Validating professional standards and codes

Challenges and opportunities

Claudia V. Angelelli
San Diego State University

This article presents a focus group study on the validation of the California
Standards for Healthcare Interpreting produced by the California Healthcare
Interpreting Association (CHIA) in 2002. The reactions of healthcare inter-
preters to the Standards, and their opinions and thoughts on its provisions
are reviewed and analyzed. The article first addresses the issues and problems
healthcare interpreters encounter when implementing the Standards, and
highlights the challenges they face when trying to balance their professional
mandate with the reality of their working environment. In particular, it
describes the difficulties of defining the interpreter’s role in the system. The
final section of the article draws attention to the need for bridges between
research and practice as a means of guaranteeing that the field of interpreting
will continue to develop.

Keywords: healthcare interpreting, professional ethics, professional

standards, interpreter role, focus groups

. Introduction

Over the past several decades significant developments have taken place in
the field of interpreting: Interpreting has been recognized as an academic dis-
cipline and a profession; interpreters now enjoy membership in professional
associations; and members of the profession abide by codes of ethics and stan-
dards of practice.
One of the most problematic issues is the role of interpreters. On the face of
it, this role should be simple to describe — the interpreter faithfully conveys a
message from one language to another while maintaining neutrality. Empirical
research (Wadensjö 1998a, 1998b, 2002; Metzger 1999; Davidson 2000, 2001;
Roy 2000; Angelelli 2004a, 2004b) points to a need to reassess the definition,

Interpreting 8:2 (2006), 75–93.

issn 1384–6647 / e-issn 1569–982X © John Benjamins Publishing Company
76 Claudia V. Angelelli

and to a hard-to-reconcile tension between theoretical definitions of the inter-

preter’s role and the reality that interpreters face daily in the workplace. This
research, however, has received relatively little attention from the interpreting
community in general and professional organizations in particular.
One explanation may relate to the way the field of interpreting has evolved
— as a response to a practical and urgent need (Angelelli 2004b: 11). Profession-
al interpreters founded organizations, which then prescribed the interpreting
practices that formed the point of departure for most of the current standards
of practice and codes of ethics (Angelelli 2000: 40), many of which were based
on conference interpreting and were transferred in toto to court and medical
settings. The prescription of norms to guide the profession went hand in hand
with the definition of the interpreter’s role which, like the norms, was based
both on theoretical principles and on personal accounts of experienced practi-
tioners who were trying to serve the profession to the best of their abilities. The
scant discussion of this topic, or the reluctance of the interpreting community
to challenge its own codes and regulations, may account for the fact that even
today the interpreter’s role is prescribed without consideration for the actual
requirements of the workplace. Because interpreting is a situated practice (An-
gelelli 2004b: 13), the complexity of the role must vary in accordance with each
specific setting in which it is performed (e.g. courts of law, hospitals, business
negotiations). This article focuses on the role of medical interpreters and on
the tension they experience while trying to fulfill their mandate, highlighting
problems that stem from the gap between empirical research on the role of the
medical interpreter and the expectations and demands of professional associa-
tions and professional life.

2. Historical and situational background

The present article is based on a focus group study on the California Standards
for Healthcare Interpreting developed by the California Healthcare Interpret-
ing Association (CHIA 2002). The research was commissioned by CHIA and
conducted in the State of California in 2001–2002.
The CHIA Standards and Certification Committee1 released the twelfth
draft of the Standards in 2001, after almost two years of writing and revis-
ing, having obtained feedback from expert American readers (e.g. executive
members of the National Council on Interpretation in Health Care and the
Massachusetts Medical Interpreters Association). The Committee’s main goal
was to create protocols for setting standards of excellence for all healthcare
 Validating professional standards and codes 77

interpreters in the State of California, in an attempt to come to grips with the

ever-greater challenges posed by the increasing ranks of linguistic minorities
and to meet the need for linguistically and culturally appropriate services. In
many cases, this takes the form of providing interpreters to limited English
proficiency (LEP) patients, but unfortunately, the programs and organizations
receiving federal financial assistance, such as hospitals and clinics, do not have
a policy on how interpreters are screened, tested, trained and evaluated. Hence,
in 1996, the directors of interpreter services in the various hospitals and pro-
vider groups in the San Francisco Bay and Los Angeles areas founded CHIA.2
Its mission is to support and promote the healthcare interpreting profession by
setting standards of excellence that ensure equal access to quality medical care
for all people.
As the principal player in establishing and adopting the Standards of Prac-
tice (2002), CHIA has multiple roles that stem from its mission statement. It
strives to professionalize the practice of medical interpreting, sponsors intern-
ships and scholarships and encourages the development of advanced-level
training in healthcare interpreting at institutions of higher education. Other
responsibilities include advocating cross-cultural awareness through the edu-
cation of healthcare professionals and promoting the networking of institutions
that provide interpreting services (CHIA 2004). In addition to providing a reg-
istry of interpreters and managing job listings, CHIA also provides interpreter
education and training opportunities, organizes annual conferences, and offers
networking opportunities for providers, agencies and interpreters.
The conceptualization of the Standards was grounded in ‘theories-in-use,’
(Argyris & Schön 1974/1992: 6–12), which suggests that people routinely make
stereotypical inferences about the behavior of others as a result of their own
culturally learned expectations and biases of ‘right’ and ‘wrong,’ even in a dif-
ferent cultural context. Given this, appropriate actions for interpreters should
be based on standard principles of medical ethics, lest untrained interpreters
fall back on ethical norms of appropriateness in their own culture — potential-
ly making incorrect inferences about the patient or the clinician, and creating
misunderstandings or confounding the diagnostic or treatment intentions of
clinicians working with patients.

3. Review of relevant literature

Defining the role of the interpreter has been a frequent subject of discussion
in Interpreting Studies (Roy 1989, 2002; Tate & Turner 1997; Wadensjö 1995;
78 Claudia V. Angelelli

Metzger 1999; Angelelli 2004a, 2004b). The interpreter as a co-participant in

the interpreted communicative event (Angelelli 2000) has been studied exten-
sively using discourse analysis (Roy 1989, 2000; Wadensjö 1995, 1998a; Da-
vidson 1998; Metzger 1999). Metzger (1999) and Davidson (2000, 2001) study
the participation of interpreters during interactions, and have challenged the
notion of neutrality. Roy (2000) discusses interpreting as a special case of dis-
course process and shows how the interpreter is addressed during the interac-
tion. Davidson (1998) examines the construction of reciprocity and meaning
in interpreted conversations, and argues that the role of the interpreter as lin-
guistic facilitator varies according to the parties to the interaction, concluding
that the difficulties in interpreted conversations lie in the construction of recip-
rocal understanding. In later work, Davidson (2000) maintains that one must
consider the context within which interpreters work and analyze their actions
against their historical and institutional context.
Kaufert and Putsch (1997) examine the dilemmas faced by medical per-
sonnel in emergency situations when two cultural systems clash, and take issue
with the neutrality prescribed for interpreters by the code of ethics of certain
interpreter organizations. They argue for a code that would address instances
when interpreters “act as advocates for patients” (1997: 77). Angelelli (2001,
2004a, 2004b) explores the social factors that affect the role of the interpreter,
the constraints imposed by the institutions in which the interpreter works and
the ways in which cultural norms and societal blueprints are manifested in the
interpreted communicative event, making the interpreter’s invisibility or neu-
trality an implausibility. Her work also addresses interpreting agencies and the
tensions they engender in both the workplace and professional associations.
Scholars are interested in the problem of prescribing guidelines and the
difficulties of sustaining them in the reality of a workplace. They explore differ-
ent classifications of the interpreter’s role, such as message converters, commu-
nication facilitators and bicultural specialists (Roy 2002: 350–351) or ways in
which roles unfold in practice (Wadensjö 1995, 1998b, 2002; Angelelli 2004a,
2004b) as perceived, enacted, described and explained by interpreters them-
selves. They also discuss metaphors and labels used to describe the role or the
perpetuated myths (Metzger 1999). Most important, they appear to agree that
these issues and classifications pose a problem, which may even lead to a po-
tential disservice to the practitioners themselves and to the field of interpreting
as a whole. The disparity between prescribed guidelines and the realities of the
workplace could be addressed if input from service users were solicited as the
guidelines were being formulated.
 Validating professional standards and codes 79

The six principles of the Standards (CHIA 2002: 10–11), which were the
main theme of the focus group discussions (see below), are:
1. Confidentiality — Interpreters treat all information learned during the in-
terpreting session as confidential.
2. Impartiality — Interpreters are aware of the need to identify any potential
or actual conflicts of interest, as well as any personal judgments, values,
beliefs or opinions that may lead to preferential behavior or bias affecting
the quality and accuracy of the interpreting performance.
3. Respect for individuals and their communities — Interpreters strive to sup-
port mutually respectful relationships between all three parties in the in-
teraction (patient, provider and interpreter) while supporting the health
and well-being of the patient as the highest priority of all healthcare profes-
sionals.
4. Professionalism and integrity — Interpreters conduct themselves in a man-
ner consistent with the professional standards and ethical principles of the
healthcare interpreting profession.
5. Accuracy and completeness — Interpreters transmit the content, spirit and
cultural context of the original message into the target language, making it
possible for patient and provider to communicate effectively.
6. Cultural responsiveness — Interpreters seek to understand how diversity
and cultural similarities and differences have a fundamental impact on the
healthcare encounter. Interpreters play a critical role in identifying cultural
issues and considering how and when to move to a cultural clarifier role.
Developing cultural sensitivity and cultural responsiveness is a life-long
process that begins with introspection.

4. The study

4. Methodology

The data for this study was collected from four focus groups (Angelelli 2002)
which met to discuss the contents of the Standards. Focus groups are used in
qualitative research to generate a group discussion among a small group of in-
dividuals selected because they have some knowledge about the research ques-
tion (Goebert & Rosenthal 2001; Greenbaum 1993; Krueger & Casey 1988;
Mason 1996; Morgan 1997; Stewart & Shamdasani 1990). They are an efficient
method of collecting data on a subject about which very little is known, and a
80 Claudia V. Angelelli

valuable mechanism for asking participants to comment on and suggest expla-

nations for research findings. This method allows for a theoretical and/or the-
matic overview of a given issue, and by extension, permits generalizations from
a theoretical perspective. Focus groups do not always yield explanations of the
issue at hand, and can be as much about differences as about agreement.

4.2 Materials and participants

The focus groups described below consisted of interpreters from three CHIA
chapters (Bay Area, Central Valley and Los Angeles) and others from the San
Diego area who were in the process of starting a new chapter.3 All were prac-
ticing healthcare interpreters with a minimum of three years of experience,
who had agreed to express their opinions, thoughts and concerns regarding the
Standards. A total of fifty-three interpreters participated in this study. Thirty-
nine (73%) were female and fourteen (27%) male. They were recruited from
interpreting agencies and other health organizations with interpreting service
departments and were not necessarily CHIA members. The only requirement
for participation was a minimum of 3 years’ experience in a health or health-
related setting (see Table 1).

Table 1. Number of participants per focus group

Group Number of interpreters % CHIA members
Central Valley 13 46
Los Angeles 13 38
Bay Area 14 79
San Diego 13 8

Table 2. Focus groups: Languages, number of participants, dates of sessions

Group: Los Angeles Central Valley Bay Area San Diego
Date: Nov. 10, 2001 Nov. 13, 2001 Nov. 14, 2001 Nov. 28, 2001
No. of Participants: 13 13 14 13
No. of Languages
(other than English): 6 7 8 15
Languages (other Cambodian, Arabic, Cam- Arabic, Chinese, Arabic, Canton-
than English): Chinese, Japanese, bodian, Hindi, Farsi, Lao, Man- ese, Dari, Farsi,
Korean, Spanish, Punjabi, Russian, darin, Portu- French, Hindi,
Thai Spanish, Ukranian guese, Spanish, Hmong, Kinyar-
Vietnamese wanda, Kirundi,
Pashto, Polish,
Somali, Spanish,
Urdu, Vietnamese
 Validating professional standards and codes 8

The groups represented a wide range of languages. Table 2 shows the num-
ber of participants and languages represented in each focus group as well as the
dates on which the sessions were conducted.
Prior to their participation, interpreters had received a letter of invitation
explaining the purpose of the study, two copies of the consent form (one to
be signed and returned, the other for their own records), and the twelfth draft
of the Standards. The participants referred to this document during the focus
group sessions. CHIA staff members served as facilitators. Discussions were
audio recorded and the tapes transcribed and analyzed for content.

4.3 Procedure

Sessions were scheduled for a two-hour slot in the evening. A side table was
set up at the entrance of the room, with refreshments and a sign-up sheet. As
the participants entered the room they were greeted by a CHIA member, who
had them sign in, indicate their language combination, and return their signed
consent form.
The facilitator opened the session by thanking the participants for their
time and explaining the basic ground rules, e.g. that participants should speak
once and then wait until others had spoken and that they should not engage in
side conversations. The discussion then started, and participants were asked to
comment on specific items, following a semi-structured protocol.

5. Analysis

A total of eight tapes (two per site) were collected, and were fully transcribed
for content. Annotations made by the author constituted the basis of subse-
quent emerging categories and patterns (LeCompte & Schensul 1999). The
analysis of the categories identified for each group was carried out three sepa-
rate times using unmarked transcript copies of the entire corpus, in order to
ensure consistency in the identification procedure. The main content catego-
ries to emerge from the transcripts were role, ethics and boundaries. The in-
terpreters expressed their beliefs, concerns and suggestions regarding each of
these and also identified areas of tension in each. Furthermore, the analysis
performed to validate the Standards also yielded interesting questions about
the document itself, about CHIA and about the profession of healthcare inter-
preting as a whole.
82 Claudia V. Angelelli

5. Role

The Standards refer to four roles that interpreters can play as they perform their
job: message converter, message clarifier, cultural clarifier and patient advocate
(CHIA 2002: 41–44). These roles are also discussed under Ethical Principles 3
and 5 (see Section 3 above). Perceiving their role as requiring that they render
messages “faithfully,” some interpreters assume the conduit role (Reddy 1979).
They see themselves as a language modem between two or more participants,
rendering all that is said into a different language. Some interpreters connect
this belief to interpreter training:
I think that I was trained to say it exactly the way the doctor says it, no omis-
sions, no […] you know, what they say is what we say. […] we’re just an invisible
voice there, just repeating everything no matter what it is, you have to repeat it.
(Participant 1, 14–01)

For other interpreters, the setting of the conversation or the content of in-
formation shared affects the role they play. For Participant 2, who works at
a teaching hospital, being a message converter would be pointless since she
believes patients do not need to be part of the teaching moments that occur
around them. As she puts it:
Usually when it is physicians talking among themselves, professor to residents,
etc., they use a totally different register […] then I just explain to them that as
they know it is a teaching hospital […] during that conversation, I just remind
them that it is a teaching hospital and that the professor is checking different
points, or I say what is the general subject they are reviewing based on what
we have just covered together, then I say what they are reviewing. And […] you
know, I don’t translate everything at that point, when they are not addressing the
patient directly, but I do tell the patient what they are talking about in general.
(Participant 2, 14–01)

For Participant 3, it is the content of the information that dictates a different

role. She gives the following example:
Let’s say you are a good interpreter, right? And you are interpreting everything
that is going on. All of a sudden, I am a nurse, I come in the room and I tell the
doctor, “you are giving the patient erythromycin and he is allergic to it. Do you
still want to give him that or change it?” Now there is no need for you to interpret
that. It has nothing to do with the patient. (Participant 3, 10–01)

The data seems to indicate that most interpreters make personal decisions
about the roles they will assume during an interpreting session, based on the
 Validating professional standards and codes 83

number and perceived importance of the interlocutors and of the topic. They
may choose to interpret everything, to explain why they are not interpreting
certain utterances, or even to omit side conversations that they regard as not
pertinent. In fact, they may opt for all of these role choices in a single ses-
sion. Other interpreters view themselves as friends and counselors of one of
the parties, and although their position might be viewed as a violation of the
Ethical Principle 2 (Impartiality), they seem to feel that their role in preventing
misunderstandings, which are often due to cultural differences, overrides it.
They adopt the role of cultural clarifiers (CHIA 2002: 43), and may take more
time to explain and clarify matters to one party than to the other. They believe
themselves to be responsible for explaining intercultural differences and for
educating the parties and would like to see that responsibility stated in the
professional code. As Participant 4 says:
The interpreter should be aware when a misunderstanding is caused by a cultur-
al difference and intervene at that point and do culture brokering. That it is the
responsibility of the interpreter to intervene and either prevent a misunderstand-
ing from happening or correct a misunderstanding that has already happened.
(Participant 4, 27–03).

Other participants were of the opinion that they should have even more re-
sponsibilities than this. They view themselves as patient advocates and believe
that they must safeguard patients’ rights. In fact, for some, this was the norm
at their workplace:
Well, I have one problem. Where I work we’re told that we’re patient advocates.
The document can’t write policy for hospitals, okay, because each hospital has to
write its own policy. I don’t mind, I can be impartial with my cousin, you know,
if she came in, I mean, I don’t know what difference that would make, but I’m not
going to be impartial towards any patient, in other words, if there is something
that is going wrong, I’m told at my institution, I am told that my job is to be a
patient advocate. That’s not being impartial, that’s being partial, and that’s the
rule where I work. (Participant 5, 15–01)

Some participants stated that they encountered discriminatory remarks that

prompted them to act as advocates even if they were not mandated to do so.
Participant 6 shared this experience:
Sometimes when there is an English-speaking patent, the doctor and the nurse
do not discuss certain things in front of the patient. They go outside. But when
the patient is non-English-speaking, I have been in that situation. I had someone,
an older person, come in and he was dying and the two doctors were standing
84 Claudia V. Angelelli

in front of the patient saying “he is going to keep coming here until he dies, until
he gets pneumonia and finally…” I can’t translate that for the patient. And I ask
the doctors, “Would you like me to translate that?” And they say, “Oh, no. This
is among ourselves.” “Then please step outside.” That is what I said. Because if
you understood what they were saying you wouldn’t have said that. (Participant
6, 11–02)

As indicated, the role of patient advocate, which is the policy for interpret-
ers at many institutions/hospitals, contradicts Ethical Principal 2: Impartiality.
Other interpreters, especially those who are staff members, employed directly
by a hospital, align themselves more with the institution than with the patients.
Impartiality is therefore a problematic topic in these situations. Other inter-
preters suggest that because of the hierarchy of the hospital system, doctors are
in control of the conversations; the interpreters follow the doctors’ lead, in that
they (the doctors) decide what can be interpreted and what not.
Even when the pre-session (CHIA 2002) of an interpreting event should
explain to the monolingual speakers that the interpreter is bound to convey
everything that is said, in practice this is not always feasible. This is illustrated
in the following comments of Participants 7 and 8:
I think a doctor has a lot of knowledge about the patient, that the decision to tell
or not to tell him certain things is his decision. So if he asks me not to tell the
patient then, I won’t. But I would say it’s not right for him to tell me a sentence
and then to stop me when I am interpreting. But if he asks me not to tell the
patient, it’s my duty not to. But what do you do when you hear “don’t tell this to
the doctor.” This is a really gray area. It’s really difficult to decide what to do and
it depends on what the situation is. What the circumstances are, who the people
are. (Participant 7, 9–04)

Usually the doctor is the one who has control of the conversation and the situa-
tion and sometimes you’re not given the chance to say anything. You can remind
the doctor that you’re supposed to interpret everything that he says […] but, at
the beginning, you don’t have time to start and, you know, usually, here in South-
ern California, and depending on the language you work with, most people have
worked with an interpreter or most people have been assisted by an interpreter
before and they know what to expect. (Participant 8, 37–04)

It is evident that the participants differ greatly in their expectations. The sta-
tus differential between providers and patients leads many to decide that the
provider has more “right” to determine what neutrality or impartiality are and
when to implement them. The participants’ comments also illustrate that inter-
preters play many different roles during patient-provider sessions, often within
 Validating professional standards and codes 85

the same encounter and sometimes within the same turn at talk. The difficulty
in believing one can consistently assume a certain role lies in the fact that no
one role can be assumed in its entirety or independently of others. It is not al-
ways possible to choose between performing as a message converter, a culture
clarifier or an advocate and the distinctions between the roles are not that clear.
Most often, an interpreter will assume part of two or more roles depending on
the course of the conversation. For example, s/he might start by rendering the
conversation between a provider and a patient faithfully, in the role of a mes-
sage converter. In the following turn, the interpreter stumbles upon a problem
resulting from cultural differences and immediately switches to culture clari-
fier. Later in the same turn, after the interpreter has returned to the role of mes-
sage converter, the provider makes a discriminatory remark and the interpreter
becomes the patient’s advocate.
When there is a shortage of professional interpreters or during an emer-
gency, bilingual providers or hospital staff will very often be called upon to
interpret. This creates an especially complicated situation, as these individuals
must wear the hats of both nurse and interpreter, for example, and these two
roles cannot be clearly differentiated. This phenomenon is also problematic
for the interpreting profession, as it implies that anyone who is bilingual can
assume the role of interpreter — without proper education, proper on-the-job
training or introduction to potential risks, problems and expectations entailed
in such a role. It is also problematic for the bilingual provider who is trying to
double as interpreter, because s/he cannot simply step out of the role of nurse
and embrace the role of interpreter as the Standards require. Finally, many of
the Standards create expectations that interpreters cannot meet. For example,
the role of culture clarifier may prove to be unrealistic, since the concept of
culture is too broad to be applied universally.
Because interpreters should not be perceived as cultural experts, I think we are
running into problems when we are sought out for expertise or advice about
culture. We need to learn techniques to elicit that information from the patient,
and then we interpret their words, their interpretation of cultural beliefs and
practices. Because my concern is that we already seem like the experts many
times just because we are bilingual or just because we look Asian or whatever.
(Participant 9, 29–02)

Interpreters are expected to be culture experts and to clarify or explain the cul-
ture of the patients. This is problematic both because no one interpreter can be
expected to understand the culture of a linguistic minority in its entirety and
because it implies that all people who speak the same language (e.g. Spanish)
86 Claudia V. Angelelli

share the same cultural beliefs (e.g. the role of the godmother or of home rem-
edies may vary significantly from Argentina, to Mexico, Spain and Equatorial
Guinea).

5.2 Professional ethics

The data shows that interpreters face a dilemma on what constitutes true ethi-
cal behavior and on how to reconcile the expectations listed in the Standards
with the expectations of the workplace. One of the primary concerns about
ethical behavior stems from the difficulty of applying general rules to a very
specific situation. For example, Ethical Principle 4: Professionalism and Integ-
rity prescribes that interpreters resist creating expectations that they cannot
fulfill (CHIA 2002: 29). As Participant 10 states:
The other thing is that… some doctor expects you to be his assistant. I was told
and he took it for granted that I would help him put the patients on the bed or get
them off the bed. What if the patients get injured? […] Doctors think that they,
they have the authority to tell you what to do, but you have to let them know.
“I’m not here to assist you physically, you know to do what the nurses would do.
I’m here just to interpret,” and you know, I, I’ve made this mistake in the past.
(Participant 10, 25–04)

This example shows that healthcare organizations sometimes have expecta-

tions (sometimes even included in job descriptions) beyond the interpreter’s
control. At times the content of the Standards may be in direct conflict with the
expectations of the workplace. Interpreters are often immersed in an ethical
dilemma, left to exercise their own discretion or to use “common sense,” and
each of these courses of action has implications for the manner in which the
interaction unfolds: in the field of medical interpreting, no two decisions can
be exactly the same, and common sense is governed by more factors than can
be specifically defined. When facing ambiguous situations, interpreters resort
to common sense by default, with an unpredictable array of potential problems
and consequences. As one participant stated:
I think you have to use your understanding and common sense […] Because we
have to convey the information that is important, you know, using your com-
mon sense. Because, sometimes, you can create bigger problems. (Participant
11, 10–02)

Evidently this view was not shared by all participants from the same region, as
evidenced by Participant 12’s remark:
 Validating professional standards and codes 87

If you do that then you are giving interpreters all kinds of options to pick and
choose what is important and what is not. And then we open a great big can of
worms. (Participant 12, 10–02)

Another potential ethical dilemma is posed by the Principle 1: Confidentiality.

Participants expressed the view that confidentiality may be understood dif-
ferently in different cultures, and perhaps the Standards should accommodate
these differences. As stated by Participant 13:
Confidentiality means that when I meet you in a community setting you do not
need to worry about me disclosing your personal information. I have had this
experience also with Spanish-speaking patients, that even though they have a
word for confidentiality, culturally it is unacceptable to keep information confi-
dential when we are talking about our own family members. In their minds that
rule does not apply to them either. That is when I step out of that interpreting role
and I become more of an advocate and I educate about how the system works.
Because without that it is very difficult to convey the full meaning of what we
mean by confidential and why this is important. (Participant 13, 6–02)

Another area of tension is Ethical Principle 4: Professionalism and Integrity. As

Participant 14 states:
At the clinic where I work the clients are migrant workers and they tend to come
over and bring you a basket of fruit, this or that, which they have just picked
from the field, and for us to decline is an insult. It is out of gratitude. It is not a
bribe. They are not asking for a favor. They are just thankful for the help we gave
them. (Participant 14, 26–02)

Participants did not think that the wording of the document takes such in-
stances into consideration. They also reflected on another problem related to
the Standards: they seem to expect interpreters to abide exclusively by Ameri-
can “ways.” In other words, whether interpreters can accept and justify gifts as
culturally appropriate raises the issue that interpreters are expected to be cul-
turally sensitive towards patients while at the same time being required to fol-
low certain rules that may not accommodate “non-American” cultural norms.
As this section has shown, interpreters and interpreter organizations have very
different expectations when it comes to professional ethics.

5.3 Boundaries

Parties to a communicative event also have different expectations as to their own

role and the role of the others. As discussed earlier (Section 5.1), interpreters
88 Claudia V. Angelelli

encounter patients who may expect them to be their friends and counselors,
whereas doctors may expect them to function as assistants and helpers. Mean-
while, professional organizations such as CHIA expect all interpreters to be im-
partial and to fulfill specific roles, while some interpreting agencies dictate roles
which seem to be in direct conflict with the requirements of the Standards.
Harmonizing these seemingly conflicting boundaries and the expectations
of the various parties is no simple task. For example, many participants viewed
the provider as the party holding the power. Sometimes the interpreter’s inabil-
ity to comply with the expectations of the provider — viewed by many as the
party wielding the most power — may cause uncomfortable working condi-
tions, at best, or the potential for a lawsuit, at worst. The statement by Partici-
pant 10 (see above), who was asked to help the doctor to get the patient onto
the bed, is a good example.
The same risk arises in the case of patients’ expectations. Due to the fact
that the interpreters understand their language and culture, many patients ex-
pect them to be their friends, counselors and helpers. Interpreters need to rely
on the Standards to enforce a limit to patients’ (and hospitals’ or providers’)
expectations, as illustrated by the following comment:
I am not against helping patients. I sound very cruel in what I say, but at the
same time we need to draw the line. What happens if we forget to exercise our lit-
tle side role and someone found out about this, the guideline, that we did not fol-
low to the T. So what happens next when we are being sued? Because […]“Well,
I didn’t do that because the interpreter didn’t take me to the pharmacy. Therefore
I didn’t get my medications.” or “He didn’t call me and remind me to come to the
appointment. And that is why my child passed away.” Then what’s next? We have
to protect ourselves. We need something that is clearly written. We cannot allow
loopholes. (Participant 15, 39–02)

It is evident that every party to the communicative event, including the inter-
preters themselves, has particular expectations regarding the role of interpret-
ers. With a variety of demands on the part of providers and a lack of specific
guidance on part of the Standards, interpreters continue to find themselves in
an untenable position. This is voiced by Participant 16:
I felt that there was something missing here […] it’s about respect and this is what
I wrote. Respect professional boundaries by declining to take other roles that may
be offered or assigned by health providers. So, one should have that ability to en-
force those boundaries. And, even though I hear that we are trained in different
ways, like the advocacy role that our friend here was talking about, that might be
part of how they have been trained but on the other hand, you have to be careful
 Validating professional standards and codes 89

because providers can easily put us in the position of doing other things which
we are not entitled to do, we don’t have the training, we don’t have the capacity
to do those things. So I definitely think that defining those boundaries should be
part of this professional business.” (Participant 16,18–01)

CHIA’s position on the topic of boundaries is very clear: interpreters shall be

impartial, accurate, and complete in their interpreting and fulfill one of the
prescribed four roles. This implies that they must not create other expectations
about their role.

6. Discussion

As evidenced by the data, interpreters are concerned with standards that con-
tradict the policies of their employers and agencies. This concern poses several
questions for CHIA as well as for other professional organizations engaged in
developing codes of ethics. Specifically, how can interpreters reconcile the ethi-
cal principle of impartiality when it seems to contradict the policies of many
healthcare institutions and interpreting agencies? What should they do in such
cases? Can the Standards ever be aligned with the many different policies of
healthcare settings or are they destined to exist in isolation? Can the Standards
supersede institutional policies? Can they ignore these policies? These are not
easy questions, but until they are addressed, interpreters will continue to be
caught between their desire to follow institutional policies and to comply with
the Standards. The complexity of the interpreter’s role has been thoroughly
studied and documented (Roy 1989; Wadensjö 1995, 1998b, 2002; Angelelli
2000, 2001, 2003, 2004a, 2004b) and any attempt to prescribe what role inter-
preters should assume must take into consideration the situational reality of
their working environments.
To complicate matters, interpreters as individuals and as members of a
profession have their own expectations of a professional association. They look
to their organization to provide answers to all their questions, and to be in
charge of implementing standardized practices, conducting standardized tests,
providing guidance on educational opportunities and defining the content of
a certification program. These expectations may not be realistic, given the lim-
its on what a growing professional organization can accomplish. Additionally,
CHIA, like many other professional organizations in the field of interpreting,
is made up of hard-working and dedicated volunteers, either practicing inter-
preters or interpreting-service administrators or managers, who may not have
90 Claudia V. Angelelli

the expertise in assessment or in pedagogy to undertake such tasks. In fact,

medical interpreters have a range of educational backgrounds, with some hold-
ing a master’s degree in medical interpreting4 and others having received no
education in the field. Many have received some sort of training, varying from
over-the-phone classes on medical terminology to a 40-hour, mostly English-
based training session. Some have also received limited instruction in the poli-
cies of their home institution or agency.
The diversity in how boundaries and roles are conceptualized can create
confusion for the interpreters. It would be unrealistic to expect that CHIA
alone could resolve these complexities, since this would involve developing a
research agenda to grapple with problems that have long plagued the health-
care interpreting arena. It would, however, be realistic to ask CHIA (and other
organizations in the field of interpreting) to begin grounding their guidelines
in research.
In all fairness, CHIA cannot be expected to fulfill all of the interpreters’
expectations. As a young organization, it has made a great contribution to the
California healthcare system with its attempts to unify and standardize inter-
preting services, and by its very existence, has boosted the morale of many
interpreters by serving as validation of the profession as a whole. Indeed, CHIA
should be applauded for considering the Standards as work in progress, and
taking the step of initial validation. Although the results of this study are not
conclusive, they are certainly steps in the right direction. CHIA has provided
interpreters with a place to voice their opinions, concerns and suggestions, at
a crucial time in the process of creating unified Standards of Practice. What
remains is to expand upon these valuable efforts and results, generating a wider
dialogue on issues such as role, expectations and ethics. Combining research
with the experiences of healthcare interpreters can truly advance the develop-
ment of the interpreting profession.
Like any organization operating in relative isolation, CHIA can only do
so much for the profession. The healthcare interpreting profession also needs
support at the state5 and federal levels. It must grow in line with the results of
empirical research (rather than anecdotes or prescriptions) and with the help
of healthcare interpreting organizations such as CHIA, making a valiant ef-
fort to address the underlying tensions that healthcare interpreters face in their
work environment.
 Validating professional standards and codes 9

7. Conclusion

This study has revealed several areas of tension relating to the role, ethics and
expectations of the healthcare interpreting profession and underscored the im-
portance of developing codes and standards in accordance with research and
scientific evidence. Interpreting standards have traditionally been developed in
response to the needs of the healthcare system. Without empirical grounding,
standards turn into professional ideology, and as the examples presented above
demonstrate, this professional ideology may be at odds with the reality of the
workplace. Although it is undeniable that the Standards are a very important
and long-overdue document, they are not and should not be considered a fin-
ished product, but rather as a step in the right direction. The Standards should
be revised periodically to account for new findings in research (e.g. on role,
ethics, boundaries and expectations). The desire to cope with the immediate
need to professionalize carries with it the risk that other organizations will con-
tinue to follow standards of practice and professional ethics that are not based
on empirical evidence. Those of us who are deeply concerned about healthcare
access for linguistic minorities must understand the reality of healthcare inter-
preting in its broadest context. We who work in the field of healthcare inter-
preting must ask ourselves whether this emerging profession (like any other)
can afford to be based on prescription, personal opinions and anecdotes, rather
than on research. The obvious answer is that it cannot.

Notes

. Special recognition goes to fellow Committee members Ann Chun, Elizabeth Nguyen,
Niels Agger-Gupta, Carola Green, Linda Haffner, Marilyn Mochel, Linda Okahara, Betariz
Solís and Gail Tang for their work in co-authoring the documents.

2. In 2004 CHIA changed its name to California Healthcare Interpreting Association, in

order to include all parties concerned with the relevant issues of the interpreting profession,
not only interpreters themselves.

3. The San Diego Chapter was established in November 2004.

4. At the time of writing, there was only one master’s program in Health Applied Linguistics
and Health Interpreting in the United States, at the University of North Texas.

5. CHIA has benefited extensively from the generous support of The California Endow-
ment, which provided initial funding to establish CHIA, support for the writing and publi-
cation of the Standards, and ongoing support for various projects and conferences.
92 Claudia V. Angelelli

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Author’s address
Claudia V. Angelelli
Department of Spanish and Portuguese
San Diego State University
5500 Campanile Drive (BAM 422)
San Diego, CA 92182–7703
USA
E-mail: claudia.angelelli@sdsu.edu

About the author

Claudia V. Angelelli is the author of Medical Interpreting and Cross-cultural Communication
(Cambridge University Press) and Revisiting the Role of the Interpreter (John Benjamins).
Her work appears in Meta, The Translator, the Annual Review of Applied Linguistics, Critical
Link, and the ATA Chronicle. She is the author of the first empirically driven language profi-
ciency and interpreter readiness test for The California Endowment and Hablamos Juntos.
She is Vice President of ATISA, Director of the ATA and of The Consortium of Distin-
guished Language Centers.