This case depicts a distressing interaction between an attending physician, his dermatologic residents, and a Haitian woman who has limited English proficiency and is suffering from an immunologic skin condition. The attending physician, in an attempt to teach his students, briefly explained in English to both the patient and residents what they would be examining. However, without obtaining explicit consent from the patient, potentially due to her English limitation, he abruptly pulled down her hospital gown, exposing her breasts. The patient’s discomfort was evident as her eyes widened and her arms remained paralyzed at her sides. This essay aims to examine the ethical dilemma surrounding this case, focusing on the violation of the patient’s right to be fully informed and give consent against the beneficence of treating her condition.

Interactions between healthcare professionals and patients from different cultures are increasingly common in our diverse society. Communication plays a vital role in patient care, and linguistic diversity can create barriers that impact the quality and accessibility of healthcare, as well as overall health outcomes. In this case, the physician failed to ensure that the patient understood the procedure being performed. This failure compromises the principles of autonomy, which are core values in the physician assistant profession. The pursuit of beneficence, in this case treating her skin condition and teaching the future clinicians, should not override the importance of respecting patients’ autonomy. It is essential to recognize that communication with foreign language or Limited English proficient patients requires different approaches. The most effective means of communication in this case is through the use of professional interpreters.

This scenario underscores the significance of utilizing networks of professional interpreters who are specifically trained in medical interpreting and adhere to principles of confidentiality, professional objectivity, and neutrality. The use of such interpreters ensures that the quality of communication between healthcare providers and patients who have limited English proficiency or struggle with the language is on par with those who are fluent. In the case described, the presence of an interpreter would have alleviated the patient’s emotional distress. Moreover, it would have guaranteed adherence to medical ethics principles, including autonomy, by facilitating the transmission of accurate information, obtaining informed consent, and ensuring respect for confidentiality and medical privacy. In addition, the therapeutic efficacy of the encounter would have been enhanced, and sufficient time would have been allocated for the teaching session.

However, it is important to acknowledge that professional interpreters are not always readily available, and there may be delays in accessing their services. In this case, if the attending had at least requested one, it possible that he could not find an interpreter, instead of ignored this patient’s right. In such cases, qualified bilingual staff who possess medical knowledge and can clarify crucial points for patient care can be utilized. However, the availability of such staff outside of working hours is limited, and their contribution to this task is often not financially compensated. Another option in certain situations is to engage a telephone interpreter.

To deliver quality care, it is essential for patients to understand their healthcare providers and to be understood by them. Core values of the PA Practice highlight the importance of providing information that is understandable to competent patients. Without effective communication, a solid bond of trust cannot be established, and most importantly, patients cannot provide their preferences, nor consent to care in a free and informed manner. Recognizing that a language barrier can hinder the therapeutic relationship, the PA Practice core values expect all Physician Assistants to exert every effort and demonstrate a genuine desire to communicate with their patients in the

appropriate language. Lastly, it is crucial to remember that patients are our partners in care, and as healthcare professionals, we should treat them with the utmost respect and dignity.

Reference

Gaurab Basu, MD, MPH, Vonessa Phillips Costa, and Priyank Jain, MD. “Qualified Medical Interpreters When Caring for Patients with Limited English Proficiency”.
AMA J Ethics. 2017;19(3):245-252. doi: 10.1001/journalofethics.2017.19.3.ecas2-1703.

Jonsen, A., Siegler, M., & Winslade, W. (2015). Clinical ethics: A practical approach to ethical decisions in clinical medicine. (8th edition).

Guidelines for Ethical Conduct for the PA Profession, AAPA, reaffirmed 2013