Vulnerabilities in transnational patient mobility

Linguistic vulnerabilities and translation and interpreting in transnational patient mobility

 

Just. Journal of Language Rights and Minorities, Revista de Drets Lingüístics i Minories

Guest editors:

Sonja Pöllabauer & Katia Iacono 

 

Transnational patient mobility refers to citizens and residents of a particular country of origin (source country) seeking medical treatment in another country (destination country) (Lunt, Horsfall & Hanefeld 2016). Patients are hence not temporary or permanent residents of the destination country and may cross borders for healthcare services for short- or longer-term care. This type of patient mobility has been addressed under different terms (e.g., medical/health/patient mobility, international/transnational/cross-border patient mobility, medical travel, or transnational healthcare) (Freyer & Kim 2013). However, some of the labels used (e.g., medical/health tourism) have been criticized for their negative or misleading connotations (Snyder, Dharamsi & Crooks 2011), for superficially linking potentially severe medical conditions with connotations of leisure and relaxation. Cross-border medical travel can occur from high-income to low-income countries and vice versa (Durham & Blondell 2017). It can involve either insurance coverage or lack thereof (Glinos et al. 2010). And even if the literature mostly discusses patient mobility, there are also types of provider mobility, such as physicians traveling to provide care to patients (Elnawawy, Lee & Pohl 2014; see Snyder, Dharamsi & Crooks 2011 on physician volunteerism).

Patients’ motives for transnational patient mobility may be grounded in availability—either of quantity (e.g., waiting lists) or types of medical services—or in affordability, familiarity with a certain type of treatment (within, for instance, a specific country or diaspora community), or perceived quality (Glinos et al. 2010; Laugesen & Vargas-Bustamante 2010). Types of availability may have geographical, financial, or legal dimensions (see also Lunt & Carrera 2010): certain services may not be available at all or to a sufficient degree of coverage in certain areas, or not at the highest quality (top-notch research); they may be too expensive (e.g., dental treatments, cosmetic surgery, or wellness treatments); not legally allowed (e.g., certain types of reproductive health treatments including surrogacy, gender transformation surgery, end-of-life assistance such as euthanasia and assisted suicide, abortion or anonymous births); or controversial such as certain cancer treatments or stem cell treatments (Laugesen & Vargas-Bustamante 2010). Law-evasive treatments have been included under circumvention patient mobility (Cohen 2012; Snyder 2022), those most usually covered out-of-pocket (Glinos et al. 2010).

Transnational patient mobility has become a worldwide and globalized phenomenon with far-reaching ethical implications (Smith 2012; Whitmore, Crooks & Snyder 2015; Cesario 2018). From an economic perspective, it has turned into a considerable business factor with diverse stakeholders involved (Lunt & Carrera 2010; Smith 2012): millions of patients, with diverse financial and social backgrounds, travel to destination countries every year to undergo medical treatment (Patients Beyond Borders 2023). Some common destination countries lie both in the global South (Meghani 2011) and in industrialized countries or the EU (see Patients Beyond Borders 2023 for country examples), depending on which type of service is sought. Within the EU, Directive 2011/24/EU regulates different types of health mobility and establishes the conditions for reimbursement of the costs incurred if the services are legal and thus covered by health insurance.

Patients choosing to undergo medical treatment in a destination country face a range of organizational, economic, and linguistic challenges (Crooks et al. 2010), though there are few studies based on empirical data about patients’ concrete experiences (Crooks et al. 2010). Informed consent and risk management are considered particularly problematic (Crooks et al. 2013; Snyder et al. 2013; Hohm & Snyder 2015): language barriers may have an impact on the patients’ right to be informed before undergoing a medical treatment; in addition, in case of medical and communication errors, it may also not be straightforward to determine which court has jurisdiction (Iacono 2021, 40).

A smaller body of literature addresses informal caregivers’ perspectives which also point to a lack of support structures and challenges in informed decision-making and risk management (Crooks et al. 2017; Whitmore, Crooks & Snyder 2017). Along with online networks and social media (Hanefeld et al. 2015; Hohm & Snyder 2015), so-called brokers or facilitators (individuals or companies) play an important role as a third party in the global healthcare market in connecting patients with providers in some countries and for certain fields (Penney et al. 2011)—again a partially commercialized practice that carries specific ethical and legal implications (Snyder, Dharamsi & Crooks 2011; Hunter 2020).

Medical providers, as the other major party, are faced with providing a satisfactory servicescape (Kim et al. 2017), including advertising, or making known, their services (Bartłomiejczyk & Pöllabauer 2022), patient recruitment, organizational matters, ethical and legal considerations, and political aspects, such as the impact of transnational patient mobility on destination health human resources (Crooks et al. 2019). Further issues arise from the provision of cultural care structures and competence (Whittaker & Chee 2015) and linguistic support (Angelelli 2015), with language being an important commodity (Muth 2018) where minority language speakers’ needs may not always be fully satisfied (e.g., availability of interpreters’ provision for languages of limited diffusion).

Despite the crucial role of communication, including translation and interpreting, in transnational patient mobility, studies on specific linguistic or cultural aspects of transnational patient mobility remain underrepresented both in translation and interpreting studies (TIS) (for some exceptions, see Angelelli 2015; Lee 2015; Muth & Suryanarayan 2020; Iacono 2021; Bartłomiejczyk & Pöllabauer 2022; Iacono 2022; Bartłomiejczyk, Pöllabauer & Straczek-Helios forthcoming; Pöllabauer et al. forthcoming) and in other disciplines that explore translation in patient travel. Moreover, while the legal, economic, or medical-ethical implications of this type of patient mobility, among other aspects, have been addressed in fields such as legal studies, economics, medicine and health sciences, or tourism research (Iacono 2022, 130), these only scarcely touch upon the particularities of transcultural communication and linguistic support, including translation and interpreting.

Issues of communication and healthcare interpreting have been addressed widely not only in interpreting research (Hsieh 2015) but also in practice guidebooks (Angelelli 2019) and in different health disciplines. This body of literature also examines aspects that pertain to transnational patient mobility (e.g., structural deficits fostering linguistic inequalities, issues of power and language in physician-patient encounters, role confusion and overload and ethical dilemmas encountered by interpreters, issues of emotionality, empathy, and self-care, interpreters’ qualifications). Specific aspects linked to transnational patient mobility, however, have been less widely explored.

So far, studies which (also) adopt a closer focus on linguistic practices in transnational patient mobility have focused on training interpreters for the field of medical tourism (Lee 2015), the commodification of linguistic resources in the framework of neoliberalist healthcare structures and its limitations in transnational patient mobility (Muth 2017, 2018), the need for entrepreneurship among language workers in patient travel (Muth & Suryanarayan 2020) and interpreters’ service portfolio (Iacono 2021, 2022), multilingual websites advertising the service of abortion clinics (Bartłomiejczyk & Pöllabauer 2022), and activists’ motivation for also engaging in linguistic support (Pöllabauer et al. forthcoming). In an exploratory study on language provision in cross-border healthcare in the EU, commissioned by the Directorate-General for Translation, Angelelli (2015) reports on language policies in five (then) EU countries (Germany, Greece, Italy, Spain, and the UK), concluding that “language support/provision for cross-border healthcare patients is neither guaranteed nor provided in an even manner across the MSs [Member States] and sites observed” (2015, 91).

Against this background, this special issue aims to shed light on specific characteristics, challenges, and ethical dimensions of communication in transnational patient mobility, including translation and interpreting. It aims to scrutinize whether these promote or exacerbate linguistic inequalities, which have been framed as linguistic vulnerabilities (Määttä, Puumala & Ylikomi 2021; see also Butler 1997 on linguistic vulnerability). Authors are invited to submit 500- to 700-word abstracts, exclusive of references, in English, Spanish, or Catalan. We particularly welcome case studies, data-driven research, and methodological discussions, both from the field of translation and interpreting studies and from other disciplinary angles.

Topics of interest include, but are not limited to the following aspects:

• challenges faced by different stakeholders in transnational patient mobility, including translators and interpreters, such as ethical, emotional, linguistic dimensions of communication and cooperation, and linguistic vulnerabilities;
• types of cooperation, (linguistic) risk management, and issues of informed consent and decision-making among different stakeholders and patients;
• perceived and assumed role space (Llewellyn-Jones & Lee 2014) of interpreters and translators and other ‘language workers’ in transnational patient mobility;
• linguistic issues in ensuring the legal protection of patients in transnational patient mobility, including issues arising from the use of machine translation;
• activism and feminist approaches to transnational patient mobility;
• motivational aspects related to communication and translation and interpreting in transnational patient mobility;
• needs of and challenges encountered in specific types of treatment, including law-evasive mobility, and by specific groups, for instance, hidden populations (Lomeña-Galiano 2020) and more vulnerable groups in sensitive fields (e.g., women, children, youth, surrogate mothers, elderly patients, end-of-life patients, transgender persons), including intersectional approaches;
• aspects of linguistic vulnerabilities in transnational patient mobility related to bioethics and health communication;
• aspects of linguistic vulnerabilities in transnational patient mobility related to biolaw and biopolitics;
• structural conditions and communication and translation policies, including communication (informal or online) with facilitators networks or brokers.

 

Just. Journal of Language Rights & Minorities, Revista de Drets Lingüístics i Minories is a journal dedicated to disseminating scholarship on the protection, enforcement, and promotion of the rights of linguistic minorities as well as related themes arising from the confluence of language, the social dynamics of dominance and oppression, and the law. All abstracts and manuscripts should use non-exclusionary language and use Just’s author guidelines (https://ojs.uv.es/index.php/JUST/about/submissions), based on the Chicago Manual of Style (CMS) (https://www.chicagomanualofstyle.org/tools_citationguide/citation-guide-2.html) for both citation and drafting. Interested authors are invited to send 500- to 700-word proposals and inquiries directly to the guest editors: Sonja Pöllabauer (sonja.poellabauer@univie.ac.at) and Katia Iacono (katia.iacono@univie.ac.at) by 1st November 2024. Authors of abstracts that are accepted for consideration will be invited to submit a full manuscript that is between 6000 and 8000 words in length (exclusive of abstract and references but including footnotes). Every manuscript will be submitted to a double-blind peer review that includes at least two referees.

 

The publication of this special issue will adhere to the following editorial timeline:

 

Abstracts (500-700 words) due to guest editors	1 November 2024
Decision on abstracts	1 December 2024
Submission of full manuscripts	1 June 2025
Final versions of papers	1 May 2026
Decision to authors	15 July 2026
Publication of special issue	9 October 2026

 

 

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