Informed consent

The deaf patient/physician/interpreter problem has been regarded from a limited and inadequate perspective, as though the interpreter is simply an enhancement intended to increase the enjoyment and benefit that the deaf person gets from the doctor. A visit to the doctor, however, is not the same as a movie or a church service. Health care is unique.
Of course, the patient requires an interpreter to get the benefit of the doctor’s instructions. But before the doctor can teach the patient to follow a course of treatment, he or she first must diagnose the patient. In most cases, this involves asking the patient questions about symptoms and such other things as general wellness, self-care practices, previous treatments, and family background. Also, for some diagnostic and therapeutic procedures, the physician must get “informed consent” from the patient. For diagnosis and informed consent, the physician requires the interpreter more than the patient does.
(In the case of surgery and invasive procedures, no matter whether the deaf patient has signed a form, he or she has not truly consented to accepting the normal and reasonable risks of the procedure until and unless the physician has first fully informed the patient. That is what “informed consent” means.)
Rejecting interpreters is a foolish liability for hospitals and physicians. It is inconceivable that their solicitors would allow any physician or hospital deliberately and systematically to provide treatments without a thorough patient history and, above all, “informed consent”. Yet physicians treating deaf patients without an interpreter are doing exactly that. If the physician cannot get through to the patient because of a linguistic barrier, they cannot get “informed consent”.

Because of my professional experience in health care administration, I have discussed health care experiences with other deaf people. When deaf patients sign the consent forms prior to surgery, they often do it without understanding them. I have talked to some deaf people who believed these forms were malpractice waivers, demanded by the physician with a monopoly on providing an essential procedure to allow him to goof up at will and with impunity. In fact, many of those people could not be dissuaded from this belief even after I had explained what the forms actually are. Without a certified interpreter, communication between consumer and provider/professional is unreliable, but when the deaf person does not know what he or she has not understood, often he or she does not even know there has been a misunderstanding. When deaf patients request to have information written down instead of trying to lipread, they often receive rudimentary notes, not the same level of communication as people who can hear.
When the deaf patient has made it clear that he or she requires sign language to understand questions and instructions and pre-consent explanations correctly, the physician and hospital or clinic that proceeds with treatment without one would be responsible if the patient failed to provide crucial information about symptoms and other factors that should have been taken into account in reaching a diagnosis, failed to follow instructions correctly, refused an important procedure because of misunderstandings about the consent form, or agreed to a risky procedure and after an adverse outcome claimed ignorance of those risks. I have heard such horror stories arising from lack of communication that I am amazed that we have not yet seen a cover story in Silent News about some doctor paying a huge fine for malpractice instead of a simple access charge under the Americans with Disabilities Act (ADA)!

It is too bad that the interpreter fee is a hardship for the physician. But sending deaf patients to a leper colony without medical care is not the solution. ADA and other human rights and equity laws are based on the principle of spreading across the majority the exceptional costs of accommodating a few. All of the costs of being deaf in a hearing world would be staggering if individual deaf people had to pay them. That is why laws like ADA require doctors to pay a bit, universities to pay a bit, companies to pay a bit, and so on. Because individual physicians balk at their personal economic impact, it might be a good idea for the medical associations to invite physicians to pool their resources and pay interpreter costs communally in order that individual doctors do not pay a disproportionate share for having deaf patients in their practice.

I think we would all look differently at this issue if we recognized that the patient is not the only party in the physician-patient relationship who requires interpretation between ASL and English. If a doctor wanted a non-interactive relationship with patients that allowed her to base her diagnosis and treatment only on laboratory results and physical evidence rather than on communication with the patient, she should have become a veterinarian.

NEWS!

See what the Supreme Court of Canada recently had to say in Eldridge v. British Columbia (Attorney General).