Andy is a nurse caring for a 14-year-old girl, Amanda, admittedwith a large tumor located in the left groin area. During anassessment, Amanda shares with Andy her personal feelings. Shetells Andy that she feels “different” from her other friends. Sheis ashamed of her physical development because all her girlfriendshave “breasts” and boyfriends. She is very flat-chested andembarrassed. Andy listens attentively to Amanda and helps her focuson some of her positive attributes and talents.
A CT scan is ordered and reveals that the tumor extends to whatappears to be the ovary. A gynecological surgeon is called in toevaluate the situation. An ultrasonic-guided biopsy is performed.It is discovered that the tumor is an enlarged lymph node and thatthe “ovary” is actually a testis. Amanda has both male and femalegonads.
When this information is given to Amanda’s parents, they do notwant her to know. They feel that she was raised as “theirdaughter.” They ask the surgeon to remove the male gonads and leaveonly the female gonads. That way, “Amanda will never need to know.”The surgeon refuses to do this. Andy believes that the parentsshould discuss the situation with Amanda, as they are denying herchoices. The parents are adamant about Amanda not knowing anything.Andy returns to the Amanda’s room, and Amanda begins asking alltypes of questions regarding the tests and the treatments. Inanswering, Andy hesitates, and Amanda picks up on this, demandingthat he tell her the truth.
How would you respond if you were Andy? I wouldinform Amanda that her questions must be answered by her physicianand encourage her to discuss her concerns and feelings with herparents. I would answer all questions possible without disclosingdiagnostic information restricted per the parents’ request.Following this interaction education can be provided to the parentsregarding Amanda’s developmental and psychosocial needs and riskfactors associated with the cessation of progression through thesestages.
What are the ethical principles and values that are inconflict here? Autonomy is in question as the pt is aminor and can not make healthcare decisions without approval of herparents. Beneficence is also being challenged as the parents haveasked the provider and health care staff to arguably act againstthe pt’s wishes by withholding information. Justice is anotherprinciple which has been challenged by the legality of Amanda beinga minor and her parents choosing treatment without any consultationof their child. Non-maleficence was conflicted upon the request ofsurgical removal of the gonads to prevent Amanda from ever becomingaware of her situation.
What are some of the long-term effects of Andy’sdecision? Amanda’s progression of psychosocial developmenttowards self-actualization can be stunted by the choices herparents are choosing and the legal restrictions put upon thehealthcare team.
What are your legal responsibilities, or obligations ifany? It is imperative that accurate and descriptive, withquotes, documentation takes place to cover and protect thehealthcare team from any legal ramifications that may persist. Itis the nurse’s obligation to act accordingly to state, federal,facility, and best practice guidelines. This does not allow thenurse to act upon personal identification of what is right orwrong.
Do you agree with the surgeon? I agree with thesurgeon, denying the parents the option to choose gender (for anotherwise assumingly health individual) who clearly is experiencingconflict regarding their sexuality does not appear to be the mostbeneficial for the pt. However it is not within the healthcareteams ability to determine what is most beneficial or not, but toadvocate for pt autonomy and practice within their scope.
What process can be used to sort through thisconflict? A counsel consisting of the healthcare team,providers, case manager, mental health consult, a member of thehospital fluent with legal aspects regarding minor care, would bebeneficial for discussing options/considerations without crossinglegal boundaries.
What is moral distress among care-givers and what canyou do to alleviate it? Moral distress occurs whencaregiver’s personal feelings are challenged by the plan of carefor whatever reason. This can make it difficult to provide supportfor the clients wishes and or support their care as they would ifnot ethically challenged. This can lead to burnout and must beaddressed by the healthcare team. All members can experience thisdistress and group talks, assessment’s regarding members ability toprocess and move forward from these events, seeking counseling,taking needed leaves, needs to be considered to maintain the mentalhealth of the healthcare team.
A student answered the questions above. Respond tothe student’s’ post. Please use college level English and grammarin your posts, and write from a professional point ofview.
