The Ethical Principle of Providing Healthcare for Deaf Patients
College of Nursing, Resurrection University
NUR 4242: Ethics in Nursing
The Ethical Principle of Providing Healthcare for Deaf Patients
The deaf community is a vulnerable population with a language barrier when accessing healthcare (Laur, 2017). Due to their condition, deaf patients cannot hear, preventing them from effectively communicating with providers and nurses about their health. According to the American with Disabilities Act, hospitals and clinics must have communication methods for patients and family members who are deaf or hard of hearing (United States Department of Justice, 2005). A sign-language interpreter is trained to effectively communicate with the patient using American Sign Language (ASL). The interpreter is an advocate for the patient and helps communicate with healthcare professionals throughout their hospital stay. This communication includes the patient’s chief complaints, signs/symptoms, tests, medications, procedures, and treatment. When a health care professional overlooks the patient’s condition and does not address the patient’s communication needs, miscommunication occurs, leading to misdiagnosis from the physician or delayed medical treatment. This is a significant issue to investigate because they do not provide a level of standard of care for the patient. There is a breach of ethical and professional duty leading to negligence and lawsuit against the hospital. This paper investigates the
Ethical Dimensions of Limited Access to Healthcare
Limited access to health care for the deaf community is an ethical problem. There are 6 million deaf patients in the United States of America and 38 million people with hearing problems (Laur, 2017). They are not receiving equal access to health care and services as abled individuals. According to the ADA, all locations must have accessibility and proper communication for an individual with a disability (U.S. Department of Justice, 2005). This lack of accessibility leads to health disparities for individuals in the vulnerable population, such as the deaf community for resources, transportation, nutrition, education, advocacy, and health promotion. Furthermore, deaf patients are at a disadvantage because they need additional help and undergo ethnocentrism due their disability. Deaf community has negative connotations and has experienced victimization and discrimination with terms such as, “deaf-dumb”, “deaf-mute” or hearing impaired meaning they do not have a voice and nor have to ability to learn or have reasonable thinking (National Association of Deaf, 2020).
Another ethical issue in the deaf community is communication barriers and whether hospitals should provide accommodation due to additional employer costs. Without additional assistance, deaf patients cannot receive critical health information and qualified health care. Research shows deaf patients make fewer appointments with their general practitioner and fewer prescription follow-ups compared to hearing patients (Laur, 2017). The lack of health information and communication access in ASL often results in deaf people, including those who are educated, scoring lower in health literacy and health knowledge.
Relevance of the Ethical Issue involving Language Barrier and Maltreatment
Deaf patients are at a disadvantage with limited access to health care because there is inequality in the treatment of deaf patients because of the language barrier. Research has shown a lack of training for health care to recognize and provide appropriately for the deaf patient (Laur, 2017). Furthermore, healthcare professionals do not know how to act around deaf community and do not provide compassion nor understanding for the patient. Providers and nurses that assume deaf patients can read their lips and write down notes without additional assistance, such as a sign language interpreter. Without providing additional assistance, deaf patients and families are frustrated because there no intentions in providing benevolence and patient-centered care.
Role of the Nurse
Part of the role as nurses is to provide patient-centered to every individual no matter the race, sex, gender, orientation, religion, culture, and disability. For a vulnerable population such as the deaf community, nurses must provide comprehension, compassion, sensitivity along with additional resources for the patient to understand the care and treatment during their visit (American Nurses Association, 2016). Furthermore, healthcare staff should focus on the diagnosis of the deaf patient versus their condition, to provide autonomy and advocacy for the patient. Ethnocentrism and lack of sensitivity contributes to victimization and lack of providing a rapport for a good patient care relationship. It is vital to educate nurse about promoting the patient’s health and wellness while providing patient-centered care to avoid any mistakes and eliminate barriers to healthcare.
Relevant Ethical Analysis: Moral Principles
Limited accessibility for the deaf community involves the lack of health care professionals providing four moral principles that affect cohesive and ethical decision making: justice, autonomy, beneficence and nonmalifience. Justice involves providing equal, and appropriate treatment due to their condition (Burkhardt & Nathaniel, 2020). When there is a lack of resources or effective needs of communication, there is lack of distributive justice to provide medical services and assistance to the deaf patients. Autonomy is the principle of allowing a patient to make their own decisions about their medical condition and self-determination (Burkhardt et.al, 2020) A patient that is deaf has limited autonomy due their language barrier and being able to express their decisions. Beneficence requires healthcare professionals to provide care that benefits the patients by preventing harm, promoting patient’s health and nonmalifience by removing harm based on a patient’s human rights (American Nurses Association, 2016). Nurses are required to provide beneficence, by having virtue ethics that involve compassion, trustworthiness with the patient, and integrity. When these moral principles are not applied during care, healthcare professionals not providing a standard of care towards their patient.
Standard of Care and Nursing Practice Act
A standard of care/practice is the minimal set of guidelines to healthcare staff must provide to provide competent care as their ethical obligation. For health care professionals, maintaining a standard of care involves patient advocacy and sensitivity no matter the patient’s cultural, social, and ethnic differences or disabilities (Laur, 2017). When healthcare professionals fail to provide a standard of care, the form of breach in their duty to care causing mistakes such as misdiagnosis and mistreatment leading to negligence. For example, healthcare professionals must be able to provide informed consent for deaf patients when providing interventions and treatments. Informed consent involves comprehension of care, risk/benefits and document the patient’s signature. In the deaf community, without providing effective means communication, there no intent of receiving informed consent, the patient is not able to understand their health condition and there is a breach in their duty to act (Laur, 2017).
Violation of Health Insurance Portability and Accountability Act
Along with standards of care, an ethical violation of patient’s privacy can occur often in the deaf community due limited communication alternatives. Health Insurance Portability and Accountability Act of 1996 (HIPPA) is a federal law that protects patient sensitive information from being released with the patient’s knowledge (Center of Disease Control and Prevention, 2020). For example, the healthcare facility may depend on untrained interpreter such as family or friend to communicate medical information to the patient. The untrained interpreter can break the patient’s confidentiality by sharing the patient’s personal information with others and without the permission of the patient. This is a violation of the patient’s privacy and confidentiality between medical personnel and the patient (CDC, 2020). This is a violation that can lead to loss of medical license and jail time. Another part of the HIPPA violation is the patient may not be comfortable sharing the information with family or friends causing a moral dilemma whether the nurse should rely on another individual besides the interpreter to relay information to the patient. Also, the untrained interpreter may not have education in medical terminology to leading to difficulties to comprehend and misinformation (Laur, 2017). Also, the patient may not be comfortable sharing the information with family or friends causing a moral dilemma whether the nurse should rely on another individual besides the interpreter to relay information to the patient Overall, the hospital is responsible in protecting patient privacy, providing resources to limit the accessibility of medical care, decrease barriers to care, train their employees to provide effective care to help deaf patients receive the care they need (U.S. Department of Justice, 2005).
Personal Professional Response
The limited access of health in the deaf community involves the lack of education and how to properly take care of patients with an intellectual or developmental disability. For example, my boyfriends’ grandmother was born deaf and knows ASL. She was diagnosed with lupus during the last stages of her life. When I would go to the doctor with his family, it would be always difficult to accommodate for his grandmother. The nurses would be awkward during the initial patient assessment say words other their breath and assume the patient cannot hear due to her disability. At times, additional resources would be denied such as sign language interpreter and my boyfriend’s mother, would need to be at clinic or there would not be an interpreter due to lack of resources. My boyfriend’s family was always there for her to advocate for proper care from the healthcare staff which should be given without a problem I was shocked by how unethically a healthcare professional would treat an individual with a disability, especially in comparison to how they treat an abled individual. Deaf patients should be provided additional community resources for the patients, their family, and caregivers to benefit the patient’s hospital or clinic visit.
I believe that the healthcare professionals should be able to de-stigmatize patients with a disability. If I had a patient that was deaf or hard of hearing, I would approach the situation by first providing a sign language interpreter, communicating with the family about the patient’s chief complaint, signs, and symptoms. I would not want to make any assumptions, or the patient feel awkward in any way. Furthermore, I would communicate with the interpreter to provide a step by step patient assessment, interventions, treatment, that the patient and family can understand. By taking these steps, I would allow for the patient and family to trust me to provide beneficence, autonomy, and mind-body-spirit care. As a current emergency medical technician (EMT) and a future nurse I will provide more time for a patient with a disability and more patience during my care. I will communicate with the family directly to understand the patient’s condition and provide comfort. Furthermore, I will limit any ethnocentrism or negative judgement towards the patient. I can learn more about my patient their behavior, emotion and lifestyle while working on a nursing care plan to deliver appropriate care. As nurses, being aware of our own actions, how we act, think, can helps improve and become better nurses.
The research behind the topic about limited access of medical care for deaf patients has opened my eyes when learning how to act and provide care to deaf patients. As a child that was never around the deaf community or people with disabilities, I never knew how vulnerable the deaf population is and limited resources available to them. In addition, I never knew about important sign language interpreters are when conveying in medical information to the deaf patient and their family. I was able to learn about ethical and moral principles involved in nursing and how to learn appropriate methods of communication for deaf patients. Deaf patients have developed National Association of Deaf (NAD) and the World Federation of Deaf (WFD) as organizations to benefit the deaf community and provide representation (NAD, 2020).
As a current medical employee and future nurse, we must consider the amount of diversity training and sensitivity involved when providing care to deaf patients. Furthermore, we must have compassion and empathy when working with someone that has a disability. I cannot imagine it being easy to ask for additional help. Therefore, it is important to advocate for vulnerable populations and provide beneficence for the patient. Questions to discuss are: Is there enough training? Should we allow family members to interpret patient information versus a social worker? How we can help advocate for a deaf community? As we think about these questions, we communicate with the community about issued faced in the healthcare setting to provide equality in healthcare.
ADA Business BRIEF: Communicating with People Who Are Deaf or Hard of Hearing in Hospital Settings. (2005, August 11). https://www.ada.gov/hospcombr.htm.
ANA Center for Ethics and Human Rights. (2016, February). The Nurse’s Role in Ethics and Human Rights – ANA Position Statement. https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/the-nurses-role-in-ethics-and-human-rights/.
Burkhardt, M. A., & Nathaniel, A. K. (2020). Ethical Theory. In Ethics and issues in contemporary nursing: nursing ethics for the 21st century (1), (pp. 20–38). Elsevier.
Center of Disease Control and Prevention. (2018, September 14). Health Insurance Portability and Accountability Act of 1996 (HIPAA). https://www.cdc.gov/phlp/publications/topic/hipaa.html.
Community and Culture – Frequently Asked Questions. (2020). https://www.nad.org/resources/american-sign-language/community-and-culture-frequently-asked-questions/.
Laur, A. (2017). Healthcare access for deaf patients – The legal and ethical perspectives. Medico-Legal Journal, 86(1), 36–41. https://doi.org/10.1177/0025817217743416