competent practice in the field
 Develop standards for health care interpreter training
 Contribute to the development of a national certification for
health care interpreters as part of the National Coalition on
Healthcare Interpreter Certification

5. Challenges in Creating theChallenges in Creating the
National Code of EthicsNational Code of Ethics
To design a code that built on and
solidified existing work
To expand upon this existing work to
ensure its relevance to all health care
interpreters, irrespective of the languages
or particular venue in which interpreters
work

6. Designing the National Code ofDesigning the National Code of
Ethics for Interpreters in HealthEthics for Interpreters in Health
Care: The ProcessCare: The Process

7. Step 1:Step 1: Reviewed Existing Codes of EthicsReviewed Existing Codes of Ethics
 Identified and collected existing codes of ethics
in health care and other related areas such as
legal and sign language interpreting
 Focused on ten codes that were considered most
relevant to our work
 Compared and identified the elements that were
held in common and analyzed how each
approached those issues that were most difficult
and controversial in the field

8. Step 2: Created a Draft CodeStep 2: Created a Draft Code
 Drafted a code that included the elements
shared across these existing codes as well
as a few that were controversial but
relevant
 Included a short commentary after each
principle that further explained and
illustrated that principle

9. Example of Draft PrincipleExample of Draft Principle
Principle #2. Accuracy and Completeness
The interpreter strives to render the message faithfully,
conveying the content and spirit of the original message,
while taking into consideration its cultural context.
It is the interpreter’s responsibility to interpret everything the speaker says
without changing the meaning. The interpreter should attempt to convey what is
said and how it is said without additions, deletions or alterations, but with due
consideration of the cultural context of both the sender and the receiver of the
message.
Whenever possible, the interpreter should convey the meaning of gestures, body
language, and tone of voice that add significantly to the content of the message.
Additionally, when the interpreter becomes aware of a mistake they have made,
the interpreter must reveal and correct the error.

10. First Draft Code of EthicsFirst Draft Code of Ethics
 Confidentiality
 Accuracy and Completeness
 Impartiality
 Professional Boundaries
 Professional Development
 Cultural Competence
 Respect for all Parties
 Professional Integrity

11. Step 3:Step 3: Conducted National FocusConducted National Focus
Groups to Review the Draft (Fall 2002)Groups to Review the Draft (Fall 2002)
 17 focus groups across the country
 Broad representation of language groups and
modes of service delivery (e.g. face to face and
telephone interpreting)
 Groups confirmed the need for a unified national
code of ethics and affirmed its development as a
positive step for the profession
 Feedback also concluded that the draft code was
fundamentally complete and appropriate although
some principles were seen as more or less
controversial

12. Step 4: 2Step 4: 2ndnd
Draft Code of EthicsDraft Code of Ethics
Included focus group commentaries and incorporated
recommended changes:
 Confidentiality
 Accuracy and Completeness
 Impartiality
 Professional Boundaries
 Professional Development
 Cultural Competence → Cultural Intervention
 Respect for all Parties
 Professional Integrity
 →Advocacy

13. Step 5: National SurveyStep 5: National Survey
 2nd
draft introduced to a larger cross-section
of working interpreters through a survey
 survey disseminated through the NCIHC
website and state associations of health
care interpreters
 approximately 2,500 surveys were
distributed, with a return rate of 20%

14. Sample Survey QuestionsSample Survey Questions
Principle #9. Advocacy
Advocacy is an action that is taken on behalf of an
individual that goes beyond facilitating communication
with the intention of supporting good health outcomes. In
some special circumstances, the interpreter may advocate
for the interests of any individual patient, provider, or
community.
Advocacy must be undertaken carefully, if at all, only if
other mechanisms for addressing a problem do not work.

15. Sample Survey QuestionsSample Survey Questions
Principle #9. Advocacy
1. This final principle is being considered for inclusion in the Code of Ethics. Do
you think the code should include a principle regarding advocacy?
___ Yes ___ No
2. Do you agree with this principle? ____ Yes ____ No Please explain.
3. When do you think it is appropriate for a health care interpreter to act as an
advocate for the patient? (Check one or more)
a. When the interpreter has tried all other avenues to resolve the problem.
b. When the health, well-being or dignity of the patient is at risk.
c. Never.
A nurse in the pre-operative area of a hospital tells a patient that her left leg is being amputated.
The patient becomes increasingly agitated, insisting that her right leg was to be amputated. The
interpreter interprets what the patient is saying, and the nurse in charge ignores the patient’s
protests. The interpreter is aware from a previous appointment that the patient is correct and the
doctor had been planning on amputating the right leg. The patient continues to protest, even as the
anesthesia is being prepared. The interpreter continues to interpret for the patient, attempting to
convey his frustration and fear, but when the situation is not resolved, the interpreter leaves the
room and calls the nurse’s supervisor. Do you agree with this application of the advocacy
principle?
____ Yes ____ No

16. Survey ResultsSurvey Results
Strong agreement on the principles as stated
in the draft.
Most controversial principle was
“Advocacy”
Commentaries generated most controversy
Commentaries generated unresolved
questions about implementation

17. Step 6: The National Code of Ethics forStep 6: The National Code of Ethics for
Interpreters in Health CareInterpreters in Health Care
 Code of ethics highlights the consensus there was on the
principles themselves - published without commentary
 Final draft was also reviewed by a select number of health
care providers and medical ethicists
 Companion document is created that offers a more thorough
discussion of the issues raised
 places the code in the context of ethical behavior in general
 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

18. National Code of Ethics forNational Code of Ethics for
Interpreters in Health CareInterpreters 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
interpreter’s path.”
Anonymous Respondent to Code of Ethics Survey

19. Core ValuesCore Values
Support health and well-being of patient
and do no harm
Remain faithful to original message
Take into consideration culture and cultural
differences to ensure understanding

20. The interpreter treats as confidential, within theThe interpreter treats as confidential, within the
treating team, all information learned in thetreating team, all information learned in the
performance of their professional duties, whileperformance of their professional duties, while
observing relevant requirements regardingobserving relevant requirements regarding
disclosure.disclosure.
 Shared with other health care professionals
 Sharing information with the treating team does not
violate confidentiality
 Avoid situations that expose you to confidential
information
 Explain your role
 Avoid being alone with the patient
 If information is shared in confidence,
 encourage patient to disclose information to provider
 decide, based on core values and legal obligations,
whether or not to share

21. The interpreter strives to render the messageThe interpreter strives to render the message
accurately, conveying the content and spiritaccurately, conveying the content and spirit
of the original message, taking intoof the original message, taking into
consideration its cultural context.consideration its cultural context.
 Essence of interpreter role
 Remain unbiased
 Do not omit, add or distort message
 Offensive language, derogatory remarks
 Possible exception: if not intentional, warn
speaker
 Interpret meaning, not words
 Correct all mistakes

22. The interpreter strives to maintainThe interpreter strives to maintain
impartiality and refrains from counseling,impartiality and refrains from counseling,
advising or projecting personal biases oradvising or projecting personal biases or
beliefs.beliefs.
 Provider-patient relationship is key
 Refrain from judging
 No personal biases and beliefs
 Last resort:
 Withdraw from assignment
 Disclose limitations
 Impartial ≠ Uncaring

23. The interpreter maintains the boundaries ofThe interpreter maintains the boundaries of
the professional role, refrainingthe professional role, refraining fromfrom
personal involvement.personal involvement.
 DO NOT mix roles
 Know your limitations
 Accept assignments you can manage
 Withdraw from assignment
 Disclose limitations
 Maintain professional relationship
 Do not provide personal information
 Avoid personal involvement

24. The interpreter continuously strives toThe interpreter continuously strives to
develop awareness of his/her own and otherdevelop awareness of his/her own and other
(including biomedical cultures) encountered(including biomedical cultures) encountered
in the performance of their professionalin the performance of their professional
duties.duties.
 Culture is a central factor in health care and
necessary to interpret meaning
 Be aware of your own culture
 Possess enough understanding of patient and
biomedical culture to facilitate communication
across cultures
 Cultural competence should be a value shared by
the whole medical team

25. The interpreter treats all parties withThe interpreter treats all parties with
respect.respect.
 Treat everyone with courtesy and dignity
 Respect autonomy and expertise of all parties

26. When the patient’s health, well-being, or dignity areWhen the patient’s health, well-being, or dignity are
at risk, the interpreter may be justified in acting asat risk, the interpreter may be justified in acting as
an advocate. Advocacy is understood as an actionan advocate. Advocacy is understood as an action
taken on behalf of an individual that goes beyondtaken on behalf of an individual that goes beyond
facilitating communication, with the intention offacilitating communication, with the intention of
supporting good health outcomes. Advocacy mustsupporting good health outcomes. Advocacy must
only be undertaken after careful and thoughtfulonly be undertaken after careful and thoughtful
analysis of the situation and if other less intrusiveanalysis of the situation and if other less intrusive
actions have not resolved the problem.actions have not resolved the problem.
Most controversial principles
Advocacy ≠ taking sides, judging, personal opinions
Only after careful and thoughtful analysis
Seek supervisor advice whenever possible
Only when clear and/or consistent observation that
something is not right and action needs to be taken to protect
patient’s health and well-being

27. The interpreter strives to continuallyThe interpreter strives to continually
further his/her knowledge and skills.further his/her knowledge and skills.
 Continue to sharpen your skills
 Language is dynamic
 Keep abreast of developments in your
profession
 Attend trainings/workshops/conferences

28. The interpreter must at all times act in aThe interpreter must at all times act in a
professional and ethical manner.professional and ethical manner.
 Monitor own performance and behavior
 Do not use knowledge to your personal
advantage
 Do not exploit the vulnerability of the patient
 Ethical business practices
 Compensation
 Punctuality
 Keeping appointments

29. Case StudiesCase Studies
Which ethical principles apply to each case
study?
What would you do?

30. The National Council on InterpretingThe National Council on Interpreting
in Health Care (NCIHC)in Health Care (NCIHC)
www.ncihc.orgwww.ncihc.org