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.
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.
A student answered the questions below. Respond tothe student’s posts/answers. Please use college level English andgrammar in your posts, and write from a professional point ofview.
How would you respond if you were Andy? If Iwere Andy, I would probably respond with of course therapeuticcommunication by being supportive of her feelings, using empathy,using silence when appropriate, and clarification when needed.However, while responding to Amanda I would try my best to answerher questions the best I can while also respecting the parents’request. If there is a time where her questions are nearingbreaking the parents request of not disclosing her diagnosis, Iwould tell her that I cannot answer that question but I will try tofind out by allowing her to speak with the surgeon.
What are the ethical principles and values that are inconflict here? There are a lot of ethical principles andvalues that are in conflict with this situation. There is autonomy,transparency, justice, and non-maleficence (to be honest there areprobably more). So, for autonomy and justice, although Amanda isunderage and can’t make medical decisions for herself, she stillhas the right to know what’s going on for herself and independence.She is being cut off from even knowing what her diagnosis currentlyis. There is no transparency of the disclosed information about herown body. It would be non-maleficence if the surgeon and parentsmade the decision to follow through with the surgical procedure andnot allowing Amanda to know what they are doing to her.
What are some of the long-term effects of Andy’sdecision? First of all, with Andy sounding hesitant aboutspeaking with Amanda he will probably lose rapport with her and notbe able to gain the trust he and she needs to be able to care forher. If Andy decides to share the information her parents are notwanting her to know he could seriously hurt the family that’llcause confusion, hurt and it would make her parents look completelyharsh being that they didn’t want Amanda to know in the firstplace. In this situation Andy really has to be careful with what hesays and what he shares. He could break a family for good if hemesses up. It is also very hard because as nurses we are ourpatients advocate and that is our job and concern to make sure weare advocating for our patients; always.
What are your legal responsibilities, or obligations ifany? This whole situation reminds me of an episode onGreys Anatomy in which the same thing happened. However, one of theresidents blurted out and disclosed the information that the younggirl had testis. The family was distraught and even wanted to ruinhis career. Since the parents are her guardian and are the onlyones who can make decisions about her health, they are not breakinglaws by hiding that information but it is adamant that health careis honest and open with the patient’s care, procedures andstatus.
Do you agree with the surgeon? Yes, I do agreewith the surgeon. As we all know, because of the surgeon’sdecisions her parents are probably going to want to get a secondopinion and try to find a surgeon who will respect their wishes ofnot letting their daughter know what is going on with herhealth.
What process can be used to sort through thisconflict? I believe that the process to sort through thisconflict is to first assess more. Try to find out the reason’s herparents don’t want that information being shared. Assessing andgathering more information would be a great start and then nextprobably educating with her parents’ long-term effects if they wereto go on with the procedure. Once Amanda turns 18, she will be ableto seek her personal health records and see that her parents didn’twant her to know this information and that could also upset Amandaknowing that she was lied to most of her life.
What is moral distress among care-givers and what canyou do to alleviate it? According to American Associationof critical-care nurses, moral distress is basically, “when youknow the ethically correct action to take but you are constrainedfrom taking it.” When you sense that you are having this distressit is important to, “seek assistance in working through it.”
