Caring for the silent stranger: Ethical hospital care for non-English speaking patients

Abstract

The past generation's revolution in medical ethics has had a tremendous impact on the definition of the therapeutic relationship. Where the traditional virtuous physician motivated by philanthropy once practiced "therapeutic deception", today health care practitioners in a variety of disciplines are held to a professional standard which demands that the therapeutic relationship be based in good communication between patient and caregiver. Medical ethics now looks to the images of contractual negotiation and covenantal compassionate presence to overcome the clash of values which may occur when patient and caregiver meet as strangers. In the U.S., a significant number of hospital patients are not only strangers to their caregivers and American medicine, they are strangers to the very language in which differences could be explained and strong therapeutic relationships established. Non-English speaking patients pose a complex problem for the ethical dedication to informed consent, as they are unable to take an active part in treatment without translation. In a study of 226 Hispanic hospital patients, non-English speaking patients were shown to have limited understanding of their conditions and treatment, and almost no meaningful interaction with their caregivers. Ironically, where patient satisfaction with medical care has been shown repeatedly to be based in factors of communication, non-English speaking patients placed almost no importance on their communication with the staff. Overall they had little interest in the active role that contemporary ethics assigns to patients. Non-English speaking patients' limited role in their own care also poses legal questions about the validity of their consent to treatment. Few non-English speaking patients are provided with translation, even for official consent documents. There is some indication, moreover, that an inability to speak English contributes to longer hospital stays. Providing the professional medical translation which would afford non-English speaking patients the ethical hospital care that they deserve might not only ensure against litigation, it may also save money for hospitals, insurers, and public health funds.