Mr

Mrs. Smyth, a 75 year old woman, is admitted to St Always hospital, in Victoria, for a (L)

hip replacement. She is anxious and worried about the operation as she has negative

memories of her late husband Gerald's experience when he required surgery, a few

years previously. Her surgeon, Dr Bold, is aware of her anxieties and decides to give

Mrs. Smyth a general overview of the procedure and not to tell her of the risks. He has a

couple of reasons for not discussing this with Mrs. Smyth. Firstly, the risks are relatively

remote (that is, they are unlikely to occur) and secondly, Dr Bold is aware of her anxiety

and decides not to cause her any further 'worries'. Dr Bold delegates the responsibility of

ensuring the consent form is completed to his resident, Dr Toms.

Dr Toms is busy the morning of Mrs. Smyth's surgery and rushes into the ward with the

consent form. Dr Toms has a brief conversation with Mrs. Smyth, informing her that the

consent form has to be completed immediately. Mrs. Smyth, anxious and worried,

begins to tell Dr Toms that her husband Gerald suffered a dreadful outcome after similar

surgery and wants to know if there are any major complications associated with the

procedure in her case. She states that "Should anything go wrong, I don't want to end up

like my husband did. I have no desire to be completely incapacitated and spend the rest

of my days in a nursing home. Can you make sure my feelings are made clear?" Dr

Toms states that the operation is relatively straightforward and that it is anticipated that

she will experience a good recovery, however before the doctor can elaborate further,

her pager interrupts the conversation. The doctor says she has to leave and will return

before the patient goes to the operating theatre. In the corridor Dr Toms asks Nurse Pim

to get the consent form "sorted out", in case she does not return before the patient goes

to theatre. Nurse Pim is particularly busy and somewhat annoyed at the doctor's

request, so she gives the consent form to Nurse Flyn a new graduate nurse, to complete