When the Law Meets Medicine


Translating Written English Texts into American Sign Language for Deaf and Hearing Interpreters

By Doug Bowen-Bailey & Trudy Suggs

A resource for Deaf and Hearing interpreters working on translating written English texts into American Sign Language.

Navigating the Resource

The links below are the contents of this resource.  When you click on a link, it will open up the contents of that segment.  To close that section, simply click its title.  If you click on another section while you have one segment still open, you may need to scroll up to access the information at the top of that part of the resource.

"When the Law Meets Medicine" Contents

Meet the Authors

Part of “When the Law Meets Medicine

Doug Bowen-Bailey

English Version

I live and work in Duluth, Minnesota on the shores of Lake Superior. Where I live means that it is impossible for me to specialize in a way that I could in a larger city. So, I end up wearing many hats. I am hearing and work as an interpreter.  I also provide mentoring services and coordinate interpreter education opportunities for Northeast Minnesota. I also create video resources on CD-ROM and DVD. This grew out of my experience as a mentor where I saw the gaps in existing resources for professional development.

I feel fortunate to be involved in so many different aspects of the interpreting process. Both working as an interpreter,  thinking about how to effectively guide other interpreters in their own professional development, and how to apply technology to assist in all of that. I am grateful for all the variety that continues to keep me excited about my work.

Trudy Suggs

English Version

Hello. I’m Trudy Suggs, from Faribault, Minnesota, where the Minnesota State Academy for the Deaf is. I’ve worked with interpreters since I was two years old and throughout my life, which translates to over 30 years of working with interpreters. I was mainstreamed in elementary school, attended, and also attended self-contained and mainstreamed classes in public schools. I went to Gallaudet University and graduated, then went back to working with interpreters in graduate school in Chicago. So, my experiences in working with interpreters have been quite diverse and comprehensive.

I’m also a Certified Deaf Interpreter (CDI), and often work with hearing interpreters. I’ve seen many different things, and the power and importance of collaboration in deaf-hearing interpreting teams. It’s truly important in almost every situation. I was delighted to work on this project with Doug, because it’s a great opportunity to provide increased training for deaf interpreters – especially nowadays, where there are such limited resources and very few training opportunities for deaf interpreters, unless we participate in workshops for hearing interpreters. So, this DVD is really a great opportunity – not only for deaf interpreters, but for hearing interpreters, too – to study native, first-language American Sign Language users like myself. I’ve really enjoyed working on this project. I hope you don’t become overwhelmed or struggle with the text and jargon like I did; it was a challenge for me. Good luck with this project!

Study Packet/Source Texts

Part of “When the Law Meets Medicine

When the Law Meets Medicine

Please download the study packet.

The English version of this study packet in in a PDF format and  includes the written source texts used for translation:

  • Notice to Patients
  • Advance Health Care Directives
  • Minnesota Patient Bill of Rights
  • Notice of Privacy Practices

It also has the English text to explain the process as well as some forms for use in analysis.

About This Project

Part of “When the Law Meets Medicine

A Note on the Video:

All of the original  sources for this study packet were actually first produced as video for the DVD version and then translated into written English.  This design is intended to provide for multiple ways to access the information in order to facilitate professional development for both Deaf and hearing interpreters.

The Goal of this Project

Welcome to the study packet for the DVD, When the Law Meets Medicine, which is designed to assist interpreters in developing skills for translating English texts into ASL.  A particular focus is English texts which have a combination of medical and legal language.  The hope is that this DVD will help you develop skills to create accurate and clear translations for the deaf patients that you might be working with.

A Brief Overview

I would like to briefly explain the history of this project.  It started with another DVD created for Fairview Health Services.  Fairview needed ASL translations of some of the admission documents they give to patients, like the Patients’ Bill of Rights and Notice of Privacy Practices.  They contacted me for assistance in this, and I contacted Trudy.  We created this DVD with a review process and passed it along to Fairview.  They were satisfied with the results, but I wasn’t satisfied with just being done with it.  It was a good resource for patients, but Trudy and I working together as a Deaf-hearing team was such an educational experience for us, that I thought it would be an opportunity for other interpreters to learn as well.   So I asked Fairview if they would be willing to allow it to be used for interpreter education and they said they would.  We then approached the College of St. Catherine and received support for it.  We have worked almost a year since then developing this DVD which incorporates the texts and translations from Fairview as well as explanations of the approach to translation and a process for going about this work.

This independent study is designed so you have the option to earn CEUs from RID’s Certificate Maintenance Program.  I’d like to give you a brief description of how it is set up.  It’s based on the work of Vygotsky, an educational psychologist who studied how people learned, and concluded that there are three steps to the process.  The first is:  Working with Object.   In this step, the learners work with something to the point where they become frustrated or encounter a struggle.  It is this frustration that motivates them to want to overcome it and prepares them to take the next step which is:  Working with Other. The “other” can be a person  or another resource like a DVD or book.  Learners work with this “other” to find strategies for resolving whatever issues they encountered in working with the object.  This makes them ready for the third step which is:  Working with Self where they can work independently.  The learners then work on their own until they encounter frustration or begin to struggle which puts them back in the first step of the learning cycle.  So, the independent study format is really designed with those three steps in mind.

Explaining Our Translation Process

Part of “When the Law Meets Medicine

I’d like to explain how the process worked for translating from the original text to the DVD, how I approached this and what my process was. However, my approach and style may be different from yours, and that’s perfectly fine. Each interpreter has an individual approach to translation. I’ll explain my approach and how I did it, though.

When I got the text from Fairview, I read through it and was daunted by the legal and medical jargon. I didn’t quite understand all the jargon, and was a bit apprehensive about the work. As I read through the text, I thought in English rather than ASL. For the words and concepts I wasn’t too sure, I made notes and asked Doug, who worked with me, about them. There were some he didn’t know, either. Neither of us are lawyers or doctors, after all. For the parts we both couldn’t decipher, we contacted the Fairview team who developed the text, and asked for clarification. I wanted to make sure I translated the text correctly. After that, I went back to the original text, and informally translated the text into ASL in my head.

Next, I had to visualize who the viewers of this DVD would be. Fairview facilities are frequented by different people who have diverse cultures, languages and experiences. For example, the deaf patient may not sign and prefer to speak, or maybe the deaf patient signs only, or maybe the deaf person only knows some signs and gestures but isn’t fluent – or has additional disabilities hindering ASL fluency. How could we meet all those different needs? Doug and I had a good discussion, and came to the agreement that the ASL translations couldn’t possibly be accessible to all individuals, so we decided I would sign for the general public, then those who didn’t understand sign could watch captioning. People who are fluent in ASL can use this DVD, and then for those who aren’t necessarily fluent in ASL, such as immigrants, or who may need some type of language facilitation, a deaf interpreter, language expert or language facilitator could be brought in. That Deaf Interpreter should be certified and have the necessary training and knowledge for such a situation. So we agreed that a CDI or language facilitator could be present when watching the DVD, and pause the film to facilitate the language or interpret. So those were the options we agreed upon. Besides, the hospital is still responsible for accommodations. That’s how we decided who to translate the text for.

The next thing I had to consider was how I could sign all the text. There was no way I could have memorized the text; I’m not quite that adept! I created my own translations to be used with a teleprompter. The translations were written in a manner that most people, even Doug, wouldn’t have understood – but that I could understand. For example, when I wanted to use this sign shown at right, I wrote SWAT. Had someone seen that word, s/he would have thought I meant “to swat a fly.” The translations had different words like that, understood only by me.  I then gave the translations to Doug, who put it on a teleprompter using a computer located underneath the camera for me to look at.When we taped, a noteworthy thing happened: I found that as I signed, sometimes what I had written didn’t feel or translate right. I didn’t always follow the script of my translation word-for-word; rather, I expanded upon the information when I felt it was appropriate. Word-for-word translation between ASL and English just can’t be done.  They’re two different languages!

That brings up another obstacle I encountered. When I work in a real-life situation as a CDI, I rely heavily on consumer feedback, making sure the consumer understands me or making sure the information I sign is clear. But here, there was no feedback from consumers, since I was signing to a camera. So keep that in mind when you work on this DVD or with consumers. You’d think that by this point, I’d be done with the translation work – not quite! When the filming was done, I still had to translate from the ASL translations into English subtitles, for people who don’t sign. We couldn’t follow the text-on-paper version, because remember, I sometimes expanded upon concepts – so had we followed the text exactly, it’d be different from what I signed. I typed out the subtitles of my translations, and gave it to Doug, who then put the subtitles on the DVD. And that’s where another situation emerged: we found that we didn’t agree on some of the wording for the English subtitles.

Doug is hearing, and I’m deaf. He felt that some of the sentences were “too deaf,” he was actually right. I grew up Deaf in a Deaf family, so my cultural identity is as a Deaf person, and my first language is ASL. Doug is hearing, but he’s involved in both cultures and is as bilingual as I am. Still, he thinks like a hearing person, and I think like a Deaf person. So when he pointed out that he felt some of my sentences were “too deaf.” I realized he was right. The grammar itself was fine, but as a whole, it had strong cultural connotations.  Sometimes I agreed with his views, but at other times I didn’t. And it was like that for him, too – he was sometimes “too hearing.” It was a really fascinating process to see how culture, identity and language influenced our choices. We worked through these differing views easily to agree upon the grammar or word choices to use. It all worked out to what you see now.

So, for me, my process includes, first, understanding the information and its purpose. Don’t assume you know the meaning or purpose – check with the people who developed the text. Next, understand who your audience is or who you’re working with, and make sure you have the right audience in mind as you sign the translations. Also, make sure your translations are accurate and clear, working with your team. Finally, create a supportive environment with your team where everyone works together. The goal is to get the best, most accurate message across, and you do that by working together as a team. This process was a really complicated process, and it didn’t happen overnight.

Overall, the whole process, starting with getting the text from Fairview, going through the filming, and ultimately creating this packet for you, was a fantastic experience for all parties involved.

Additional Translation Resources

The following are resources to consider as you develop your own process of translation that will work for you.

  • Boudreault, Patrick (2005). Deaf interpreters. In Terry Janzen (Ed.) Topics in Signed Language Interpreting ( p. 323-355). Amsterdam and Philadelphia: John Benjamins Publishing Company.
  • Collins, Judith M. and John Walker (2005). What is a Deaf Interpreter? In Rachel Locker McKee (Ed.) Proceedings of the Inaugural Conference of the World Association of Sign Language Interpreters (WASLI) (p. 79-90). Trowbridge, UK: Douglas McLean Publishing.
  • Gile, Daniel (1995). Basic Concepts and Models for Interpreter and Translator Training. Amsterdam and Philadelphia: John Benjamins Publishing Company.
  • Kiraly, Don (2000). A Social Constructivist Approach to Translator Education. Manchester, UK: St. Jerome Publishing.
  • Nida, Eugene & Charles R. Taber (2003). The Theory and Practice of Translation (4th ed.). Leiden and Boston: Brill.

Explaining Our Review Process

Part of “When the Law Meets Medicine

I want to explain about how these DVDs were reviewed.  Note that there were two separate processes.  One was for the DVD produced for Fairview that had the actual texts and translations.  The other was for this DVD produced for interpreter skill development.

For the Fairview review process, we had three initial reviewers.  One was a Deaf woman who was experienced with medical settings having worked as patient advocate.  The next was a late-deafened man who knew some signs, but relied more on captioning and so was able to check the accessibility of the English subtitling.  The third was an interpreter who was experienced in medical settings and would have full access to both the spoken English and the ASL translations.

The reviewers were all given a draft of the DVD, the original English texts, and a form which had a place for them to comment on each segment of the text.  An example is given here which shows they had the choice of marking something as Acceptable, Adequate, or Unacceptable.  Acceptable meant no reason not to proceed.  Adequate meant that there were things that could be improved, but the problem could also be lived with.  Unacceptable meant that the project couldn’t go forward without it being fixed.

Most of the feedback was that things were acceptable.  A few segments were just adequate, and none of what the feedback we received suggested that we needed to re-film.  We did bring the comments about what could be improved to Fairview.  One particularly common comments was on the original backdrop used for filming.  Visually, the blue and white backdrop was too distracting.  This made the DVD unusable for DeafBlind individuals.  This feedback gave added weight to Trudy’s and my feeling that this DVD could not be for everyone, and that sometimes to make sure the information was clear, Fairview would need to provide a language facilitator or CDI, as Trudy suggested before.  So, the review process was really helpful in giving us more strength in making suggestions to Fairview for future practices as well.

For the review process for this DVD, When the Law Meets Medicine, we had a different process in place.  We asked several Deaf interpreters, as well as one hearing interpreter, to check the DVD to make sure that the process made sense and the signing was clear.  We received the same feedback about the visually distracting background as we did in the Fairview process.  I hope on those texts that you watch them in shorter segments so that you don’t end up with a headache and that you are able to get through the imperfections to find the benefit that is there.

We also received feedback on the approach to translation.  Trudy talked about how we worked together as a Deaf-hearing team and then collaborated with the staff of Fairview Health Services. There are other models such as a Deaf-Deaf team where there is a Deaf person who does the translation in discussion and review with another Deaf person.  A future project may be to try to model how this can be an effective approach.  (You can also check the additional resources in the segment on “Explaining Our Translation Process.“) Overall, the reviews showed that we could move forward with these projects.  We know that they are not perfect, but we didn’t have the time and resources to make all the necessary revisions to bring them to perfection.  However, the review did show that this DVD help to meet the goal of supporting interpreter skill development just as the Fairview DVD helped to improve patient access.

In doing that, the review process for both projects were very important, both in improving the quality and in deepening our understanding of effective translation practices.

The First Text: Notice to Patients – Step 1

Part of “When the Law Meets Medicine

Before continuing, be sure you have downloaded the PDF and have the source document to work with.

With this background, it is now time for you to start your own work on translating these texts. The first text is the Notice to Patients which discusses Fairview’s commitment to provide access to all of its patients. This is the shortest of the documents – only one page – but you do not have to work on it in its entirety.  The text is on page 12 of the PDF. It is separated into three sections, so if you choose, you can go through this process working on only one section at a time. That may be helpful for you to find out what works best for your own learning style without taking on too much of the text.

Notice to Patients: (Page 12 of PDF)

Translation in Sections

  • Section 1:  Lines 3-8
  • Section 2:  Lines 10-27
  • Section 3:  Lines 30-32

Step 1:  Working with Object

At this point, you should begin your translation process – reading the text and deciding how you would translate it into ASL. It is vital that you do not skip this step in order to watch Trudy right away. Creating your own translation first will help you observe Trudy’s work with increased focus.

Also, it is helpful to videotape your own translation so you can go back and look at it, instead of working from memory about what you think you did.  Videotaping your own work is crucial to this process and will be very helpful as you compare and evaluate your own professional growth.

Following the text is a form for analysis. Watch your first translation on video and write down the parts that you noted as clear and the ones you struggled with. This analysis will help you to observe Trudy’s translations more carefully to see how she managed those passages.

The First Text: Notice to Patients – Steps 2 & 3

Part of “When the Law Meets Medicine

Step 2: Working with Other

Now that you have gone through the first step and analyzed your own translation, you are ready to watch Trudy’s translation. Continue using the analysis form to note how Trudy handled sections you noted as difficult or areas of concern.

After you watch Trudy, go back to the Notice to Patients page on the DVD that has her reflections. Watch what she has to say about her work. (They are also included here in written English.) (DBB)

Trudy?s Reflections on “Notice to Patients”

In these reflections, I will discuss some of the terms and concepts I had difficulty with. First, I’ll discuss the Notice to Patients text. The text with this study packet has each line numbered, so if I refer to text on a particular line, you can find it easily by number rather than having to search through the entire text.

The first word I found to be an obstacle was health. I always signed it as shown in Version 1 at left. However, an ASL teacher told me that the sign I used might not be the best choice. She suggested that it would be better to use Version 2 (shown at left), because the first version implies recovering, while the second sign is more general and refers to the body. It also could mean going to the doctor for a check-up or things of that nature – but not necessarily recovering as the first sign indicates. That was a new line of thinking for me. I actually used both signs in the video; it may not be such a major deal, but overall, the signs do hold different meanings. When I recognized the different meaning of both signs, I realized that I could have used the latter sign instead. Even if I’ve used ASL as my first language for all of my life, I continue to learn from other people about what the appropriate signs are to this day.

Another word that I struggled with – and I actually had to think about this word a bit – was the word facilities. Fairview itself is actually made up of many buildings and facilities. I had to decide if I really wanted to sign different words like “hospital and buildings” every time I signed this concept, or if I should fingerspell the word. Or should I have signed building? However, a facility doesn’t always mean it’s a building; it may be there is a clinic inside a building that isn’t affiliated with Fairview, but just happens to have the clinic there. Or it may refer to a meeting like Alcoholics Anonymous, which is a program, but not necessarily a building. I decided to expand upon the word each time I signed, by saying “doctors, hospitals, different buildings.” You will see me repeating that string of words each time the word facilities appears. That may be somewhat cumbersome and time-consuming, but conveys a better translation.

Lines 9-12 or 13 are a good example of how Fairview’s language, or rather, its legal jargon, is quite vague. In fact, the text is very complicated and includes a lot of jargon. When I looked at that part, I wondered, “How do I sign this?” After I thought about it, I decided to come at it a certain way. Here’s an example of a sentence that says, “…ensure thorough and accurate communication to include, but are not limited to, explaining…” For that specific part, I didn’t worry about signing every word. What I did instead was signed, “I will list…” It’s important to note how I used the word “I.” The text here is written in the third person, but here, I made the translations in the first person because when signing in ASL,

it’s important to establish a cultural and linguistic link with the viewer, I said, “I will explain those,” and then I ticked them off using my fingers. This is key. Oftentimes, hearing interpreters will list things without delineating it in a spatial sense. That’s a significant gap in ASL. Using my fingers to list items, so that the consumer or deaf person will be able to visualize what’s to come and how much will be coming, is a spatial and important linguistic element of ASL.

The next thing is “at no charge.” This is a minor example, but some people will say that word-for-word. I said “cost-none” – the reason I mention that is because of the conceptual meaning. I’m signing as if I’m holding a casual conversation, rather than formal interpreting for this situation; those little things make for better translations. The Notice to Patients wasn’t a major struggle, given its simplicity, but the next one is more challenging! (TS)

Shadowing the Translation

Before moving on to the next step, try copy-signing while you watch Trudy’s work again. Shadowing a signer can be an excellent way to begin to incorporate new ideas into your own work.

Step 3: Working with Self

Now that you have had the opportunity to view Trudy’s work and her reflections, return to the text and develop a revised translation. Using the analysis form, you may want to write down new ideas that emerged in this process for incorporation into your next translation.

Videotape your new translation and compare it to your original translation to see your areas of professional growth. (DBB)

The Second Text: Advance Healthcare Directives

Part of “When the Law Meets Medicine

Before continuing, be sure you have downloaded the PDF and have the source document to work with.

Preparing to Work with this Text

The Translation

Reflections on The Translation

The Third Text: MN Patient Bill of Rights

Part of “When the Law Meets Medicine

Before continuing, be sure you have downloaded the PDF and have the source document to work with.

Preparing to Work with this Text

The Translation

Reflections on The Translation

The Fourth Text: Notice of Privacy Practices

Part of “When the Law Meets Medicine

Before continuing, be sure you have downloaded the PDF and have the source document to work with.

Preparing to Work with this Text

The Translation

Reflections on The Translation

Credits for the Project

Part of “When the Law Meets Medicine

ASL Translations and Reflections

Trudy Suggs
T.S. Writing Services

Video Production and Project Design

Doug Bowen-Bailey
Digiterp Communications


Juan Bernal
Priscilla Moyers
Amanda Gilderman

Staff of the CATIE Center at the College of St. Catherine

Rosa Ramirez
Laurie Swabey
Richard Laurion