A National Code of Ethics for Interpreters in Health Care • July 2004 • Page 20 of 23
A large part of the controversy, however, comes from the confusion that exists about the
meaning of advocacy and what its implications are in practice. On the surface, advocacy appears
to be a contradiction of the ethical principle of impartiality – the obligation not to judge, take
sides, or express personal opinions and biases with respect to the content of the communication
in the clinical encounter. But these proscribed actions are clearly not examples of advocacy.
The act of advocacy should derive from clear and/or consistent observations that something is
not right and that action needs to be taken to right the wrong. On a deep level, advocacy goes to
the heart of ethical behavior for all those involved in health care – to uphold the health and well-
being (social, emotional and physical) of patients and ensure that no harm is done.
Interpreters are seen in different ways by the parties. On the one hand, they are often said to be a
potentially intrusive presence, inhibiting the close, private relationship between patient and
provider. On the other hand, their presence is “forgotten” or considered inconsequential. In this
latter situation, a party may say or do things that go beyond the bounds of respectful
interpersonal interactions or ethical practice. When what the interpreter sees or experiences has
a significant likelihood of serious negative consequences for a patient or patients, or, for that
matter, for others in the system, and every effort to resolve the matter judiciously with the parties
involved has been unsuccessfully tried, interpreters have the ethical obligation – like any other
professional in the same situation – to take action and advocate on behalf of the wronged
individual or individuals. Essentially, they have an obligation to “bear witness,” that is, to bring
forth evidence of the wrongdoing to the appropriate parties in order to redress the wrong that has
been done.
Assuming an advocacy stance, however, should never be taken lightly. Interpreters should
undertake this action only after careful and thoughtful analysis of the situation. In coming to this
decision – to advocate or not – they may want to seek the advice of supervisors and colleagues in
the field, remembering, however, to preserve the anonymity of the parties involved when seeking
such advice. In some cases, they may want to consult an ethicist. In every case, they need to
find out what the appropriate mechanisms and protocols are for such action in the institution in
which they are interpreting and follow them. In every case, interpreters should conduct
themselves in ways that respect the privacy and rights of the parties involved.
8. The interpreter strives to continually further his/her knowledge and skills.
The intent of this principle is to ensure that interpreters continue to develop their understanding
of the content and context in which they interpret and continue to sharpen their skills.
The ability to interpret accurately and completely is, to a large extent, dependent on how much
background knowledge the interpreter has of the content and the context of the communication
(Seleskovitch, 1978). In the field of health care interpreting, the areas of knowledge that are
most salient include the medical context (e.g., the basic parts and functioning of the body and
common disease syndromes and their respective treatments) and the socio-cultural context of the
patient populations for whom the interpreter interprets (e.g., beliefs about wellness and illness,
folk illnesses and remedies, and the impact of assimilation and acculturation on the presentation
of illnesses). This does not mean that interpreters are expected to have the depth and breadth of
knowledge that health care professionals or anthropologist have in their respective fields.
However, the more background knowledge the interpreter has, the more likely it is that the