Intelligibility Enhancement: A Bioethical Mandate to Reduce Bias in Communication
Practices associated with the modification of a speaker’s accent to enhance communicative
intelligibility in a non-primary language raise significant ethical questions about bias for
communication-focused healthcare workers and for advocates of vulnerable populations in areas
with diverse linguistic practices, such as immigration and asylum advocates. These questions
arise due, in part, to the socio-cultural context in which some healthcare practitioners and some
advocates practice and those they serve live, as well as the relational nature of communication.
In this global bioethics session, it is argued that due to the ambiguity inherent in accent
modification practices, healthcare practitioners and advocates must weigh a variety of
considerations before determining in what contexts and under what circumstances such services
are professionally acceptable to offer or to encourage clients or patients toward. The argument
offered in the presentation is rooted in consideration of the complex nature of the ethical terrain
related to communication. After surveying potentially relevant models from other healthcare
professions and finding them wanting, we support our position in light of the current evidence-
based assessments of the non-pathological nature of speech variation, as well as the literature on
communication, in particular the lack of consensus around accounts of functionality.
We conclude by offering anti-bias recommendations for healthcare practitioners and teams, as well as for advocates for immigration and asylum seekers. Also to be discussed are the normative implications of this account, which include shifting the burden from the speaker alone to a shared burden between speaker and listener that is both more just and more practical.