＜報告＞

JAITS

医療通訳者のための倫理規程―全国標準化に向けての動きー
Naoko Okuyama(Conference Interpreter)

Abstract
As Japan faces a sharp increase in foreign residents and foreign visitors, demand for qualified
medical interpreters has been rapidly rising. Efforts are under way to standardize medical
interpreters’ services across the nation through the creation of a national certification system
and government-accredited training programs. A code of ethics is an essential part of medical
interpreter training, but a nationwide, unified code has yet to be developed for medical or mostother types of interpreters for that matter.1 The paper looks at a US code of ethics for medical
interpreters, developed by the National Council on Interpreters in Health Care (the NCIHC),
and the NCIHC’s efforts to establish a national certification system for medical interpretersand compare those with codes of ethics developed by different parties, and ongoing efforts
toward standardization in Japan.
1. Introduction
A code of ethics for medical interpreters is considered essential around the world. In Japan,
different organizations have developed their own versions, but harmonizing them into anational code is not an easy task, largely because Japan does not have a national qualification
for interpreters, except for national government-licensed guide interpreters.
The Ministry of Health, Labor, and Welfare (MHLW) has made a code of ethics available on
its website.2 It was developed based on the ministry’s 2010 standards for medical interpretingand examples overseas. Furthermore, some academic institutions, medical associations,non-governmental organizations, and municipal international exchange associations have
independently attempted to develop or have developed their versions of codes of ethics. Someof them have developed exams that include ethics questions to certify medical interpreters.
In contrast, Australia has a standard code of ethics, developed by the Australian Institute ofInterpreters and Translators Inc. (AUSIT). The country’s National Accreditation Authority forTranslators and Interpreters (NAATI) endorses and promotes the AUSIT code of ethics. The

OKUYAMA Naoko, “In Pursuit of a National Code of Ethics for Medical Interpreters,” Invitation to
Interpreting and Translation Studies, No.21, 2019. pages 77-85. ©by the Japan Association for Interpreting
and Translation Studies

『翻訳研究への招待』No.21 (2019)

AUSIT code is therefore taught and used in exams as the national guidelines forinterpreter-training programs. In a new credentialing system NAATI launched 20183, it
introduced a new type of certification called certified “specialist interpreters in the medical andlegal” fields. The move underscores the unique qualification that is required for medical
interpreters.
In Japan, the demand for medical interpreters is bound to grow, as the government
encourages the hiring of foreign workers to help make up for Japan’s labor shortage, andpromotes tourism and medical tourism for visitors from abroad. A unified code of ethics for
medical interpreters is therefore urgently needed. Such a code is essential not just forinterpreters but for their clients and medical professionals they deal with. It would giveinterpreters unified guidelines to work from when they encounter all sorts of complex
situations in the medical setting.
To examine efforts to harmonize codes of ethics, the National Code of Ethics for Interpreters
in Health Care developed by the NCIHC in the United States was studied. This particular code
was chosen because the United States, like Japan, does not have a national certification system
for medical interpreters. More importantly, the NCIHC is in the process of creating one. The
presence of a national licensing system and unified exam system would significantly facilitate
the development of a unified code. There must be a host of things that Japan could learn fromthe NCIHC’s work. The NCIHC code was compared against codes of ethics for medical
interpreters currently used in Japan.
2. Study on the NCIHC Code of Ethics
Developing a national code of ethics for medical interpreters was the first of a three-step
approach taken by the NCIHC. Once the national code of ethics is developed by the NCIHC’s
Standards, Training and Certification (STC) Committee, the NCIHC’s next step is to develop
the National Standards of Practice based on the code of ethics that has been developed. Then,
as a third step, it will work to create a national certification system in the United States. The
paper mainly discusses the NCIHC’s first step -- developing a national code of ethics -- but
also touches on the subsequent steps, as these steps are interrelated.
To develop a unified code of ethics, the STC Committee first collected and reviewed
existing codes of ethics in the United States. The committee identified common denominatorsand the most divisive or controversial elements in the codes. It then strove to extract from them
“what are considered morally appropriate behaviors for its practitioners as they perform theirduties.” It conducted national focus groups to review the draft, and elicited feedback through anational survey. It attempted to develop a code of ethics as broad guidelines, not as standardpractices or concrete steps to take in difficult circumstances. Consideration was also given in78

医療通訳者のための倫理規定

this step to make the code of ethics not specific to certain cultures, races, genders or ethnic
groups or religions. In other words, a code of ethics was so developed to be transcultural. It
should be noted that an overarching principle throughout this process is to put the patient’s
welfare and happiness first.
The following are the main body of the NCIHC’s code of ethics:
1) The interpreter treats as confidential … all information learned during the professional
performance of duties.
2) The interpreter strives to render the message accurately …
3) The interpreter strives to maintain impartiality and refrain from counseling, advising andprojecting personal biases and beliefs.
4) The interpreter maintains the boundaries of the professional role…
5) The interpreter continuously endeavors to develop awareness of her/his own and other… cultures in the performance of their professional duties.
6) The interpreter treats all the parties with respect.
7) When the patient’s health, well-being, or dignity are at risk, the interpreter may bejustified to act as an advocate…
8) The interpreter continually strives to further his/her own knowledge and skills.
9) The interpreter must at all times act in a professional and ethical manner.
The aforementioned items that make up the NCIHC code of ethics largely correspond withcodes of ethics studied in the paper, except for the advocacy clause described in (7). Only threecodes4 out of those studied in the paper list advocacy as a role of medical interpreters.
The NCIHC code defines advocacy as follows:“Advocacy is understood as an action taken on behalf of an individual that goes beyond
facilitating communication, with the intention of supporting good health outcomes.
“In the course of their practice, interpreters will sometimes see injustices or ethicallyinappropriate behavior that may jeopardize one or more persons in the encounter or that may
negatively impact different groups within the medical institution. In such cases, interpreters
may find it ethically necessary to take an advocacy role, that is to speak out in their own
voice in order to plead a cause or attempt to right a wrong.” (the NCIHC 2004)
The NCIHC describes the idea of advocacy in relation to medical interpreting a“controversial” one. In its first draft of the code, it ruled out a principle that calls for advocacy.
However, advocacy was eventually included after responses in focus groups clearly indicated79『翻訳研究への招待』No.21 (2019)

interpreters’ need for guidance on advocacy.
3. Study on codes of ethics in Japan with a focus on advocacy
A few Japanese codes of ethics list advocacy as a role of interpreters. Advocacy is one of the
12-point principles in a code of conduct for medical interpreters in the MHLW online textbook
on medical interpreting. The textbook was written by an expert panel5 in line with theministry’s 2017 revised curriculum guidelines and compiled by JME, a Japanese medical
education foundation. The code of conduct says advocacy may be undertaken only when thepatient’s dignity or life is at risk. It says interpreters must use appropriate knowledge andjudgement in undertaking advocacy.
Japan Association of Medical Interpreters (JAMI) includes advocacy of rights in its Code of
Ethics for Professional Medical Interpreters (2011). It says that professional medical
interpreters respect the dignity and rights of all people to live a healthy cultural life and torespect patients’ independence in pursuing it. The clause does not specify the patient as an
object of protecting the rights of but cautions that interpreters respect a patient’s independencein pursuing it.
Some medical interpreters follow a Japanese translation of the Code of Ethics developed by
the International Medical Interpreters Association (IMIA), a US-based, not-for-profit
organization. The code also has advocacy as one of its 12-point principles. It allows
interpreters to engage in patient advocacy “only when (deemed) appropriate and necessary forcommunication purposes, using professional judgement.” It is noteworthy that the code limits
the practice of advocacy to communications, whereas the NCIHC defines advocacy as actions
that “go beyond facilitating communication.”６
The descriptions in the aforementioned codes are much simpler than the NCIHC’s. Making
judgment on whether action that the interpreter is to take is regarded as forms of advocacy
permitted by each code would be difficult if what is written in these codes are the only guide. It
is not clear what sorts of scenarios were assumed when these codes were developed to include
advocacy as one of the principles.
Other codes of ethics that were studied this time, however, do not include advocacy. The
NPO Center for Multicultural Society Kyoto is one of the Japanese organizations that develop
materials for training medical interpreters, educating users, and enhancing social recognition ofthis profession. The NPO has created what it calls Standards for Medical Interpreters incollaboration with another NPO, Multilingual Society Resource Kanagawa（MIC Kanagawa）. The
standards are divided into three categories – knowledge, skills, and ethics. The following are 11

items under the ethics category:80

医療通訳者のための倫理規定

1. Respect for basic human rights
2. Confidentiality
3. Respect for privacy
4. Neutrality and objectivity
5. Accuracy
6. Maintenance and improvement of expertise
7. Building a good relationship
8. Avoidance of establishing personal relationships with users
9. Collaboration and cooperation with health professionals, support association andprofessionals.
10. Maintenance and improvement of health
11. Maintenance of good behavior
All items listed above largely correspond to ideas incorporated in the NCIHC code of
ethics except for advocacy. Mizuno and Naito (2019) state that act of advocacy goes against
the principle of neutrality and impartiality required for interpreters, but the treatment of
advocacy in the code of ethics for medical interpreters is different among countries andorganizations. Mizuno (2005) also states that there is no wonder why advocacy is stressed in
medical interpreting, where the patient’s health and welfare comes first, even though it isoutside the roles of interpreters. Given the situation like this, whether to include it in a national
code of ethics, if established, would be controversial.
International codes of ethics for general interpreters were also studied as a reference. The
AUSIT Code of Ethics, the Australian unified guidelines, specifically rules out advocacy fromthe boundary of the interpreters’ roles, as explained in “Code 6: Clarity of Role Boundaries.”“The focus of interpreters and translators is on message transfer. Practitioners do not, in thecourse of their interpreting or translation duties, engage in other tasks such as advocacy,
guidance or advice.” (AUSIT 2012)
The International Association of Conference Interpreters (AIIC)’s code of ethics, which is
not specifically designed for medical interpreters, does not explicitly ban advocacy, but there isno mention of advocacy either.
Based on these existing codes, therefore, it is presumed that if advocacy is to be required asa role of interpreters, it would be uniquely for medical interpreters. Even in that field, whether
interpreters should argue for the patient’s rights on their behalf to protect their health and rights
is apparently still debatable. The following strict conditions the NCIHC attached to the81

『翻訳研究への招待』No.21 (2019)

undertaking of advocacy by medical interpreters suggest the controversial nature of this role.
“Advocacy must only be undertaken after careful and thoughtful analysis of the situationand if other less intrusive actions have not resolved the problem.” (the NCIHC 2004)
4. Path to a National Certification System
The NCIHC has already completed its second step after having developed a code of ethics
for medical interpreters as general guidelines. It created the National Standards of Practice forInterpreters in Health Care in 2005 based on the code of ethics, using available state-levelstandards as a reference. The National Standards of Practice equip interpreters with the bestpractices that they should follow based on the principles in the code of ethics. It says thestandards are to be used for training, hiring, and performance monitoring. It also says thestandards provide the basis for discussion on the merit of the certifying process of professional
interpreting competence. The development of the standards enabled the NCIHC to move onto
its third and final step of establishing a national system to assess qualification of interpreters.
Japan’s approach to a unified medical interpreting code of ethics and a broader
standardization of the service appears to be less organized than the NCIHC’s approach.
However, it covers most elements that are required in achieving the objectives. Activities
equivalent to the NCIHC’s second step have also taken place in Japan, such as discussing bestpractices in the field but not in a way to build consensus for their nationwide application.
Pioneering activities are being undertaken by the International Society of Clinical Medicine(ICM), a Japanese corporation that promotes international cooperation in clinical medicine. It
is presently spearheading an effort to create a national certification system for medical
interpreters in Japan. It aims to start registering certified medical interpreters in January of2020. It has been working with the MHLW in line with the MHLW’s study on the creation of anational medical interpreter certification system. There are three conditions that interpretersmust meet in order to become registered as government-certified medical interpreters. First,
applicants must pass an exam conducted by organizations designated by the ICM. Second,
applicants must have taken a medical interpreting course that is developed based on the
curriculum guidelines provided by the MHLW. The guidelines call for allocating at least ten
90-minute classes on ethics and communications out of a course consisting of at least fifty
90-minute classes. Heavy emphasis is placed on the ethical conduct of medical interpreters.
Exams required for certification, therefore, would test whether applicants are capable ofresponding to various challenging situations based on one code of ethics. Third, they must takea seminar held by the ICM at the time of registration.
Initiatives by the ICM have finally paved the way for creating a platform for providing82

医療通訳者のための倫理規定

standardized, quality medical interpreting services in collaboration with the government. Whatis important at this stage is to make sure the ICM’s initiatives have the support of all
stakeholders involved.
Some stakeholders have contributed to the process. The MHLW online textbook that covers
a code of ethics was written by JME, and compiled by an expert panel advising the MHLW,
whose chairperson is the head of NPO Center for Multicultural Society Kyoto. The ICM
invited public comments in 2017 on its planned introduction of the certification system.
Fifty-one people who contributed comments included 23 who belonged to medical interpretingorganizations, seven from higher education institutions, and six from hospitals and clinics. The
contributors had only a few active interpreters and no municipal government officials. Sincemunicipal governments are on the front line of dealing with foreign residents in theircommunities, they would have to be involved in this process.
The fact that the current ICM board members do not include active practitioners is also a
concern. The board is headed by Yoshiki Sawa, a professor of cardiovascular surgery at Osaka
University Graduate School of Medicine. It also includes nine other academia in the medical
field. The remainder of the board are medical researchers. One of the members on board is St.
Luke’s International University Professor Tsuguya Fukui, who is also the head of St. Luke’s
International Hospital in Tokyo. The hospital provides free telephone interpretation services
although medical interpreters are not available on site except for an English-speaking staff toassist foreign patients.
The concern about who should be in charge of a medical interpreter certification system
stems from the NCIHC’s experience of changing the party to lead its standardization initiatives,
after it found out the party that had led the efforts until then was inappropriate. In 2009, the
NCIHC set up the Commission for Medical Interpreters because it determined that thecommittee structure at that time would not be able to deliver a proper national certification
system. It instead formed the committee “by interpreters and for interpreters.” The NCIHC
cites neutral leadership as one of the guiding principles in the development of a national
certification system. It says it is “imperative” that a national dialogue be led by a neutral party
whose primary interest is the well-being of those in need of interpreting services.”
Similar calls have been made in Japan and Australia. In a 2016 research report on
certification of medical interpreters by the MHLW7 also recommends that a third-party bodywith no conflict of interest in certification be set up to run a medical interpreters certification
system. It also suggests that a certification exam be developed by experienced medical
interpreters. In Australia, NAATI also separated training delivery from certification testing in
the new credentialing system.
At a certain point in near future, this issue should be revisited to make sure any of the83

『翻訳研究への招待』No.21 (2019)

stakeholders’ interest is placed ahead of the others.
4. Summary
The NCIHC code of ethics for medical interpreters has been studied in comparison withcodes of ethics that are being used in Japan. The paper focused on advocacy as a role ofmedical interpreters, as it is outside the traditional job description for interpreters. The researchsuggests the issue remains debatable and that further study will be needed to determine
whether advocacy should be included in the event a unified code of ethics is developed.
The ongoing effort to establish a national certification system reinforces the need for a codeof ethics that applies to all medical interpreters in the nation. It is hoped the work toward
standardization will facilitate harmonization of the current codes of ethics and best practices
developed by different organizations. Under the leadership of the ICM, the registration ofnationally certified medical interpreters is set to start in 2020. It is hoped a unified code of
ethics will be developed in time. In the meantime, the interests of all stakeholders should beconsidered before the plan is finalized so that the standardization would benefit all
stakeholders including the patients, health professionals and medical interpreters.
..........................................................................
【著者紹介】
奥山奈穂子 (OKUYAMA Naoko) 会議通訳者・放送通訳者・翻訳者。NHK グローバル・メディアサービス国際研修室通訳講師。クイーンズランド大学日本語通訳翻訳修士。
...................................................................................

Notes:
1) Sign language interpreters have the Ethical Guidelines of Japanese Sign Language Interpretersdeveloped by Japan Association of Sign Language Interpreters since 1997.
2) The MHLW code of ethics is contained in its online textbook on medical interpreting (2017, p.99).
3) NAATI shifted from the accreditation system to a certification system.
4) The three codes that included advocacy are the MHLW code of ethics (2017), “Standards for Medical
Interpreters” by NPO Center for Multicultural Society Kyoto, and the Code of Ethics developed byInternational Medical Interpreters Association (2016).
5) The chair of the committee was Aguri Shigeno, the head of NPO Center for Multicultural Society
Kyoto.
6)

NCIHC (2004, p. 3, paragraph 7)7) 厚生労働省（2016）「医療通訳の認証の在り方に関する研究」

84医療通訳者のための倫理規定

References
AIIC. (2018). [Online] Code of professional ethics. Retrieved on April 8 fromhttps://aiic.net/page/6724/code-of-professional-ethics

2018-version/lang/1

AUSIT. (2012, November). [Online] Code of Ethics and Code of Conduct. Retrieved on April 8 fromhttps://ausit.org/AUSIT/Documents/Code_Of_Ethics_Full.pdf
Committee to Review Standards for Medical Interpreters. (2010). [Online] Center for Multicultural
Society Kyoto: Translation Standards for Medical Interpreters Retrieved April 15 fromhttps://www.tabunkakyoto.org/
IMIA. (2016). [Online] International Medical Interpreters Association Code of Ethics.
Retrieved on April 8 fromhttps://imia medinfo.org/wp/wp-content/uploads/2015/07/IMIA-Code-of-Ethics-2016.pdf
Japan Association of Medical Interpreters (JAMI) (2011). [Online] The Code of Ethics forProfessional Medical Interpreters. Retrieved on April 8 fromhttp://www.jami-net.jp/htdocs//?action=common_download_main&upload_id=11
Multicultural Society Kyoto: Translation Standards for Medical Interpreters (n.d.).
Retrieved on April 15 from https://www.tabunkakyoto.org/
NCIHC. (2004). [Online] National Code of Ethics for Interpreters in Health Care. Retrieved on April 8
from https://www.ncihc.org/assets/documents/publications/NCIHC
医療通訳の基準を検討する協議会「医療通訳共通基準」(2010). [Online] Retrieved on April 8 fromhttps://www.tabunkakyoto.org/
厚生労働省（2017）「医療通訳育成カリキュラム基準」（改訂版）
https://www.mhlw.go.jp/file/06-Seisakujouhou-10800000-Iseikyoku/0000209866.pdf
厚生労働省（2016）「医療通訳の認証の在り方に関する研究」[Online] Retrieved on July 25 fromhttp://mhlw-grants.niph.go.jp/niph/search/NIDD00.do?resrchNum=201620052A
国際臨床医学会（2017）「国際臨床医学会認定医療通訳者制度規則（案）に対する意見募集（パブリックコメント）の回答に対する分析結果 [Online] Retrieved on April 8 fromhttp://kokusairinshouigaku.jp/activities/authentication/m-interpreter/files/sum_pub01.pdf
水野真木子 （2006）「各種通訳倫理規定と基本理念―会議、コミュニティ、法定、医療通訳の倫理規定を比較してー」 日本通訳翻訳学会 「通訳研究」第 5 号 (p.169)
水野真木子 内藤 稔（2019）「コミュニティ通訳 多文化共生社会のコミュニケーション」(新装版第三冊)（pp. 67-69）みすず書房

85

『翻訳研究への招待』No.21 (2019)86