from pptx import Presentation
from pptx.util import Inches, Pt
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE
import math

NAVY = RGBColor(0x0B, 0x25, 0x45)
TEAL = RGBColor(0x13, 0x7C, 0x8B)
CORAL = RGBColor(0xE0, 0x5A, 0x47)
GOLD = RGBColor(0xE8, 0xA8, 0x38)
LIGHT = RGBColor(0xF4, 0xF7, 0xFA)
WHITE = RGBColor(0xFF, 0xFF, 0xFF)
INK = RGBColor(0x22, 0x2B, 0x38)
GREY = RGBColor(0x6B, 0x77, 0x85)
FONT = "Calibri"

prs = Presentation()
prs.slide_width = Inches(13.333)
prs.slide_height = Inches(7.5)
BLANK = prs.slide_layouts[6]
warnings = []


def rect(slide, x, y, w, h, fill, line=None, shape=MSO_SHAPE.RECTANGLE):
    s = slide.shapes.add_shape(shape, Inches(x), Inches(y), Inches(w), Inches(h))
    s.fill.solid()
    s.fill.fore_color.rgb = fill
    if line is None:
        s.line.fill.background()
    else:
        s.line.color.rgb = line
    s.shadow.inherit = False
    return s


def text(slide, x, y, w, h, t, size=16, bold=False, color=INK, align=PP_ALIGN.LEFT,
         anchor=MSO_ANCHOR.TOP, italic=False):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.vertical_anchor = anchor
    tf.margin_left = tf.margin_right = Inches(0.05)
    tf.margin_top = tf.margin_bottom = Inches(0.03)
    p = tf.paragraphs[0]
    p.alignment = align
    r = p.add_run()
    r.text = t
    r.font.size = Pt(size)
    r.font.bold = bold
    r.font.italic = italic
    r.font.name = FONT
    r.font.color.rgb = color
    return tb


def est_lines(s, size, width_in):
    cpl = max(1, int(width_in * 72 / (size * 0.50)))
    return max(1, math.ceil(len(s) / cpl))


def bullets(slide, x, y, w, h, items, size=14, color=INK, bullet_color=TEAL, name=""):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = tf.margin_right = Inches(0.05)
    total = 0
    for i, it in enumerate(items):
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        p.space_after = Pt(5)
        r0 = p.add_run()
        r0.text = "\u25A0  "
        r0.font.size = Pt(size - 5)
        r0.font.color.rgb = bullet_color
        r0.font.name = FONT
        # allow "Lead: rest" bolding
        if "|" in it:
            lead, rest = it.split("|", 1)
            r1 = p.add_run()
            r1.text = lead
            r1.font.bold = True
            r1.font.size = Pt(size)
            r1.font.name = FONT
            r1.font.color.rgb = color
            r2 = p.add_run()
            r2.text = rest
            r2.font.size = Pt(size)
            r2.font.name = FONT
            r2.font.color.rgb = color
            full = lead + rest
        else:
            r1 = p.add_run()
            r1.text = it
            r1.font.size = Pt(size)
            r1.font.name = FONT
            r1.font.color.rgb = color
            full = it
        total += est_lines(full + "xxx", size, w - 0.3)
    need = total * size * 1.2 / 72 + len(items) * 5 / 72
    if need > h:
        warnings.append(f"OVERFLOW? {name}: need {need:.2f}in > {h:.2f}in")
    return tb


def header(slide, title, kicker=None):
    rect(slide, 0, 0, 13.333, 1.1, NAVY)
    rect(slide, 0, 1.1, 13.333, 0.06, TEAL)
    text(slide, 0.6, 0.18, 12.1, 0.8, title, size=28, bold=True, color=WHITE, anchor=MSO_ANCHOR.MIDDLE)
    if kicker:
        text(slide, 0.6, 1.25, 12.1, 0.5, kicker, size=15, italic=True, color=GREY)


def footer(slide, n, src=None):
    rect(slide, 0, 7.12, 13.333, 0.38, LIGHT)
    text(slide, 0.6, 7.14, 10.8, 0.32, src or "Consent for surgical procedures", size=10, color=GREY,
         anchor=MSO_ANCHOR.MIDDLE)
    text(slide, 12.0, 7.14, 0.8, 0.32, str(n), size=10, color=GREY, align=PP_ALIGN.RIGHT,
         anchor=MSO_ANCHOR.MIDDLE)


def notes(slide, t):
    slide.notes_slide.notes_text_frame.text = t


def card(slide, x, y, w, h, title, items, accent=TEAL, size=13, name=""):
    rect(slide, x, y, w, h, WHITE, line=RGBColor(0xD5, 0xDD, 0xE6))
    rect(slide, x, y, w, 0.08, accent)
    text(slide, x + 0.12, y + 0.14, w - 0.24, 0.45, title, size=16, bold=True, color=accent)
    bullets(slide, x + 0.12, y + 0.62, w - 0.24, h - 0.7, items, size=size, bullet_color=accent, name=name or title)


def new(title, kicker=None, src=None):
    s = prs.slides.add_slide(BLANK)
    rect(s, 0, 0, 13.333, 7.5, WHITE)
    header(s, title, kicker)
    footer(s, len(prs.slides), src)
    return s


# ---------------- 1. Title ----------------
s = prs.slides.add_slide(BLANK)
rect(s, 0, 0, 13.333, 7.5, NAVY)
rect(s, 0, 5.2, 13.333, 0.08, GOLD)
rect(s, 0.7, 1.6, 0.12, 2.5, CORAL)
text(s, 1.05, 1.5, 11, 0.5, "SURGERY  |  PROFESSIONALISM, ETHICS AND MEDICAL LAW", size=14, bold=True, color=GOLD)
text(s, 1.05, 2.0, 11.5, 1.8, "Consent for Surgical Procedures", size=46, bold=True, color=WHITE)
text(s, 1.05, 3.3, 11.5, 1.2, "Identify, discuss and defend the medicolegal, sociocultural and ethical issues",
     size=22, color=RGBColor(0xCF, 0xE3, 0xEA))
text(s, 1.05, 5.5, 11, 0.5, "Presenter: ____________________        Date: ____________________", size=16,
     color=RGBColor(0xCF, 0xE3, 0xEA))
text(s, 1.05, 6.2, 11, 0.5,
     "Sources: Bailey & Love 28e, Sabiston, Miller's Anesthesia 10e, Scott-Brown, Rosen's, Campbell-Walsh; case law",
     size=12, color=RGBColor(0x9F, 0xB6, 0xC8))
notes(s, "Opening: consent is both a legal requirement and the practical expression of respect for the patient's "
         "autonomy. This talk identifies the issues, discusses them under three lenses (medicolegal, sociocultural, "
         "ethical), and shows how each position can be defended.")

# ---------------- 2. Objectives ----------------
s = new("Learning objectives and roadmap")
steps = [("IDENTIFY", "Elements of valid consent and where it commonly fails", TEAL),
         ("DISCUSS", "Medicolegal, sociocultural and ethical issues, with case law", NAVY),
         ("DEFEND", "Justify practice choices to patient, peers, court and ethics committee", CORAL)]
for i, (h, d, c) in enumerate(steps):
    x = 0.7 + i * 4.1
    rect(s, x, 1.7, 3.8, 2.1, c)
    text(s, x + 0.2, 1.85, 3.4, 0.6, h, size=26, bold=True, color=WHITE)
    text(s, x + 0.2, 2.5, 3.4, 1.2, d, size=16, color=WHITE)
text(s, 0.7, 4.1, 12, 0.5, "Roadmap", size=20, bold=True, color=NAVY)
bullets(s, 0.7, 4.6, 6, 2.4, ["1. Definition, elements and ethical basis",
                              "2. Process: who, when, what to disclose",
                              "3. Medicolegal issues and key cases",
                              "4. Special situations"], size=16, name="roadmap1")
bullets(s, 6.9, 4.6, 6, 2.4, ["5. Sociocultural issues",
                              "6. Ethical dilemmas in surgical practice",
                              "7. Defending your position",
                              "8. Checklist, evidence and take-home points"], size=16, name="roadmap2")
notes(s, "Make the three verbs explicit: the exam or viva usually expects you to take a position and justify it.")

# ---------------- 3. Definition & elements ----------------
s = new("What makes consent valid?", "Consent is a process of shared decision-making, not a signature on a form",
        "Bailey & Love 28e; Sabiston; Miller's Anesthesia 10e")
els = [("CAPACITY", "Able to understand, retain and weigh the information, and to communicate a choice", TEAL),
       ("VOLUNTARINESS", "Free from coercion or pressure from family, staff or circumstances", NAVY),
       ("INFORMATION", "Enough accurate information about nature, risks, benefits and alternatives", CORAL)]
for i, (h, d, c) in enumerate(els):
    x = 0.7 + i * 4.1
    rect(s, x, 1.85, 3.8, 1.9, c)
    text(s, x + 0.2, 1.95, 3.4, 0.5, h, size=22, bold=True, color=WHITE)
    text(s, x + 0.2, 2.5, 3.4, 1.2, d, size=15, color=WHITE)
card(s, 0.7, 4.0, 6.0, 2.95, "Key historical cases (US)", [
    "Schloendorff v Society of New York Hospital (1914):| every adult of sound mind may decide what is done to their body",
    "Salgo v Leland Stanford (1957):| coined 'informed consent'; duty to inform of risks, benefits and alternatives"],
     accent=NAVY, size=14)
card(s, 6.9, 4.0, 5.75, 2.95, "Why it matters", [
    "Legal:| treatment without valid consent can amount to battery or negligence",
    "Ethical:| expresses respect for autonomy; builds trust and transparency",
    "Practical:| aligns expectations and reduces complaints"],
     accent=TEAL, size=14)
notes(s, "Bailey & Love lists the three elements: capacity, absence of coercion, sufficient information. "
         "Miller's Anesthesia notes Schloendorff (1914) and Salgo (1957).")

# ---------------- 4. Ethical principles ----------------
s = new("Ethical foundation: four principles applied to consent", None, "Sabiston; Campbell-Walsh Urology")
pr = [("Autonomy", "Right to choose, including refusal. The surgeon offers the chance to be informed and does not force information on a patient who declines it.", TEAL),
      ("Beneficence", "Act in the patient's best interests. Basis for treating in emergencies when the patient cannot decide and no surrogate is available.", NAVY),
      ("Non-maleficence", "Avoid harm. Disclose foreseeable risks and be candid if something goes wrong.", CORAL),
      ("Justice", "Fair access to information and to treatment, whatever language, literacy, gender or status.", GOLD)]
for i, (h, d, c) in enumerate(pr):
    x = 0.6 + (i % 2) * 6.2
    y = 1.5 + (i // 2) * 2.7
    rect(s, x, y, 5.9, 2.5, LIGHT)
    rect(s, x, y, 0.15, 2.5, c)
    text(s, x + 0.35, y + 0.15, 5.3, 0.55, h, size=24, bold=True, color=NAVY)
    text(s, x + 0.35, y + 0.8, 5.3, 1.6, d, size=16)
notes(s, "Campbell-Walsh: autonomy, beneficence, nonmaleficence and justice remain the foundation of ethical practice; "
         "informed consent is essential to surgery with limited exceptions. Sabiston: in emergencies, presumed consent rests on beneficence.")

# ---------------- 5. The process ----------------
s = new("The consent process: who, when and what", "A continuous conversation that starts well before the day of surgery",
        "Scott-Brown Vol 1; Miller's Anesthesia 10e; Sabiston")
card(s, 0.6, 1.8, 4.0, 5.1, "Who and when", [
    "Ideally the operating surgeon, or a team member trained for the procedure",
    "Duty cannot be delegated away:| responsibility rests with the clinician providing the therapy",
    "Anaesthetist obtains consent for anaesthesia",
    "Allow time to reflect; rushing has ethical and medicolegal consequences",
    "Reconfirm on the day of surgery"], accent=TEAL, size=13)
card(s, 4.7, 1.8, 4.0, 5.1, "What to disclose", [
    "Diagnosis, nature and purpose of the operation",
    "Common and serious (material) risks",
    "Benefits and realistic outcomes",
    "Reasonable alternatives, including no treatment",
    "Recovery, cost and follow-up",
    "Possible need for transfusion or additional procedures"], accent=NAVY, size=13)
card(s, 8.8, 1.8, 3.95, 5.1, "Often forgotten", [
    "Surgeon's own experience and learning curve",
    "Innovative or novel procedures: disclose the uncertainty of the risks",
    "Who will actually operate, including trainees",
    "Photography, teaching and research use",
    "Teach-back to confirm understanding"], accent=CORAL, size=13)
notes(s, "Sabiston: a surgeon late in adopting a technique must disclose lack of experience; for innovative operations, disclose uncertainty. "
         "Miller: the duty to inform cannot be morally or legally delegated; colleagues may assist.")

# ---------------- 6. Medicolegal: legal basis & standards ----------------
s = new("Medicolegal issues: battery, negligence and the standard of disclosure", None,
        "Bailey & Love 28e; Samira Kohli v Prabha Manchanda (2008); Montgomery v Lanarkshire (2015)")
card(s, 0.6, 1.4, 4.0, 2.5, "Two routes to a claim", [
    "Battery / trespass:| no consent, or treatment beyond what was agreed",
    "Negligence:| consent given, but disclosure inadequate and harm followed"],
     accent=CORAL, size=13)
card(s, 4.7, 1.4, 4.0, 2.5, "Standard of disclosure", [
    "Professional standard (Bolam, Sidaway):| what a responsible body of doctors would disclose",
    "Patient-centred (Canterbury; Montgomery):| what a reasonable patient would want to know"],
     accent=NAVY, size=13)
card(s, 8.8, 1.4, 3.95, 2.5, "Duty of candour", [
    "Tell the patient when something goes wrong, whether or not there was fault",
    "Complications of the disease itself are excluded"],
     accent=TEAL, size=13)
# Table of cases
rows = [("Case", "Principle"),
        ("Samira Kohli v Prabha Manchanda (India SC, 2008)", "Consent for diagnostic laparoscopy did not cover hysterectomy; a competent adult's consent cannot come from relatives; extension only if a genuine emergency"),
        ("Montgomery v Lanarkshire (UK, 2015)", "Disclose material risks and reasonable alternatives that a reasonable patient would want to know"),
        ("Gillick (UK)", "A child under 16 who shows sufficient maturity can consent for themselves")]
tbl = s.shapes.add_table(4, 2, Inches(0.6), Inches(4.1), Inches(12.15), Inches(2.85)).table
tbl.columns[0].width = Inches(4.3)
tbl.columns[1].width = Inches(7.85)
for r, row in enumerate(rows):
    for c, val in enumerate(row):
        cell = tbl.cell(r, c)
        cell.text = val
        para = cell.text_frame.paragraphs[0]
        para.runs[0].font.size = Pt(13)
        para.runs[0].font.name = FONT
        para.runs[0].font.bold = (r == 0 or c == 0)
        cell.vertical_anchor = MSO_ANCHOR.MIDDLE
        cell.fill.solid()
        if r == 0:
            cell.fill.fore_color.rgb = NAVY
            para.runs[0].font.color.rgb = WHITE
        else:
            cell.fill.fore_color.rgb = LIGHT if r % 2 else WHITE
            para.runs[0].font.color.rgb = INK
notes(s, "Samira Kohli: consent was for diagnostic laparoscopy; hysterectomy and bilateral salpingo-oophorectomy were performed after "
         "consent was taken from her mother. The Supreme Court held that this was not valid. Verify the citation in your local legal reference "
         "before quoting it in an exam or a court setting. Bailey & Love discuss duty of candour and the Montgomery-type disclosure.")

# ---------------- 7. Documentation & forms ----------------
s = new("Medicolegal issues: documentation, forms and delegation", None, "Scott-Brown Vol 1; Miller's Anesthesia 10e; recent reviews")
card(s, 0.6, 1.4, 6.0, 2.65, "Forms of consent", [
    "Implied:| e.g. patient offers arm for examination",
    "Expressed oral:| adequate for minor procedures, but poorly provable",
    "Expressed written:| standard for surgery, anaesthesia, blood transfusion and high-risk procedures",
    "Signature on a form is evidence of consent, not proof of understanding"], accent=TEAL, size=13)
card(s, 6.75, 1.4, 6.0, 2.65, "What to record in the notes", [
    "Discussion of risks, benefits, alternatives and questions asked",
    "Leaflets and decision aids provided",
    "Capacity assessment, interpreter used, who was present",
    "Specific wishes, e.g. refusal of blood products"], accent=NAVY, size=13)
card(s, 0.6, 4.2, 6.0, 2.75, "Common causes of litigation", [
    "Wrong or additional procedure beyond the scope agreed",
    "Material risk not disclosed (nerve injury, sterility, scarring)",
    "Consent taken by an unprepared junior, or minutes before surgery",
    "Consent from the wrong person, e.g. spouse for a competent adult"], accent=CORAL, size=13)
card(s, 6.75, 4.2, 6.0, 2.75, "Recent evidence (systematic reviews)", [
    "Procedure-specific consent forms reviewed (Ann R Coll Surg Engl 2025, PMID 39360925)",
    "Inadequate disclosure and poor patient recall in neurosurgical consent (Surgeon 2025, PMID 39658497)",
    "Strategies to improve the consent process (Br J Neurosurg, PMID 39491339)"], accent=GOLD, size=13)
notes(s, "Scott-Brown: consent for surgery implies consent for anaesthesia in the UK, but anaesthetists are advised to obtain specific consent. "
         "The three PubMed items are recent systematic reviews; read the abstracts before citing specific conclusions.")

# ---------------- 8. Special situations ----------------
s = new("Special situations", "Where consent is difficult, and what the law and ethics allow", "Bailey & Love 28e; Barash Clinical Anesthesia 9e; Rosen's")
card(s, 0.6, 1.8, 4.0, 5.1, "Emergency", [
    "Doctrine of medical necessity: treat to save life and limb in the patient's best interests",
    "Rests on presumed consent and beneficence",
    "A valid advance refusal of that treatment must still be honoured",
    "Postpone, where safe, until capacity returns",
    "Convenience is not necessity"], accent=CORAL, size=13)
card(s, 4.7, 1.8, 4.0, 5.1, "Lacking capacity", [
    "Capacity is task-specific and can fluctuate",
    "Disagreeing with advice does not prove incapacity",
    "Reversible causes (pain, drugs, delirium) should be treated first",
    "Surrogate or legal guardian decides on the patient's known wishes",
    "Involve the psychiatrist or ethics committee in doubtful cases"], accent=NAVY, size=13)
card(s, 8.8, 1.8, 3.95, 5.1, "Children", [
    "Parents or guardians consent for young children",
    "Obtain the child's assent and explain age-appropriately",
    "Mature minors may consent (Gillick competence, UK)",
    "Parental authority is not absolute: refusal that endangers the child can be overridden by court or authorities"], accent=TEAL, size=13)
notes(s, "Bailey & Love: unconscious emergency patients can be operated on under necessity; advance decisions must be honoured. "
         "Rosen's: refusal grounded in firm religious belief does not prove incapacity. Barash: parental authority is not absolute.")

# ---------------- 9. Extending the procedure ----------------
s = new("Scenario: the patient is asleep and the surgeon finds more", "Extending the operation under anaesthesia", "Bailey & Love 28e; Samira Kohli (2008)")
rect(s, 0.6, 1.8, 5.8, 5.0, NAVY)
text(s, 0.85, 1.95, 5.3, 0.5, "Case", size=20, bold=True, color=GOLD)
text(s, 0.85, 2.5, 5.3, 4.2,
     "A woman consents to diagnostic laparoscopy and laparotomy only if required. Under anaesthesia, extensive disease is found. "
     "The surgeon obtains a signature from a relative and performs hysterectomy with bilateral salpingo-oophorectomy.\n\n"
     "Was this valid?", size=16, color=WHITE)
card(s, 6.6, 1.8, 6.15, 2.4, "Analysis", [
    "Consent was limited to the diagnostic procedure",
    "Relatives cannot consent for a competent adult",
    "The condition was not immediately life-threatening: no emergency"], accent=CORAL, size=14)
card(s, 6.6, 4.35, 6.15, 2.45, "Better practice", [
    "Discuss pre-operatively the possible findings and the options",
    "Document wishes, or stage the surgery and wake the patient",
    "Extend only to avert death or serious harm"], accent=TEAL, size=14)
notes(s, "This mirrors Samira Kohli v Prabha Manchanda. Bailey & Love: if the patient consents only to a D&C, do not perform a hysterectomy 'in her best interests' because she is anaesthetised.")

# ---------------- 10. Sociocultural ----------------
s = new("Sociocultural issues", "Autonomy is understood differently in different families and communities",
        "Rosen's; Campbell-Walsh; Barash; ethical and legal commentary")
card(s, 0.6, 1.8, 4.0, 5.1, "Family and society", [
    "Family-centred decision-making is the norm in many settings; relatives may ask the doctor to withhold bad news",
    "Spousal or in-laws' permission is often demanded for women, but is not legally required for a competent adult",
    "Patients may defer to the doctor (paternalistic trust)",
    "Ask the patient how they want decisions made"], accent=TEAL, size=13)
card(s, 4.7, 1.8, 4.0, 5.1, "Language, literacy, belief", [
    "Use trained interpreters, not relatives",
    "Low health literacy: plain words, pictures, teach-back",
    "Consent forms in a language the patient reads",
    "Fatalism, fear of anaesthesia, stigma (cancer, stoma, amputation)",
    "Gender preferences for the operating team"], accent=NAVY, size=13)
card(s, 8.8, 1.8, 3.95, 5.1, "Religion and refusal", [
    "Jehovah's Witnesses may refuse blood but still want the best surgical care",
    "Discuss which products and cell salvage are acceptable",
    "Refusal on firm religious belief does not mean incapacity",
    "Respect, document and plan bloodless techniques"], accent=CORAL, size=13)
notes(s, "Campbell-Walsh: refusal of blood does not mean refusal of care. Rosen's: refusal for firmly held religious belief does not prove incapacity. "
         "Bailey & Love notes the need to discuss which blood products or salvage systems are acceptable.")

# ---------------- 11. Ethical dilemmas ----------------
s = new("Ethical dilemmas in surgical consent", None, "Sabiston; Miller's Anesthesia 10e; Scott-Brown")
dl = [("Patient declines information", "Offer the chance to be informed; do not force details. Record the waiver."),
      ("Therapeutic privilege", "Withholding information to avoid harm is narrow and hard to defend. It never replaces a discussion about preferences."),
      ("Family requests concealment", "The patient's right to know outweighs the family's request unless the patient has chosen otherwise."),
      ("Peri-operative DNR", "Required reconsideration: discuss and agree what is acceptable during anaesthesia and surgery."),
      ("Trainees and learning curve", "Disclose who operates and the surgeon's experience; do not substitute surgeons without consent."),
      ("Innovation vs research", "Disclose uncertainty; use ethics review and research consent where appropriate.")]
for i, (h, d) in enumerate(dl):
    x = 0.6 + (i % 3) * 4.1
    y = 1.4 + (i // 3) * 2.8
    rect(s, x, y, 3.95, 2.6, LIGHT)
    rect(s, x, y, 3.95, 0.1, CORAL if i % 2 else TEAL)
    text(s, x + 0.15, y + 0.2, 3.65, 0.8, h, size=17, bold=True, color=NAVY)
    text(s, x + 0.15, y + 1.0, 3.65, 1.6, d, size=14)
notes(s, "Sabiston: the responsibility is to give the chance to be informed, not to recite information against the patient's wishes; "
         "innovative procedures need disclosure of uncertainty. Miller's: pregnancy testing and routine tests also need consent.")

# ---------------- 12. Defend ----------------
s = new("Defending your position", "Be ready to justify what you did, and why, to four audiences")
aud = [("The patient", "Plain-language explanation, respect for the choice made, honest answers when things go wrong", TEAL),
       ("The court or medical council", "Valid capacity assessment, material risks disclosed, alternatives offered, contemporaneous notes, emergency criteria met", NAVY),
       ("Colleagues and ethics committee", "Principle-based reasoning: autonomy first, beneficence in emergencies, least restrictive action", CORAL),
       ("Yourself", "Would I be comfortable explaining this decision to the patient afterwards?", GOLD)]
for i, (h, d, c) in enumerate(aud):
    y = 1.8 + i * 1.28
    rect(s, 0.6, y, 3.4, 1.15, c)
    text(s, 0.75, y, 3.1, 1.15, h, size=17, bold=True, color=WHITE, anchor=MSO_ANCHOR.MIDDLE)
    rect(s, 4.0, y, 8.75, 1.15, LIGHT)
    text(s, 4.2, y, 8.4, 1.15, d, size=15, anchor=MSO_ANCHOR.MIDDLE)
text(s, 0.6, 6.85, 12, 0.3, "", size=10)
notes(s, "Frame defence as justification of process, not outcome: a bad result with good consent is defensible; a good result without consent may still be a battery.")

# ---------------- 13. Defence arguments ----------------
s = new("Defending consent-related claims and decisions", None, "Bailey & Love 28e; Sabiston; case law")
card(s, 0.6, 1.4, 6.0, 5.5, "Defensible when", [
    "Capacity assessed and documented",
    "Material risks and alternatives disclosed in understandable terms",
    "Consent given freely, by the right person, before premedication",
    "Procedure stayed within the agreed scope",
    "Emergency: delay would risk life or serious harm and no valid refusal existed",
    "Candid, prompt disclosure of complications",
    "Procedure-specific forms and decision aids used"], accent=TEAL, size=14)
card(s, 6.75, 1.4, 6.0, 5.5, "Common weak points", [
    "Blanket forms ('any other procedure necessary') used to cover non-urgent extensions",
    "Consent taken on the day, in the anaesthetic room, or by a stranger",
    "Language barriers ignored; relative used as interpreter",
    "No record of the discussion",
    "Relying on the spouse or parent for a competent adult",
    "Concealing a complication or the surgeon's inexperience",
    "Overriding a refusal because the surgeon 'knows best'"], accent=CORAL, size=14)
notes(s, "Bailey & Love and Sabiston provide the underlying reasoning. Samira Kohli rejected extension for convenience or because a relative agreed.")

# ---------------- 14. Debate ----------------
s = new("Defending the principle: can informed consent be justified?", "Arguments commonly raised in viva or debate")
card(s, 0.6, 1.8, 6.0, 4.9, "Critique", [
    "Patients cannot fully understand complex surgery",
    "Disclosure may cause anxiety and harm",
    "Forms protect hospitals more than patients",
    "Time pressures limit real discussion"], accent=CORAL, size=15)
card(s, 6.75, 1.8, 6.0, 4.9, "Defence", [
    "Understanding is improved by plain language, aids and teach-back",
    "Patient values, not just medical facts, decide what is best",
    "Trust and satisfaction improve with good communication",
    "The alternative, paternalism, has a poor record of respecting people",
    "Limited exceptions (emergency, waiver, incapacity) keep it workable"], accent=TEAL, size=15)
notes(s, "Sabiston describes how earlier generations of surgeons decided for patients purely on medical grounds; today we accept patients choose about their own bodies.")

# ---------------- 15. Checklist ----------------
s = new("Practical checklist before every operation", None, "Synthesis of Bailey & Love, Sabiston, Scott-Brown, Miller")
chk = ["Capacity assessed; reversible causes addressed",
       "Right person consenting; no coercion",
       "Interpreter and accessible information used",
       "Diagnosis, procedure, benefits, material risks, alternatives discussed",
       "Experience, trainee role and novelty disclosed",
       "Wishes on blood products, DNR and extensions recorded",
       "Time to reflect; questions answered; teach-back done",
       "Written form signed, matches the operation list and site",
       "Reconfirmed on the day by the team",
       "Candour plan if something goes wrong"]
for i, c in enumerate(chk):
    x = 0.6 + (i % 2) * 6.2
    y = 1.4 + (i // 2) * 1.1
    rect(s, x, y, 6.0, 0.95, LIGHT)
    rect(s, x, y, 0.7, 0.95, TEAL)
    text(s, x, y, 0.7, 0.95, str(i + 1), size=22, bold=True, color=WHITE, align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    text(s, x + 0.8, y, 5.1, 0.95, c, size=14, anchor=MSO_ANCHOR.MIDDLE)
notes(s, "Use this as an audit tool for your own unit.")

# ---------------- 16. Take-home ----------------
s = prs.slides.add_slide(BLANK)
rect(s, 0, 0, 13.333, 7.5, NAVY)
text(s, 0.8, 0.6, 11.5, 0.8, "Take-home points", size=34, bold=True, color=WHITE)
rect(s, 0.8, 1.45, 1.6, 0.07, GOLD)
pts = ["Valid consent needs capacity, voluntariness and adequate information.",
       "Disclose what a reasonable patient would want to know, including alternatives and your experience.",
       "Consent is limited to what was agreed; extend only in a true emergency.",
       "Relatives cannot consent for a competent adult.",
       "Culture and religion shape decisions: ask, interpret, respect and document.",
       "Be candid when things go wrong. Defend the process, not the outcome."]
bullets(s, 0.8, 1.9, 11.7, 4.8, pts, size=20, color=WHITE, bullet_color=GOLD, name="takehome")
notes(s, "Close by asking the audience how their own unit handles extension of surgery and consent for trainees.")

# ---------------- 17. References ----------------
s = new("References")
refs = ["Bailey & Love's Short Practice of Surgery, 28th ed. Consent, capacity, children, duty of candour (clinical law section).",
        "Sabiston Textbook of Surgery. Application of ethical principles to central issues in surgical practice: informed consent.",
        "Miller's Anesthesia, 10th ed. Informed consent and informed refusal; competence and capacity; legal implications.",
        "Barash, Cullen & Stoelting's Clinical Anesthesia, 9th ed. Informed consent, assent and parental permission.",
        "Scott-Brown's Otorhinolaryngology Head & Neck Surgery. Obtaining patient consent for planned surgery.",
        "Rosen's Emergency Medicine; Campbell-Walsh-Wein Urology. Decision-making capacity; Jehovah's Witnesses and transfusion.",
        "Samira Kohli v Dr Prabha Manchanda (2008) 2 SCC 1, Supreme Court of India. Verify the citation locally.",
        "Montgomery v Lanarkshire Health Board [2015] UKSC 11. Gillick v West Norfolk and Wisbech AHA [1986] AC 112.",
        "Norvill J et al. Ann R Coll Surg Engl 2025 (PMID 39360925); Elmahdi A, Smith D. Surgeon 2025 (PMID 39658497); Br J Neurosurg (PMID 39491339)."]
bullets(s, 0.6, 1.4, 12.1, 5.6, refs, size=14, name="refs")

prs.save("/tmp/workspace/consent-ppt/output/Consent_for_Surgical_Procedures.pptx")
print("slides", len(prs.slides))
for w in warnings:
    print(w)