Maria is a healthy 45-year-old woman who enjoys travelling overseas with her de- facto partner Juliet. They have been planning to visit France for a tour of the Champagne region as soon as they are vaccinated against Covid-19 and Australia's international borders reopen. However, during a routine blood test, Dr Simone Stalenhag, Maria's regular GP, discovered that Maria has a high platelet count and promptly referred her to a haematologist, Dr Chester Nakayama, who is a specialist of blood related diseases.

Dr Nakayama diagnosed Maria with primary thrombocytosis, which is also called a blood cancer. He explained to Maria that the cause of her blood cancer is unknown and while blood tests show that her cells don't have any genetic mutations, the best way to find out what is causing her high platelet count is to perform a bone marrow biopsy. Maria was shocked to have discovered that she has a blood cancer and told Dr Nakayama that she refuses the diagnosis because she has no symptoms, she feels perfectly healthy and she believes the word 'cancer' will cause her and her partner anxiety. She understands that she has primary thrombocytosis due to a high platelet count, but not why this is called cancer and she does not feel that a bone marrow biopsy is necessary at this point in time.

Dr Nakayama informed Maria how the procedure will be performed, the purposes of obtaining a sample of her bone marrow, the material risks of the procedure and the consequences of not performing the procedure. One of the symptomatic consequences of primary thrombocytosis can be spontaneous blood clots in the arms and legs, which if untreated through medication can lead to heart attack. Dr

Nakayama forgot however to explain that the bone marrow biopsy may only result in finding out the cause of, but not treating the primary thrombocytosis.

During this conversation, Dr Nakayama felt that Maria was not listening to him. She seemed to only stare out the window of his office and at one point shook her head saying she doesn't want the bone marrow biopsy. She mentioned that she would like all of the information to be provided in writing to her before making a decision. Dr Nakayama said his secretary would send her a copy of the information via email as well as a medical authorisation form for the procedure. The information will also set out his fees and any out-of-pocket expenses. As Maria departed from his office, Dr Nakayama mentioned that he has personally had 5 bone marrow biopsies during his lifetime and they were all fine, and he has performed over 1000 bone marrow biopsies since he became a haematologist.

The next day Maria called Dr Nakayama's office to inform him that she will do the bone marrow biopsy because she dreamt about having a heart attack and her partner convinced her to do it to prevent further ill-health.

A) Before proceeding with the bone marrow biopsy, Dr Chester Nakayama asks you whether Maria has lawfully consented to the procedure. Advice Dr Chester Nakayama by using the elements of valid consent to medical treatment.

1) voluntariness

2) specific procedure

3) adequate information disclosure

4) competency.