Medical interpreters, societal commitments, and the challenges of footing the bill.

Over at The White Coat Underground, PalMD looks at the ways in which delivering good health care to deaf patients depends on providing good interpreters -- and notices the difficulty of making this happen:

How do we approach this as a society?

Item 1: Deaf people have special needs with regards to interactions with the health care system.

Item 2: The government mandates that proper interpreters be provided for doctor visits.

Item 3: Neither patients nor doctors can afford to provide this service.

Now don't go telling me that "all you rich doctors can afford to get the interpreter"---we most emphatically cannot. That is a simple fact, and if you don't believe me, then you don't. Epur, si moeve.

There is not a great deal of support for an expensive government mandate that would pay for interpreters for the deaf. How do we provide this critical service?

I think the way Pal has framed this is exactly right -- this is a question that is an ethical challenge to us as a society. Given the limits on what any of us can accomplish as individuals, what are we committed to doing collectively? What ought we commit to do collectively? And what does this say about what goods we regard as necessities to a good life -- or about which members of society we believe are entitled to partake of this good life?

If the government is mandating the provision of proper interpreters for the deaf when health care is provided, this suggests that at least some important voices within our society recognize that these interpreters can be a necessary condition for the delivery of good health care to deaf persons. Pal's post does a nice job illustrating some of the reasons why deaf persons might need good interpreters to receive good health care.

Now, it's worth noting that the Americans with Disabilities Act mandate for proper interpreters falls short of actually asserting that every member of society is entitled to good health care. For whatever reason, U.S. society isn't quite there yet. However, the regulation does seem to reflect a commitment to the idea that, if you have access to health care (whether on your own dime, or paid for by employer-provided insurance, or paid for by a government entitlement program), your need for an interpreter ought not to be an impediment to getting the full benefits of that health care. In other words, there seems to be a commitment not to waste health care resources by delivering something that is almost adequate but falls short for want of an interpreter.

Except, you might wonder, how much of a "commitment" can this be if the government that requires provision of proper interpreters at doctors visits does not also provide funds to pay for these interpreters? Is this not a classic example of talking the talk without walking the walk?

Still, there's something important about starting by talking the talk. One of the important functions of government is looking out for the needs of members of society that might be marginalized if everything were left to a majority vote. The needs of kids would be especially vulnerable -- it's alarming how many child-free members of society feel that they receive no benefit whatsoever from public schools and child nutrition programs, for example. And the needs of people with disabilities might be similarly imperiled.

Operating as a society, though, is all about banding together and recognizing the well-being of others as valuable (rather than just trying to figure out as individuals how to get the largest possible slice of the community pie for ourselves). Recognizing a societal structure like a government out to take us out of a purely individualistic viewpoint as far as what is required and who's going to pay for it.

My sense is that, as a society, we may be undergoing a shift in terms of how we understand goods like health care -- something owed only to those who can afford them, or the kind of good that provides part of the basic level of care for society's members without which we may not be able to produce other societal goods. We also seem to be undergoing a shift in terms of who we understand to be a real (and potentially productive) member of society. And, we certainly seem to be seeing changes in health care infrastructure and in the economics of providing health care.

Amid all these changes, it would be heartening if resources for interpreters for the deaf were prioritized, whether by the government (paid for by public monies) or by health care providers (budgeted in to the cost of doing business), or by local communities (on the theory that good interpreting services are necessary to facilitate full participation of all of a community's members in civic life). Of course, as you may have heard, the U.S. is currently experiencing a bit of an economic crisis.

There are things we ought to do -- things that we feel we owe our fellow members of society so that they even have a chance of partaking of health care and human flourishing -- despite the fact that we don't yet have a good plan to pay for them. To the extent that we regard health as a necessity, not a luxury, this means that in the long term we need to find a way to make it happen (even if this means making some hard choices about other expenditures that really are more like luxuries), and in the short term we should find some creative ways to meet the needs while sharing the pain.

Some creative approaches might involve using webcam technology to enlist the services of geographically remove interpreters, or setting up loan-forgiveness programs to encourage more people to train and work as medical interpreters. I'm leery of putting people's kids in the position of serving as their interpreters in health care contexts (since this has raised all kinds of ethical issues involving patient confidentiality, putting lots of responsibility on the shoulders of minors, and conflicts that seem built in to the parent-child relationship). However, I'm wondering if there would be good ways to set up interpreter co-ops (where your time interpreting for other deaf patients could build up a credit toward interpreting services when your relative needs them).

And, rather than letting stop-gap solutions be our ending point, we need to really think about how to build the societal infrastructure to build the world that reflects our shared values. We can't push the responsibility off to someone else. We need to find a way to share the burden of providing what is needed. Otherwise, we will certainly share the burden of not providing our fellows with the conditions they need to flourish and to contribute to society. If we don't pay now, we'll pay much more later.


More like this

Before I started medical school I worked at a clinic that served the deaf and hard-of-hearing community. I was the "front office", greeting patients, answering the phone by TDD/TTY or by relay service (this was before the existence of text messaging, instant messaging, or anything else that relied…
...they supported socialized medicine. Last week, Forbes writer Rick Ungar made the following historical observation: In July of 1798, Congress passed - and President John Adams signed - "An Act for the Relief of Sick and Disabled Seamen." The law authorized the creation of a government operated…
Every so often, as the health care reform initiative spearheaded by the Obama Administration wends its way through Congress (or, more precisely, wend their ways through Congress, given that there are multiple bills coming from multiple committees in both Houses), I've warned about various chicanery…
We're starting to hear about how Obama intends to implement healthcare in this country. President Barack Obama says he's open to requiring all Americans to buy health insurance, as long as the plan provides a "hardship waiver" to exempt poor people from having to pay. Obama opposed such an…

I should mention that the center on deafness was where i was first called "pal". I singed everything with my initials, and it made for easy signing. I wasn't very fond of the usual sign for "peter" as it is basically a church steeple.

A signing individual might be nice, but most deaf people can read and write.

And some doctors and nurses do sign. I don't think the selection process would be significantly different from picking a doctor who speaks Spanish or Ukrainian.

[apologies if this is a duplicate post, the web page seemed to hang]

It had not occurred to me about the special medical problems of deaf people.

Considering how difficult it is for hearing people to communicate with medical people, I can only imagine he difficulties with deaf people.

Writing is much slower than signing/speaking....and many people with a hearing loss (people first language anyone?) don't read and write at age-appropriate levels depending on age they were first exposed to sign/english language and their general instructional history.

Most major research hospitals (most major hospitals?) have interpreters on call. i.e. you pick up the phone and request an interpreter and they come on the line. Using special handsets you can have a conversation with the patient. Most communities have interpreter services where you can find/hire someone temporarily....

By hypatia cade (not verified) on 24 Feb 2009 #permalink

California law requires Language and ASL Interpreter's be available for medical offices and hospital settings. Under this law the patient may request a certified ASL Interpreter from the California ASL certified list.
And while I know that just a handful of ASL interpreters exist in the Bay Area as opposed to language interpreters, the constant support of this profession will yield more ASL Interpreters.

By Sally Head (not verified) on 27 Apr 2009 #permalink