Is this truly a right?

During my time living in New York City, I worked at several different hospitals at various points.  One of them was a Major City Hospital with a massive and very well-regarded emergency department.  Being a famous emergency department in a Major City Hospital, we got lots and lots and lots of very interesting patients.  And being in New York City, said patients hailed from all over the globe and came from all kinds of cultures.  It was for this kind of experience that I chose to spend that particular time working at that particular hospital, and I have no regrets about doing so.

Before I proceed with the remainder of the post, I should pause and make something as clear as I possibly can.  I have absolutely no problem with immigrants, and am in favor of a much more liberal (and, as I understand it, libertarian) immigration policy.  I had no direct relatives in the United States before the turn of the last century, and were it not for immigration I would not be here.  I think immigrants are part of what makes this country great, and feel we should be a much more welcoming country to immigration.  What criticisms I may express henceforth should not be taken to mean I want immigrants to go away: I do not.

So, back to the ED at Major City Hospital in New York City.  As I said, we got patients from all over the place.  Many of them spoke little or no English.  Spanish speakers posed little difficulty.  I speak a little Spanish, and got pretty good at medical Spanish by the end of my time there.  Plus, there were lots of coordinate bilingual Spanish speakers in the department.  Much more problematic were other languages.  I had many patients from China who could not tell me in English whether they spoke Mandarin or Cantonese, such that I eventually got an index card that asked in Chinese which language they spoke and asked them to point to the correct language so I knew which translator to obtain.

Which brings me to what triggered this post.  I had reason to be in a hospital the other day, and I saw the sign displayed above.  (It was not a hospital where I am on staff, though I have seen a similar sign in affiliated hospitals.)  It advises patients that they have the right to an interpreter, and advises them to point out the language they speak from a pretty comprehensive list.  When I was at Major City Hospital, finding an interpreter generally meant using a special phone to dial up a translation service.  I couldn’t find a reliable figure for what using such a translation service costs, but I got the distinct impression that it ain’t cheap.

Is it horribly xenophobic to question whether it is truly a right to expect a translator when you go to the hospital in a country where a different language is spoken?  If you speak Cape Verdean Creole, is it really contingent on the hospital to obtain a translator for you?  Do hospitals in other countries have a similar understanding of their obligations?  Is it unreasonable to expect patients to bring an English-speaking friend or family member with them to translate if they speak an obscure language?

Do I believe hospitals should make every effort in understanding their patients?  Of course I do.  In the course of delivering care to their patients, I would hope that hospitals would try to obtain a translator as often as is necessary.  It is not with providing translation per se that I have a problem.  It is with describing such a provision or courtesy as a right.  Doing so locates the obligation to provide a translator with the hospital, when I think it should rest with the patient.  If a patient cannot bring someone to interpret, I would hope the hospital would do its best to find one.  But for hospitals that lack the resources to provide that kind of service, I find it troubling to describe that situation in terms of rights being violated.

I can only imagine how disorienting it would be to move to a different country.  Heaven knows, when I was merely a tourist in India I was completely overwhelmed by seemingly small tasks like trying to get from place to place.  (Should any of you find yourself in my company at some point in the future and wish to hear a meandering tale of my own hubris and subsequent humbling, I would be happy to tell you of my trip to see the Taj Mahal.)  I would want America to be as welcome as possible to those who come here seeking a better life for themselves.  But I question whether certain accommodations are truly things to which everyone is entitled, or if thinking of them thusly shifts certain obligations from the individuals who should be shouldering them onto other people.

As always, I welcome your thoughts.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. I don’t think it should be a right, but pantomime medical interviews with patients are a joke. Even with interpreters, I do not think I provide quite the same level of care. The language barrier, is a barrier.

    With that said, if I chose to live in another country, I think the expectation is I would learn the language and at least how to coexist without offending the locals. For some reason, we here are expected to bend over backwards for whatever ridiculous cultural peccadilo is foisted upon us. And if we don’t roll with it, are labeled culturally insensitive.

    • No doubt about pantomime medical interviews or care delivered via interpreter. I hope I made it clear that I would want hospitals to provide translation as much as is feasible. I just think calling it a right is a bridge too far.

      • Whether or not you want to call it a “right”, the onus should be on the hospital to provide a translator. It’s in the best interests of the patient, the treating physician, and the institution.

        If I were a doctor, I would consider it my right (or whatever) to have the hospital provide a trained interpreter or professional translation service for patients who couldn’t speak English. I wouldn’t want to be responsible for treating a conscious, mentally competent adult who couldn’t give informed consent. I wouldn’t want to be responsible for giving a medication to someone who couldn’t tell me whether they were allergic to the drug.

        Sure, some patients bring their loved ones to interpret, but they shouldn’t have to. What if a grown patient doesn’t feel comfortable relying her private medical history through her mother? What if the mother doesn’t understand medical terminology? How do I know if the family interpreter is filtering or biasing the information she’s relaying to the patient?

        The patient should be empowered to say, “I brought my bilingual Mom with me to the ER for moral support, but I want a professional interpreter.” Whether you call that a right or not is just semantics.

        • If you call it a “right”, then the onus is on the hospital to find funding to pay the translators. This frequently means laying off nursing staff or other cuts in central personnel.

          • In my mind , this is just another service that is NOT directly related to health care. You don’t have a right to it and if communication failure results in a negative outcome it is NOT the fault of the hospital or doctor.

            But even saying it is your RIGHT to have a translator does not mean that the hospital has to provide it. I have a right to bear arms but no one is going to just give me a gun. I have to buy it myself.

            That said, it is a very good idea to have this service available. But it should be billed as any other service should be. It can cost quite a bit to find someone to translate some obscure language. Someone who has managed to learn the local language should not have to pay for those who have not.

            And, yes I know that this is NOT how the system currently works.

    • “With that said, if I chose to live in another country, I think the expectation is I would learn the language and at least how to coexist without offending the locals. For some reason, we here are expected to bend over backwards for whatever ridiculous cultural peccadilo is foisted upon us. And if we don’t roll with it, are labeled culturally insensitive.”

      I think I mostly agree. But in addition to not being sure of which “small, relatively unimportant offense or sin” is being foisted on doctors, I also wonder at how long it takes enough fluency to be able to speak with a doctor about one’s medical trouble.

      For example, I have a pretty strong working knowledge of French. Although I’m not fluent, if for some reason I were to move to France, my knowledge is probably enough to meet the standards of “well, if he wants to live here, he should learn the language.” But I’m not sure I know enough of the intricacies of the language to be able to adequately describe what hurts and to what degree and where my pain is on a scale of one to ten if I were to find myself in a French hospital. I’m not convinced that the hospital would then have the obligation to provide an English translator, but I do think optimal care would probably require me to have an English translator.

      What I’m trying to say is, someone can make a good faith effort to learn the language, and go a long way to learning it, but then still need a translator when it’s really important. Again, I don’t think that means translators are a “right.”

  2. Yes. a translator is an absolute right. However, it need not be on their schedule.
    Otherwise you get people getting committed to mental hospitals merely for not speaking the local language (and then being left there for upwards of ten years)…

    I’ve been in other countries often enough to know that I would want an english-speaker around, if I needed to be treated. And I often did not have a well-spoken native around.

    Amend: If the doctors are capable of creating enough understanding with the patient without the use of words, then… yeah. How do you get informed consent for a procedure? How do you get from “umm… belly pain” to “is it shooting, throbbing, etc?”
    Yeah, I think any doctor who is expected to treat (on a non-emergency basis) people without a translator needs special training.
    Note: it seems like a call to the local embassy might be enough to drum up a free translator, wouldn’t it? At least for the really oddball countries…

      • You’ll note that I haven’t put much of a time limit on when the hospital needs to get the translator there. I can certainly think of a 30 day inpatient stay, where you were able to get the translator on the phone once, after a week.

          • No, but when one uses an emergency department, one doesn’t hold the same expectations of care.
            1) the potential for patient being unconscious or otherwise unable to give informed consent is relatively high.
            2) the ability for a doctor to determine what’s wrong is, in some cases at least, not language dependent. And, importantly, I think (and I might be wrong) that the chance for a SEVERE medical error based on the patient/doctor being unable to communicate goes up over time… (if only because “patient wishes to leave room” may transform into “patient attempting to escape room/hospital”)
            3) it’s unreasonable to ask for a translator to be instantaneously available for every dangnab language out there!

  3. In some sense, there is a uniquely American wrinkle in that we don’t have A language. With no official language – and I am resolutely opposed to enshrinement of one – it becomes somewhat more difficult to outline explicitly what the rules of the road are.

    Now, that said, a private hospital should have a fair amount of leeway in deciding which languages you have a right to expect spoken there. I don’t know anything about the legal environment here – is there really a state-imposed mandate about a right to a translator?

    • ~looks up~

      ~looks down~

      I’m pretty sure Americans ~have~ a language. The problem is that like so many other issues, we can’t talk about it because “The other guys” turn an opinion on it into some kind of political commentary on your opinions of immigration and your inherent racism. Team Red and Team Blue both do it…

  4. My wife’s previous employer, in a major and diverse metropolitan area, simply had a phone service for it. The patient calls in, they find the translator, the translator then calls the phone the doctor is waiting at, and they talk. With a central phone bank in Florida, it seems really quite economical. I’d need a good explanation as to why this represents an undue burden before giving a hospital a pass on it.

    Not that I think it should be a legal requirement, but it is something that should be strongly encouraged to the point of giving hospitals (unless they’re in Salmon, Idaho or something) a pass.

    • This is a similar system to what we used at Major City Hospital. Again, I do not know how much it cost, but I got the distinct sense that using the translator phone was pricey.

      If anyone knows how much this service actually costs per minute, I would be genuinely delighted to learn. I couldn’t find a reliable figure despite my mad Google skillz.

  5. Officially *NOT* having an expectation of speaking a particular language means that you can’t have an expectation that a particular language will be spoken.

    The countries that have language laws make reasonable accommodations, I’m sure, to speak to patients who don’t speak one of the several official languages, but, at the end of the day, the existence of language laws provide a shield for the hospitals insofar as they officially get to say “Sie sprechen deutsch in was?” “Was?” “DEUTSCH, MATERFICHER!” instead of merely saying it unofficially.

    • “Officially *NOT* having an expectation of speaking a particular language means that you can’t have an expectation that a particular language will be spoken.”

      I don’t think I agree. I agree a hospital would be on firmer grounds if it’s translation-provider services fall up short if there were a legally official language. But I don’t think we can credibly say that the expectation is not there just because there’ s no official language. If English is the dominant language spoken in the country, then one might expect–and I suspect non-English speakers in the US are reminded daily–that the default expectation is usually that one speaks English.

      There are enclaves, to be sure (I live in a Ukrainian and Polish speaking part of town), the default outside these enclaves, and to a large degree within, seems to almost always be English. Or if the non-English language is sometimes the default language–as what appears to be the case in some Spanish speaking neighborhoods in Chicago–then English is the assumed fallback.

      • It’s probably a safe assumption that English is the assumed fallback and our downright liberal immigration policy has done a very good job of maintaining it as such… having people who speak Tagalog and French and German and Chinese and Russian and Portuguese and Farsi and Urdu and Japanese all show up in the same city is a great recipe to have everybody just shrug and say “hell with it, let’s speak the same language as they do on the television shows that made us want to move here.”

        That’s all an organic consensus, though. The packaging on more and more products in my local store is trilingual anymore (NAFTA, baby) and goodness knows what tomorrow will bring. God knows, Europe is making me wonder whether German is going to make a comeback soon…

  6. I think this shows the poverty of our political language.
    We (meaning liberals mostly but conservatives on occasion) like to define things as “rights”, partly because rights tend to be such absolutes and political trump cards.

    So things like health care generally, and multi-lingual ballots/ services/ interpreters/ contraception/ day care end up being discussed like this, at the first-principal Constitutional level.

    As much as I support single payer health care, I am much more amenable to seeing it in the context of a larger community ethos of obligation and committment.

    “Rights” oddly enough frames things in the “every man for himself” logic whereby I can walk into an establishment and demand this that or the other thing as a contract deliverable. An entitlement, with no reciprocal obligation or engagement.

    This was orignally way back in the 1970’s what caused me to embrace conservatism- the view as I had it, of the liberal vision of society as being nothing more than squabbling interest groups fighting for a share of the pie, without the collective concern for the commonweal.

    • I agree about the overuse of “rights.” I think it’s partially a result of the logic that a “right” can be legally enforced by the courts while an “ethos of obligation and commitment” is a combination of best practices and positive law.

      • Very true- we don’t really have the language or cultural framework for such a system.

        Cultural conservatives are actually very correct in their stressing of how culture produces tangible societal effects, influencing wealth, poverty, crime, and general happiness.

  7. I’ve used a phone translator service and it works pretty well. While i don’t know how much it costs its seems like something every hosptial should have easy access to with the number clearly posted. A right??? Americans love to talk in terms of rights which i don’t think is helpful or often relevent. Yeah it locates who is repsonsible for what but it also ends up in self-rightous arguments and trying to devine whether the sainted founders intended hosptials to have use a phone translator line. Talk about whether its a good idea and if so how to go about it. I know that brands me as a liberal but so be it.

  8. It seems like subtle marketing to me. This hospital claims its patients have a “right” to these translation services, so a patient who needs such a service needs care again, they’ll go there again or risk being surprised by a hospital where their “right” is not respected.

    • This is more or less my take as well. I’ve seen retail outlets with a sign along the lines of “our customers have the right to prompt, courteous service” — so to me it seems more likely that the hospital’s sign is just advertising company policy with a bit of salesmanship thrown in rather than an assertion that translator provision is a moral right.

  9. i dunno about right, but it’s definitely a necessity. it’s not particularly cheap, but the costs are per-call as well as a retainer for the institution/system i work for in nyc, which wraps into other translation services for print materials, etc. the bulk of what we end up using is spanish, but also some hebrew, russian, etc.

    nyc law, and perhaps nys, require translation services be available to all patients. has been this way since at least the last decade.

  10. I don’t know if it’s a right out here in DK, but I know that they have implemented having translators available at the major hospitals here too.

    This is in response to a hospital being sued for the death of a young boy who had swallowed a battery – the parents tried to tell the attending Dr. what their son had done, but he couldn’t understand them or didn’t believe them – and he discharged the boy without further tests.

    Because Danish is NOT an easy language to learn, especially for folks from the Middle East or Asia – implementing translators was in the best interest for everyone. They even have video conferencing for translators now, if there isn’t a specific language available at the hospital.

  11. Google Translate now supports a bunch of languages…far from perfect, and the patient would need to be literate, but I could see it being a decent alternative when more expensive options aren’t available. On the other hand, there’s no accountability for poor translation

  12. If we’re willing to spend thousands of dollars on a test or scan that might shed light on one aspect of a patient’s condition, we shouldn’t balk at the cost of a translation service, which can shed light on a virtually unlimited number of important facts about the case.

    Translation isn’t just a nicety or a courtesy, it’s a precondition for adequate medical care. How much is it worth to get informed consent? To learn the events leading up to an accident? To find out that the patient is deathly allergic to penicillin?

    The onus should be on the hospital to take all reasonable steps to secure an appropriate translator, preferably someone who’s trained in medical interpretation.

  13. Were I to fall ill somewhere beyond the Anglosphere, I would not expect to be treated in English. I would hope that an English translator could be found to assist with communications. But I could not reasonably expect or demand one.

    Here in the U.S. it’s a little different in that there is no official language but I think it’s very much the expectation on the part of anyone that the dominant language here is English and there should be no expectation that anything but the dominant language will be spoken for any transaction of significance. And that’s where it should rest — such an expectation should not be enshrined in law, one way or the other.

    As for hospitals, where good communication between patient and caregivers is a necessity, Big City Hospital’s solution of an on-call translation service is the way to go. Add the cost to the bill — it’s better than a dead patient.

    • “Here” is actually a word that conceals more than describes, er, here (in this case). In this case, “here” is New York City, which, especially in this regard as to languages spoken, is more than just a little different from just any old place with an official language, that difference being merely that difference in the formal law. No, New York City is New York City. It’s a lot different when it comes to the reality of labguages spoken on the ground. Cairo, Illinois may be (may! be) closer to just the little bit different that you’re saying things are “here.”

      I don’t think it’s clear that what may hold with regard to what the law might-should (not) have to say about how hospitals must address these different realities on the ground will be the same in Cairo, Ill. as it will be in New York City.

  14. So yesterday my Mexican neighbour A’s keys were stolen and wants me to watch his apartment. He lives with another Mexican, B, who was at work. A comes running over to my place, tells me the story. I call the landlord. I have A call B, talk to him.

    An hour later, B comes pounding on my door. “They’re fleeing!” he shouts. He’d gone to sleep, the thieves unlocked the door, he surprised them, they fled. So I call the cops and the landlord again.

    So I’m there with this poor cop, translating, writing out the police report in English. The nearest Spanish speaker worked in the jail in Eau Claire, 18 miles away, at least.

    Then I look at the kitchen table. Three cigarette butts in an ashtray. Neither A nor B smoke. I tell the cop “There’s your DNA, A and B don’t smoke.”

    Now things get interesting. Turns out the thieves were B’s friends and they had been in the apartment before, though I know A has been barred off the property as a condition of probation. If C wants to enter A and B’s joint domicile, it becomes a civil matter, no longer criminal. I don’t believe about half of what B was telling me and neither does the cop. The discussion ends up like this:

    “So if these people return, I want you to call 911 and say, in English ‘2-1-7 Brown Street, Apartment 2’. Now say it for me.”

    Comedy gold results. Turns out B has been living in the USA for three years and can’t even say his own address, in English. It occurred to me, I’ve been living next to these guys for over a year and it never bothered me before, that I was the one speaking Spanish and they never spoke English to me. I get so mad at B. I tell him “I’ve stuck my neck out for you, convinced this policeman not to get immigration involved, written out this report and taken three hours out of my work day, only to find out it’s a about half the truth …. doesn’t it embarrass you even a little that you can live here and not learn so much as one word of English?”

    And he sits there like a sack of cornmeal.

    • B’s language skills are rather beside the point. He should be embarrassed for taking advantage of you.

  15. The local CVS has a similar sign. I haven’t seen it elsewhere, but I am very rarely at the pharmacy counter. I’d be *shocked* if even half those languages were spoken in my town, let alone spoken b pharmaceutical employees at that CVS. I have to assume there is a call-in line.

    As to the rights question… Tricky to answer. Is a translator a right? Not anywhere I’ve seen. But is quality heath care a right? Many would argue so. If a translator is a key component of quality health care, it would follow that access to one would be a right, or at least a necessary extension of one. Of course, if you reject quality health care as a right, it quickly falls apart.

    • Pretty much this. In general, nobody has the right to conduct a conversation in the language of their choice. But insofar as patients at the hospital have a right to effective medical care, and insofar as effective care demands translation, they have a right to such translation.

      It would be different, I think, if translation services of the sort discussed above didn’t exist or weren’t practical. But when you can just press a few buttons on your phone and be connected to someone who can translate your English into Pashto or Hmong, then it’s pretty reprehensible to not do so in the case of a hospital visit.

      Sure it isn’t cheap. But I bet it’s cheaper than most of the various and sundry medical procedures you use to diagnose and treat the patient. You wouldn’t demand that the patient provide his own X-ray because it’s expensive and inconvenient for the hospital to do so. Why demand the the patient provide a translator, who is just as vital to the patient’s health as the x-ray?

  16. A big problem is that family members or self-proclaimed bi-lingual staff cannot be relied on to translate accurately and properly. A LOT gets lost in poor translations. Trained and credentialized translators will pay for themselves in care outcomes. Fluency is a spectrum, and even reliably bilinguals will SURELY be weak in medical terminology unless they have specialized training.

    Relying on bilingual staff or, worse, family members is the linguistic equivalent of driving in the dark without headlights.

    Letting people know they have a “right” to a translator is probably not a good approach. They should be instructed that it is medically recommended that they avail themselves of the services of a PROFESSIONAL translator.

  17. I see no translator services for Mushmouth, Lisp, Mumble, or Incomplete Sentences.
    I see more of people that speak those languages than any listed on that sign.
    Discrimination, obviously.

  18. When one starts seeing Healthcare as a “Right” rather than “A Service Someone Else Provides”, one starts seeing all sorts of little strings attached and one is usually quite surprised where the obligations from these emanations from the penumbras also fall.

  19. A pseudo-right is what you get when you take money from the federal government. So if you like the “right to a translator” you’re gonna love ObamaCare. But then hospital ERs are already drowning in red ink from having to take all comers and treat them for free. So what’s it’s gonna be, another death squad or a tax increase.

      • Well, I’d say we have to have both, these death squads ain’t gonna pay for themselves. 😉

      • Sorry, it was way to early in the morning for me to be commenting. Unlike the federal government, doctors and hospitals are not allowed to just print money to pay the bills. They have to get paid by somebody from somewhere to pay for all those expenses like, staff, electricity, etc. freebies courtesy of federal requirements like translators and ER visits for which they receive little or no compensation. So the feds will have to step up and make more pretend payments for these mandated services, but “oops” they don’t have any money either so they will have to either cut services by not allowing treatment of certain classes of patient/illnesses, or mandate less expensive but not as effective treatments and/or just raise taxes on the 49% who still pay taxes.

        My favorite stir the poopie solution is to just conscript all the doctors and force them to work for slave wages (which if you do the math on current solo and small practices that take insurance, medicare or medicaid is pretty much what happens already). This gives me flashbacks on all the doctors I worked with in the 70s who came to America from Britain and Canada, etc., to escape national health care and apparently what a futile gesture it was.

  20. Is it possible that these translation service companies are marketing themselves to hospitals telling the administrators that they have a legal obligation to provide translation services, and no one has checked to find out whether this is true or not?

    My brother works for a major US bank. They started getting phone calls from people claiming to work for “Visual Translation Services for the Deaf”. They would say, I have one of your customers on video conference with me, they want to do some banking business. The bank was very reluctant to do business this way. For one, they started to have fraud. The translation service was claiming to do business for customers who weren’t deaf. There is no list to tell the bank who is a legitimate translation service and who is a scammer.

    The bank started refusing to accept the calls and referring the callers to their TTY service. A deaf activist organization filed suit. It was the “right” of deaf people to communicate in any manner they wanted and if the bank was experiencing any fraud, they just had to suck it up.

    The bank offered to setup they own visual translation customer service center, offer refused, they asked if they could flag customer’s accounts to indicate that the customer had given preauthorization to use these services, refused.

    As it stands right now, the bank has to accept these calls, and do whatever the caller asks, with no controls that they are legitimate companies, or even actually have the client on the phone.

    Some people have created “rights” that didn’t exist before, because they are willing to file lawsuits to protect them.

  21. The last time I was out of the country, American Express provided a call-in emergency translation service to their customers. Doctors and/or hospitals might want to contact them and inquire if they can use this service if their patient is and AmEx card holder.

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