Andy is assigned to care for a 14-year-old girl, Amanda, admitted with a large tumor located in the left groin area. During an assessment, Amanda shares her personal feelings with Andy. She tells him that she “feels diff erent” from her friends. She is ashamed of her physical development because all her girlfriends have “breasts” and boyfriends. She is very fl at-chested and embarrassed.

Andy listens attentively to Amanda and helps her focus on some of her positive attributes and talents.

A computed tomography (CT) scan is ordered and reveals that the tumor extends to what appears to be the ovary. A gynecological surgeon is called in to evaluate the situation. An ultrasonic-guided biopsy is performed. It is discovered that the tumor is actually an enlarged lymph node, and the “ovary” is actually a testis. Amanda has both male and female gonads.

When the information is given to Amanda ’ s parents, they do not want her to know. Th ey feel that she was raised as “their daughter.” Th ey ask the surgeon to remove the male gonads and leave only the female gonads. Th at way, “Amanda will never need to know.” Th e surgeon refuses to do this. Andy believes the parents should discuss the situation with Amanda as they are denying her choices. Th e parents are adamant about Amanda not knowing anything. Andy returns to Amanda ’ s room, and Amanda begins asking all types of questions regarding the tests and the treatments.

Andy hesitates before answering, and Amanda picks up on this, demanding he tell her the truth.

1. How should Andy respond?

2. What ethical principles are in confl ict?

3. What are the long-term eff ects of Andy ’ s decision?