Understanding patient needs without understanding the patient: the need for complementary use of professional interpreters in end-of-life care

Abstract

High-quality doctor-patient communication in end-of-life care results in better quality of life for patients. In linguistically and culturally diverse societies, language discordant consultations become daily practice, leading to difficulties in eliciting patient preferences toward end-of-life care. Although family members invariably act as informal interpreters, this may cause some ethical dilemmas. We present a case of a palliative patient whose son acted as an interpreter. This case generated a triple- layered ethical dilemma: (i) how to safeguard patient autonomy against paternalistic interventions by family members, (ii) how to respect the relational context in which patient autonomy can be realized, and (iii) how to respect the ethno-cultural values of the patient and his family. These issues are being discussed and reflected upon within the framework shared decision making involving informal- and professional interpreters. The complementary use of professional interpreters next to family members acting as informal interpreters is recommended.

Multiple Stakeholders' Perspectives Regarding Barriers to Hospice Enrollment in Diverse Patient Populations: A Qualitative Study

“…In addition to previously identified approaches, 1,13,22,25 this study also identifies novel ideas for addressing hospice enrollment disparities; for example, an administrator described the need for an EOL cultural interpreter, someone to serve as a cultural proxy between the patient and the health care system, specifically around the issue of EOL care. In addition, a hospice nurse suggested having specifically trained hospice language interpreters who have education in GOC conversation techniques to improve translation, rapport, and compassionate care.…”

Relational autonomy: what does it mean and how is it used in end-of-life care? A systematic review of argument-based ethics literature

“…Secondly, it has to be free from external interference of health professionals, relatives, or the society in general [28, 30, 33, 37, 39]. Thirdly, the agent has to be competent and sufficiently informed [26, 28, 36, 37, 41, 45, 46, 51, 52, 55, 63, 64].…”

“…Authors acknowledged that respect for individual autonomy has served to protect patients against paternalism [27, 30, 36, 37, 39, 41, 43–45, 50, 52, 54, 59, 60, 62, 64, 65] and to help them overcome futile treatment decisions [37, 43, 47, 53]. Putting patients’ values, interests, and beliefs at the centre of healthcare decisions empowers them [29, 30, 33, 36, 45, 66, 67].…”

“…Application of the principle of autonomy in real-life situations has contributed to the development of patient’s rights, including privacy, confidentiality, self-determination, and primacy of truth-telling in end-of-life scenarios [25, 28, 33, 35, 37, 38, 44, 49, 54, 55, 57, 59, 62]. Included articles highlighted the point that the notion of individual autonomy is consistent with commonly used legal and ethical standards in end-of-life decision-making, namely informed consent [25, 27, 29, 30, 33, 35, 38, 47, 52]; advance directives [25, 27, 35, 37, 48, 49, 52, 53, 59, 60, 65, 68]; surrogate decision making [35, 37, 46, 48, 53, 65]; and the best-interest standard [37–39, 45–47, 64, 65].…”

“…They affirmed that an individualistic conception of autonomy is too closely linked with Western cultural values. This aspect neglects alternative ethnocultural values, such as family harmony, filial piety, and community fealty [25, 29, 32, 38, 43, 44, 46, 51, 57, 59, 64]. These values are essential in collectivist decision-making societies [25, 37, 38, 43, 51, 60, 63].…”