同理心、態度中立和醫療口譯員角色

Abstract

本研究的目的有二：了解同理心如何融入醫療口譯，以及試圖解釋為何醫療口譯服務使用者對不同醫療口譯員的角色看法不同。本研究整理醫療口譯服務使用者對醫療口譯員的觀點調查和醫療口譯員的倫理守則，發現醫療口譯員的四種角色中，傳聲筒、澄清者、文化中介者的角色行為被視為恰當行為，倡議者的角色行為則有許多爭議。本研究假設這個現象和口譯員的態度中立與否有關，由於中立態度非常抽象，但剛好是同理心的必備條件，因此本研究用同理心理論來檢驗各個口譯員角色的態度，以驗證研究假設並達成第二個研究目的。同理心理論同時用以探討同理心融入醫療口譯的方法，並達成第一個研究目的。

本研究比對醫療口譯和同理心，發現在情境、口譯員和同理者的溝通技巧與態度中立上有很多相似處，並由此驗證口譯員也有同理口譯服務使用者。本研究因此依據單語醫療情境中的同理心理論模型，加入雙語情境的特性，發展雙語醫療情境中的同理心理論模型，包括表達同理心模型和同理心環模型。用這些理論模型以及同理心的表達技巧檢驗各醫療口譯員角色的態度，研究結果發現： 1.傳聲筒、澄清者、文化中介者都忠實翻譯使用者的語意，並表達對講者的同理心給聽者聽，但倡議者的多數角色行為既非翻譯，也沒有表達同理心。因此傳聲筒、澄清者、文化中介者的態度是中立的，而倡議者的態度多為不中立，此發現驗證本研究的假設。 2.擔任文化中介者的醫療口譯員在翻譯講者的語意時，因為同理聽者和講者的文化差異，而表達對講者的高層次同理給聽者聽，亦即在譯文中顯化(explicitation)講者未明確說出的文化意涵，或歸化(domestication)講者的表達至符合聽者文化背景的表達方式，以增進雙方對彼此的了解並協助溝通。 3.傳聲筒角色只負責語言轉換，澄清者、文化中介者則認為協助溝通是他們的首要工作，倡議者則最重視捍衛醫療口譯服務者的權利或表達其個人意見。

本研究提出醫療口譯員的角色架構，並強調同理心和態度中立的重要，應用至醫療口譯理論中，能幫助口譯員清楚覺察角色轉換、了解採取非中立角色行為可能的負面影響，並學習如何在醫療口譯中融入同理。本研究建議政府建立醫療口譯中介機構，由該機構負責培訓口譯員、提供口譯員諮詢、媒合口譯服務、協調服務使用者和口譯員的溝通、提供客訴服務…等，倡議者角色的非中立行為即可由該中介機構負責，讓口譯員的角色功能更一致。本研究結果亦可運用至口譯員訓練課程，幫助口譯員了解自己的角色及功能、同理心的概念與技巧、態度中立的重要，以及和中介機構的合作與角色分工。

This study aims to understand how empathy is demonstrated in medical interpreting and explain the inconsistent views of medical interpreting service users on different medical interpreters’ roles. Among the four roles adopted by medical interpreters, surveys on service users and interpreter’s codes of ethics show that some tasks taken by an advocate are regarded controversial while behaviors of a conduit, a clarifier and a culture broker are considered appropriate.

Comparing settings, communicative skills and attitudes of neutrality between medical interpreters and empathizers, great similarities are identified. Based on the confirmation that medical interpreters empathize with service users, this study expands levels of expressed empathy and empathy cycle models in a monolingual two-way setting to a bilingual three-way setting. Published cases of medical interpreting are analyzed to find that: 1.Roles of conduit, clarifier and culture broker perform interpreting and express empathy while an advocate neither performs interpreting nor expresses empathy in most of the cases. Roles of conduit, clarifier and culture broker are thus neutral while an advocate is mostly not neutral; 2.A culture broker also empathizes with the receiver of the rendition and thus expresses advanced empathy with the speaker by making implicit culture factors explicit in rendition or domesticating the source utterance in the way the receiver is used to; 3.A clarifier and a culture broker prioritize their tasks of communication facilitation over merely linguistic transformation like a conduit while an advocate values on defending service users’ rights or more often on expressing personal opinions.

Findings of this study can be utilized to provide a theoretical framework of roles for medical interpreters in practice. Medical interpreters therefore can have a clearer awareness of role switching, the possible negative consequences of adopting the non-neutral role and how to demonstrate empathy. In addition, to establish an independent organization of medical interpreting is suggested. The organization should be responsible for medical interpreters’ training and supervision, dispatch of medical interpreting services, mediation between interpreters and stakeholders of medical services when conflicts arise and so forth. Through this system, medical interpreters are more likely to maintain a neutral stance. In terms of training medical interpreters, results suggest that the content of training should include clear framework of roles, concept and skills of empathy, the demonstration of neutral attitudes and how to work with the organization.