Care Without Understanding Isn’t Care

Language access is essential for patient safety, valid informed consent, and a core equity.

Language access is not optional. It is a core requirement for patient safety, valid informed consent, and equity. In a universal health system, care that patients cannot understand breaches not only legal but ethical duties. Without a shared language, symptoms go unvoiced, diagnoses are misunderstood, and consent cannot be truly informed.

Case example: Studies in Canadian hospitals show that immigrant and refugee patients experience higher rates of diagnostic error and longer lengths of stay when professional interpreters are not used. In pediatric settings, children have been pressed to interpret for parents during complex clinical discussions, a practice that violates ethical standards and increases the risk of harm. For example, Canadian Institute for Health Information (CIHI) Report summarizing Canadian hospital data indicate that patients who speak neither English nor French have about a 30 % higher rate of unintended harm events during hospital stays compared with those who speak an official language. Also, Canadian qualitative and survey research studies of immigrants and linguistic minorities in Canada report that limited English/French proficiency impedes patients’ ability to describe symptoms accurately, leads to misdiagnosis, delayed treatment, and poor treatment adherence and undermines trust and the therapeutic relationship. Finally, research on Francophones outside Quebec found that patients and interpreters reported poor patient assessment, misdiagnosis, delayed treatment, and limited understanding of condition and prescribed therapy due to primarily language barriers.

From a legal perspective, informed consent requires understanding. Health Canada–associated reviews and public health analyses note that language barriers are associated with failure to provide adequate informed consent and protect patient confidentiality. Patients without language access are more likely to experience poor understanding of their condition and prescribed care, reducing the validity of consent.

Although human rights tribunals across Canada have recognized that failure to accommodate language needs in health services can constitute discrimination based on race, ethnic origin, or place of origin, Canada still lacks enforceable national standards for language access in health care. Interpreter services remain patchwork: unevenly funded, inconsistently used, and too often treated as ancillary rather than essential. Clinicians frequently report limited training on when and how to access and work with interpreters. One of the reason why the progress has been slow is because health care is organized and delivered by the ten provinces and three territories, with wide variation in policy, funding, and accountability for medical interpretation.

Yet, when health systems provide trained interpreters, culturally adapted translations, and language‑concordant clinicians, the evidence shows reduced harm, better alignment with legal and ethical duties, and creation of more equitable, patient‑centred care.

Policy implications: Language access should be a built‑in system standard and funded service line, not a discretionary add‑on.

Policy recommendations

• Require publicly funded health services to provide qualified professional interpreters (in‑person, video, and phone) at no cost to patients, available 24/7 for urgent and emergent care, with minimum qualifications (e.g., certification, medical terminology training, confidentiality standards).

• Define language access as a patient safety standard within accreditation and quality frameworks. Audit compliance and tie funding and performance incentives to meeting the standard.

• Fund and require training for clinicians and staff on when and how to use interpreters, working with language‑concordant providers, documenting language needs, onboarding and annual refreshers.

• Prohibit the routine use of children and untrained family members as interpreters; allow exceptions only for immediate, life‑threatening emergencies with prompt follow‑up by a professional interpreter; document any exception.

• Track and publicly report outcomes related to language access (e.g., unintended harm events, diagnostic delay, readmissions, consent quality, lengths of stay), stratified by language proficiency; use data to drive improvement and accountability.

A health system patients cannot understand is not equitable. Ensuring language access saves lives, reduces harm and costs, and upholds human rights.

Join us on February 23rd for critical conversation around Language Access as a Civil Right: Advocacy Across North America!

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Bowen, S. (2015). The impact of language barriers on patient safety and quality of care. Canadian Patient Safety Institute.

Bowen, S. (2001). Language barriers in access to health care. Health Canada.

Manson, S. E., Gruneir, A., Bronskill, S. E., Calzavara, A., Jaakkimainen, R. L., & Rochon, P. A. (2019). Patient-physician language concordance and quality and safety outcomes among frail home care recipients admitted to hospital in Ontario, Canada. Health Affairs, 38(1), 156–165. https://doi.org/10.1377/hlthaff.2018.05087

Canadian Institute for Health Information. (2020). Unintended hospital harm among patients with language barriers. CIHI.

Karliner, L. S., Jacobs, E. A., Chen, A. H., & Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Medical Care Research and Review, 64(3), 255–299. https://doi.org/10.1177/10775587073059

Schenker, Y., Wang, F., Selig, S. J., Ng, R., & Fernandez, A. (2007). The impact of language barriers on patient care: A systematic review. Public Health Reports, 122(3), 336–346. https://doi.org/10.1177/003335490712200307

Flores, G. (2006). Language barriers to health care in the United States. New England Journal of Medicine, 355(3), 229–231. https://doi.org/10.1056/NEJMp058316