By Ryan Foley
I was on an assignment in which a young female patient lied to her doctor during an annual physical exam. When the doctor asked, “Are you sexually active?” she replied, “no.” On another occasion when I was her interpreter, she answered the same question affirmatively. By maintaining confidentiality, was I acting ethically?
It is always an awkward feeling when the participants we are interpreting for are less than honest with each other. As we are members of the treating team we should always be alert for situations that could impact the wellbeing of the patient; however, as interpreters, we are not gatekeepers of truth. The average person tells a falsehood almost three times in a 10-minute conversation according to a study conducted at the University of Massachusetts.
Despite an obvious interest in their health and wellbeing, occasionally patients intentionally lie to save face or for protection from perceived threats. In your scenario, the patient is a young girl. Was there another family member present that made answering the question truthfully impossible for her? If so, the healthcare provider may need to be aware of how this could potentially affect the answers of the young girl.
Assuming the patient understands the question as interpreted, and is knowingly withholding the truth, the first question you should ask yourself is, is this really an ethical dilemma?
The question of sexual activity is not uncommon during an annual physical, especially when the patient is a teenager. It is asked so that the doctor can open the discussion up for the patient to ask questions that may be on her mind, give helpful advice, and determine if an STD screening might be warranted. In my experience, the answer is never taken at face value by a health care provider. For example, many times the same information is covered regardless of the patients’ answer. In situations like this, an interpreter has no need to break confidentiality. With no ethical principles coming into conflict, there is no ethical dilemma. However, changing just a few variables can turn this situation into an ethical dilemma.
The moment the patient could potentially be in danger, a danger that an interpreter hasn’t been able to overcome by skillfully using interpreting techniques to make sure the doctor’s question and intent is clear, the principles of confidentiality and the value of life come into conflict. Now we have an ethical dilemma. One such dilemma would be a patient who is lying to his doctor about regularly using a particular drug that will dangerously interact with medication the doctor is about to prescribe for him.
The fundamental principle guiding all codes of ethics for interpreters is “the interpreter shall do no harm” through action or inaction. We never easily break confidentiality as this could do harm to the patient beyond the physical, but there are rare cases when more harm can be done by ignoring dangerous and potentially life threatening scenarios.
Learn the three-step strategy to ethical decision-making at our upcoming webinar entitled Strategy of Ethical Decision Making. Click here to register.