Bertie and Adelaide Brainy live in Peaceville, an outer suburb of Brisbane. They met when they were in second year of a Bachelor of Liberal Arts degree at the University of the Eastern Suburbs in Brisbane. Though Bertie's major was philosophy, and Adelaide's was classics, both shared a love of elegant dining. After a whirlwind romance, Bertie and Adelaide married. In 2021 they have four children - Rachel aged 21, Shona aged 14, Sheenagh aged 12, and Shaun aged 10.

Adelaide works at a local high school teaching ancient history. Bertie (who undertook a Masters in Audiology) now works as an audiologist. He specialises in diagnosing and treating ageing rock stars who are suffering from noise induced binaural hearing loss (loss of hearing in both ears). Bertie is such a rock and roll fan he offers his services on a pro bono basis. Bertie spends a great deal of his time travelling or starring in advertisements in the world press.

In November 2021, Bertie flies from London to Cairns for work. He wakes the following morning with a sore throat. At 6 p.m., Bertie attends a local general practitioner's surgery in Cairns where he is seen by Dr Ryanne. Dr Ryanne is very junior, having only recently graduated from medical school. She is also very tired after having worked for 14 days straight. Dr Ryanne barely looks up when Bertie describes his symptoms to her. Dr Ryanne tells Bertie it sounds a lot like he has strep throat. Dr Ryanne offers to apply some topical anti-bac (an anti bacterial spray) to the back of Bertie's throat. Bertie agrees. Bertie returns to Brisbane. After a particularly difficult week dealing with family issues, Adelaide and Bertie decide they do not want to have any more children. Put simply, they cannot afford the costs associated with bringing up a child. Bertie and Adelaide are sent by their general practitioner to see Dr Bad, a surgeon. Dr Bad examines Bertie and writes down his medical history. She advises Bertie to undergo a vasectomy (a sterilisation operation performed on a male). Dr Bad asks Bertie to return to see her after one, three and six months, with a sample of his semen, so that his fertility can be tested over that period. Bertie undergoes the vasectomy procedure.

Rachel, who has long suffered from epilepsy, undergoes an operation performed by Dr Excellent, a neurosurgeon. Dr Excellent has invented a new procedure through which new connections are established in the brain by applying a laser to different parts of the brain. While Rachel is having the procedure performed, Dr Smart (who is assisting Dr Excellent in carrying out the procedure) alerts Dr Excellent to some unusual brain activity being exhibited by Rachel. Dr Excellent suspends the operation temporarily, so Dr Excellent can call some senior neurosurgical colleagues, Drs Right and Right On. Dr Excellent describes what is going on to Dr Right and Dr Right On. The two senior neurosurgeons advise Dr Excellent that they regard continuing with the surgery as a reasonable thing for him to do. Dr Excellent resumes the conduct of the surgery.

Shona is embarrassed by the size of her nose. She attends a medical appointment with Dr Good to discuss her options. Bertie and Adelaide also attend. Dr Good suggests Shona consider having a rhinoplasty ("a nose job"). Dr Good describes, in considerable detail, the physical intrusions involved, the level of pain associated with the surgery, and the possible side effects and complications. Shona understands, in broad terms, the nature of the procedure. She struggles, however, to comprehend some of the risks and side effects of the procedure. She is horrified by what Dr Good tells her about a rhinoplasty. Shona makes it clear that she doesn't want a rhinoplasty. Bertie and Adelaide, on the other hand, think that Shona having a rhinoplasty is a great idea. They happily give their consent for Dr Good to proceed.

Professor Brainy (Bertie's father), attends the surgery of Dr Keen (a surgeon). Professor Brainy had seen Dr Keen some years earlier for treatment of lung cancer. At that time, Dr Keen removed part of Professor Brainy's left lung. Professor Brainy is informed by Dr Keen that his cancer is back and has now spread to his bladder and other internal organs. Dr Keen tells Professor Brainy that he needs to have surgery to remove his bladder "as a matter of urgency". Dr Keen assures him that the surgery is appropriate and strongly recommended. Professor Brainy has the surgery done by Dr Keen.

It transpires that:

Dr Bad told Bertie his sterilisation procedure should be regarded as irreversible but does not mention that recanalisation of the vas can occur in approximately one in three thousand cases, If recanalisation does occur, the patient is no longer sterile.

Bertie has had a recanalisation of the vas.

Bertie forgot all about the need to return to see Dr Bad to have his semen analysed. Dr Bad made no further contact with Bertie.

There are two schools of thought in Australia as to whether a patient should be warned of the risk of recanalisation of the vas. One group of medical practitioners says patients should always be warned. The other group says that they should not be warned.

A prominent article in the Transnational Journal of Obstetrics and Gynaecology (an English journal) has criticised the view that patients should not be warned as "contrary to any reason" and "just plain silly".

Following resumption of sexual relations with her husband, Adelaide became pregnant. She has given birth to conjoined twins, Paula and Pauline. Paula and Pauline share several organs in common. If separated, Paula has a 40% of survival, but Pauline will definitely die. If not separated, there is a 55% chance they will both die.

Rachel has suffered permanent damage to the functioning of her lower limbs as a result of brain damage suffered in her operation. This would not have occurred had the operation been discontinued by Dr Excellent at the time he suspended the operation to consult with his colleagues.

Professor Brainy died after his surgery was performed. The surgery was competently performed by Dr Keen, but Professor Brainy was just too sick to have undergone the procedure.

Bertie did not have strep throat. He had a common cold made worse by the dry air of the aircraft in which he had recently travelled. A reasonably competent general practitioner with more than 5 years post admission experience would have been able to tell the difference between a cold and strep throat. Topical anti-bac is not an effective treatment of a common cold.

There are recognised side effects of anti-bac. Either can occur in 1 in every 8000 cases. Those side effects are dysphagia (difficulty swallowing) and permanent change to the texture of the skin at the back of the throat. Dr Ryanne did not tell Bertie about either side effect. Bertie suffers permanent change to the texture of the skin in the back of his throat.

Bertie is prepared to say, that, had Dr Ryanne told him of the risk of dysphagia, he would not have agreed to have anti bac sprayed in his throat. If Dr Ryanne had told him of the risk of a permanent change to the texture of the skin at the back of the throat, he would have agreed to have the anti bac sprayed in his throat. Advise generally as to the above. You may assume that any litigation will commence within the period prescribed by the Limitation of Actions Act 1974 (Qld).

How, at all, would your answer to the above question change if:

a. Instead of Paula and Pauline being conjoined twins, they were simply twins (that, is, babies born at the same time) and both had normal prospects of survival. Paula was born in good health, Pauline was born with severe disabilities necessitating life-long care.

b. Instead of Shona seeking advice about a rhinoplasty, she was seeking advice about having gender reassignment treatments. Dr Good described, in considerable detail, to Shona and her parents, the physical intrusions involved, the level of pain associated with the various procedures, and the possible side effects and complications of the treatments. Shona is keen to proceed with having the treatments. Bertie and Adelaide are yet to express a view as to whether they agree with Shona having the treatments.

You may assume that Dr Good is a specialist in the field of gender reassignment and he regards gender reassignment treatments as appropriate treatments for Shona.