const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  HeadingLevel, AlignmentType, BorderStyle, WidthType, ShadingType,
  VerticalAlign, LevelFormat, PageBreak, TableOfContents
} = require('docx');
const fs = require('fs');

// ─── Helpers ────────────────────────────────────────────────────────────────

function h1(text) {
  return new Paragraph({
    heading: HeadingLevel.HEADING_1,
    children: [new TextRun({ text, bold: true, size: 32, font: 'Arial' })],
    spacing: { before: 360, after: 180 }
  });
}

function h2(text) {
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    heading: HeadingLevel.HEADING_2,
    children: [new TextRun({ text, bold: true, size: 26, font: 'Arial' })],
    spacing: { before: 240, after: 120 }
  });
}

function h3(text) {
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    heading: HeadingLevel.HEADING_3,
    children: [new TextRun({ text, bold: true, size: 24, font: 'Arial' })],
    spacing: { before: 200, after: 100 }
  });
}

function para(text, opts = {}) {
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    children: [new TextRun({ text, font: 'Arial', size: 22, italic: opts.italic || false, bold: opts.bold || false })],
    spacing: { before: 60, after: 60 },
    alignment: opts.align || AlignmentType.JUSTIFIED
  });
}

function quote(text) {
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    children: [new TextRun({ text: '\u201C' + text + '\u201D', font: 'Arial', size: 22, italic: true, color: '1F497D' })],
    spacing: { before: 100, after: 100 },
    indent: { left: 720 },
    alignment: AlignmentType.JUSTIFIED
  });
}

function bullet(text, level = 0) {
  return new Paragraph({
    numbering: { reference: 'bullets', level },
    children: [new TextRun({ text, font: 'Arial', size: 22 })],
    spacing: { before: 40, after: 40 }
  });
}

function numbered(text, level = 0) {
  return new Paragraph({
    numbering: { reference: 'numbers', level },
    children: [new TextRun({ text, font: 'Arial', size: 22 })],
    spacing: { before: 40, after: 40 }
  });
}

function pageBreak() {
  return new Paragraph({ children: [new PageBreak()] });
}

function spacer() {
  return new Paragraph({ children: [new TextRun('')], spacing: { before: 80, after: 80 } });
}

// Simple table builder
function simpleTable(headers, rows, opts = {}) {
  const colCount = headers.length;
  const colWidth = opts.colWidth || Math.floor(9000 / colCount);

  const headerCells = headers.map(h => new TableCell({
    children: [new Paragraph({
      children: [new TextRun({ text: h, bold: true, font: 'Arial', size: 20, color: 'FFFFFF' })],
      alignment: AlignmentType.CENTER
    })],
    shading: { fill: '1F4E79', type: ShadingType.CLEAR, color: '1F4E79' },
    verticalAlign: VerticalAlign.CENTER,
    width: { size: colWidth, type: WidthType.DXA }
  }));

  const tableRows = [
    new TableRow({ children: headerCells, tableHeader: true }),
    ...rows.map((row, ri) => new TableRow({
      children: row.map(cell => new TableCell({
        children: [new Paragraph({
          children: [new TextRun({ text: cell, font: 'Arial', size: 20 })],
          alignment: AlignmentType.LEFT
        })],
        shading: { fill: ri % 2 === 0 ? 'EBF3FB' : 'FFFFFF', type: ShadingType.CLEAR },
        verticalAlign: VerticalAlign.CENTER,
        width: { size: colWidth, type: WidthType.DXA }
      }))
    }))
  ];

  return new Table({
    rows: tableRows,
    width: { size: 100, type: WidthType.PERCENTAGE }
  });
}

// Flowchart box (single centered shaded box)
function flowBox(text, fill = 'D6E4F7', bold = false) {
  return new Table({
    rows: [new TableRow({
      children: [new TableCell({
        children: [new Paragraph({
          children: [new TextRun({ text, font: 'Arial', size: 22, bold })],
          alignment: AlignmentType.CENTER
        })],
        shading: { fill, type: ShadingType.CLEAR, color: fill },
        verticalAlign: VerticalAlign.CENTER,
        margins: { top: 100, bottom: 100, left: 200, right: 200 }
      })]
    })],
    width: { size: 60, type: WidthType.PERCENTAGE },
    float: { horizontalAnchor: 'margin', absoluteHorizontalPosition: 0, relativeHorizontalPosition: 'center' }
  });
}

// Centered arrow paragraph
function arrow() {
  return new Paragraph({
    children: [new TextRun({ text: '\u25BC', font: 'Arial', size: 28, bold: true, color: '1F4E79' })],
    alignment: AlignmentType.CENTER,
    spacing: { before: 40, after: 40 }
  });
}

// Flowchart row builder - step boxes in a vertical flow
function flowchart(steps) {
  const result = [];
  steps.forEach((step, i) => {
    // Each step: { text, fill, bold }
    const fill = step.fill || (i === 0 ? '1F4E79' : i === steps.length - 1 ? '1E6B44' : 'BDD7EE');
    const textColor = (i === 0 || i === steps.length - 1) ? 'FFFFFF' : '000000';
    result.push(new Table({
      rows: [new TableRow({
        children: [new TableCell({
          children: [new Paragraph({
            children: [new TextRun({ text: step.text, font: 'Arial', size: 22, bold: step.bold || (i === 0 || i === steps.length - 1), color: textColor })],
            alignment: AlignmentType.CENTER
          })],
          shading: { fill, type: ShadingType.CLEAR },
          verticalAlign: VerticalAlign.CENTER,
          margins: { top: 120, bottom: 120, left: 300, right: 300 },
          borders: {
            top: { style: BorderStyle.SINGLE, size: 6, color: '1F4E79' },
            bottom: { style: BorderStyle.SINGLE, size: 6, color: '1F4E79' },
            left: { style: BorderStyle.SINGLE, size: 6, color: '1F4E79' },
            right: { style: BorderStyle.SINGLE, size: 6, color: '1F4E79' }
          }
        })]
      })],
      width: { size: 70, type: WidthType.PERCENTAGE },
      alignment: AlignmentType.CENTER
    }));
    if (i < steps.length - 1) {
      result.push(new Paragraph({
        children: [new TextRun({ text: '\u25BC', font: 'Arial', size: 32, bold: true, color: '1F4E79' })],
        alignment: AlignmentType.CENTER,
        spacing: { before: 20, after: 20 }
      }));
    }
  });
  return result;
}

// Two-column flowchart (side by side comparison)
function twoColFlow(leftSteps, rightSteps, leftLabel, rightLabel) {
  const maxLen = Math.max(leftSteps.length, rightSteps.length);
  const rows = [];

  // Header row
  rows.push(new TableRow({
    children: [
      new TableCell({
        children: [new Paragraph({ children: [new TextRun({ text: leftLabel, bold: true, font: 'Arial', size: 22, color: 'FFFFFF' })], alignment: AlignmentType.CENTER })],
        shading: { fill: '1F4E79', type: ShadingType.CLEAR },
        margins: { top: 100, bottom: 100 }
      }),
      new TableCell({
        children: [new Paragraph({ children: [new TextRun({ text: rightLabel, bold: true, font: 'Arial', size: 22, color: 'FFFFFF' })], alignment: AlignmentType.CENTER })],
        shading: { fill: '833C00', type: ShadingType.CLEAR },
        margins: { top: 100, bottom: 100 }
      })
    ]
  }));

  for (let i = 0; i < maxLen; i++) {
    const l = leftSteps[i] || '';
    const r = rightSteps[i] || '';
    rows.push(new TableRow({
      children: [
        new TableCell({
          children: [new Paragraph({ children: [new TextRun({ text: l, font: 'Arial', size: 20 })], alignment: AlignmentType.LEFT })],
          shading: { fill: i % 2 === 0 ? 'DEEAF1' : 'FFFFFF', type: ShadingType.CLEAR },
          margins: { top: 80, bottom: 80, left: 200, right: 200 }
        }),
        new TableCell({
          children: [new Paragraph({ children: [new TextRun({ text: r, font: 'Arial', size: 20 })], alignment: AlignmentType.LEFT })],
          shading: { fill: i % 2 === 0 ? 'FCE4D6' : 'FFFFFF', type: ShadingType.CLEAR },
          margins: { top: 80, bottom: 80, left: 200, right: 200 }
        })
      ]
    }));
  }

  return new Table({
    rows,
    width: { size: 100, type: WidthType.PERCENTAGE }
  });
}

// ─── DOCUMENT CONTENT ───────────────────────────────────────────────────────

const children = [];

// ── TITLE PAGE ──
children.push(
  spacer(), spacer(),
  new Paragraph({
    children: [new TextRun({ text: 'RS TAGGED QUESTIONS', bold: true, font: 'Arial', size: 52, color: '1F4E79' })],
    alignment: AlignmentType.CENTER, spacing: { before: 400, after: 200 }
  }),
  new Paragraph({
    children: [new TextRun({ text: 'Forensic Medicine and Toxicology', bold: true, font: 'Arial', size: 36, color: '2E74B5' })],
    alignment: AlignmentType.CENTER, spacing: { before: 100, after: 100 }
  }),
  new Paragraph({
    children: [new TextRun({ text: 'Chapter 3: Medical Law and Ethics', bold: true, font: 'Arial', size: 28, color: '2E74B5' })],
    alignment: AlignmentType.CENTER, spacing: { before: 100, after: 200 }
  }),
  new Paragraph({
    children: [new TextRun({ text: 'Comprehensive Exam-Ready Answers', italic: true, font: 'Arial', size: 24 })],
    alignment: AlignmentType.CENTER, spacing: { before: 100, after: 100 }
  }),
  new Paragraph({
    children: [new TextRun({ text: 'Source: KS Narayan Reddy\'s The Essentials of Forensic Medicine & Toxicology, 36th Edition (2026)', italic: true, font: 'Arial', size: 20 })],
    alignment: AlignmentType.CENTER, spacing: { before: 100, after: 60 }
  }),
  new Paragraph({
    children: [new TextRun({ text: 'Parikh\'s Textbook of Medical Jurisprudence, Forensic Medicine & Toxicology', italic: true, font: 'Arial', size: 20 })],
    alignment: AlignmentType.CENTER, spacing: { before: 60, after: 400 }
  }),
  pageBreak()
);

// ── SECTION 1: LONG ESSAYS ──
children.push(
  new Paragraph({
    children: [new TextRun({ text: 'SECTION 1: LONG ESSAYS', bold: true, font: 'Arial', size: 36, color: '1F4E79' })],
    alignment: AlignmentType.CENTER, spacing: { before: 200, after: 300 }
  })
);

// ── LONG ESSAY 1: NMC ──
children.push(
  h1('1. National Medical Commission (NMC) and its Functions'),
  h2('Introduction'),
  para('The National Medical Commission (NMC) is a statutory body established under The National Medical Commission Act, 2019. NMC came into existence on 25th September 2020 as the country\'s apex regulator of medical education and profession, after dissolution of the 63-year-old Medical Council of India (MCI).'),
  para('The NMC Act replaced the Indian Medical Council Act, 1956. The primary objective was to bring in transparency, accountability, and academic quality in medical education across India. The Act also aims to create a system that promotes equitable and universal healthcare.'),
  spacer(),
  h2('Composition'),
  para('NMC comprises 33 members:'),
  bullet('One Chairman'),
  bullet('Ten ex-officio members and twenty-two part-time members'),
  bullet('Out of the twenty-two part-time members, nineteen are nominated by States and Union Territories'),
  bullet('The Chairperson, certain part-time members, and the Secretary are appointed by the Central Government on the recommendation of a Search Committee'),
  spacer(),
  h2('Organizational Structure of NMC'),
  para('Illustration 1.1: NMC Organizational Structure', { italic: true, bold: false }),
  spacer(),
  ...flowchart([
    { text: 'NATIONAL MEDICAL COMMISSION (33 Members)', fill: '1F4E79', bold: true },
    { text: 'Chairman + 10 Ex-officio + 22 Part-time Members', fill: '2E74B5', bold: false },
    { text: 'Four Autonomous Boards', fill: '5B9BD5', bold: true },
  ]),
  spacer(),
  simpleTable(
    ['Autonomous Board', 'Key Functions'],
    [
      ['1. UGMEB (Under-Graduate Medical Education Board)', 'Recognition of UG qualifications; competency-based curriculum; minimum standards for medical institutions; faculty training'],
      ['2. PGMEB (Post-Graduate Medical Education Board)', 'Recognition of PG and super-specialty qualifications; curriculum for skills, ethics; promotes PG family medicine courses'],
      ['3. MARB (Medical Assessment and Rating Board)', 'Permission for new medical institutions; allows new PG courses or seat increase; inspections and ratings of colleges'],
      ['4. EMRB (Ethics and Medical Registration Board)', 'Maintains National Medical Register; issues practice licenses; disciplinary matters; enforces Code of Medical Ethics; penal erasure powers'],
    ]
  ),
  spacer(),
  h2('Powers and Functions of NMC'),
  bullet('Professional Ethics & Etiquette: Promotes professional ethics; assesses healthcare requirements; develops roadmap for medical education'),
  bullet('Fee Regulation: Frames guidelines for fees in 50% seats of private medical institutions'),
  bullet('Community Health Provider (CHP): Grants limited licenses for mid-level practice in primary and preventive healthcare in rural/underserved areas'),
  bullet('NEXT Exam (National Exit Test): Single national licensing examination for medical graduates; also qualifies foreign graduates for practice in India; replaces the earlier USMLE-equivalent system'),
  bullet('Quality Benchmarking: Oversees curriculum reforms, introduces competency-based medical education (CBME)'),
  bullet('International Standards: Ensures Indian medical degrees are recognized abroad'),
  spacer(),
  h2('NMC vs MCI - Key Differences'),
  simpleTable(
    ['Feature', 'MCI (Old)', 'NMC (New)'],
    [
      ['Established under', 'IMC Act 1956', 'NMC Act 2019'],
      ['Existence', 'Dissolved 2020', 'Since 25 Sept 2020'],
      ['Structure', 'Single council', '4 Autonomous Boards'],
      ['Licensing exam', 'State/University exams', 'NEXT (National Exit Test)'],
      ['Fee regulation', 'No direct power', 'Regulates 50% private seats'],
      ['CHP provision', 'Absent', 'Allows mid-level providers'],
    ]
  ),
  spacer(),
  h2('Significance'),
  para('The NMC has been welcomed as a major reform in Indian medical regulation. By splitting functions into four autonomous boards, it avoids concentration of power. The introduction of NEXT ensures standardized quality of graduates. The CHP provision aims to address the shortage of healthcare providers in rural India.'),
  spacer(), pageBreak()
);

// ── LONG ESSAY 2: PROFESSIONAL MISCONDUCT ──
children.push(
  h1('2. Professional Misconduct - Definition, Types, Penal Erasure and Procedure of Inquiry'),
  h2('Definition'),
  quote('Professional misconduct is conduct that falls below the standard expected of a registered medical practitioner, sufficient to render him unfit to remain on the Medical Register. It includes infamous conduct in a professional respect, i.e., conduct which would be regarded as disgraceful or dishonourable by professional brethren of good repute and competency.'),
  para('-- KS Narayan Reddy, 36th Ed.'),
  spacer(),
  h2('Types of Professional Misconduct'),
  bullet('Issuing false certificates'),
  bullet('Covering or associating with unqualified practitioners (dichotomy/fee splitting)'),
  bullet('Performing criminal abortions'),
  bullet('Unethical advertising or self-promotion'),
  bullet('Violation of professional secrecy without justification'),
  bullet('Sexual misconduct with patients'),
  bullet('Excessive prescribing of controlled substances'),
  bullet('Negligent practice causing harm'),
  bullet('Drunkenness during professional duties'),
  bullet('Corruption or demanding improper fees'),
  spacer(),
  h2('State Medical Council (SMC) - Inquiry Process'),
  para('Illustration 2.1: Flowchart - Procedure of Inquiry by SMC', { italic: true }),
  spacer(),
  ...flowchart([
    { text: 'COMPLAINT RECEIVED (by patient/relative/court/suo moto)' },
    { text: 'Complaint submitted to President of State Medical Council by Registrar' },
    { text: 'Referred to Sub-committee / Executive Committee for investigation & legal advice' },
    { text: 'Prima facie case? -- NO: Complainant informed; case dismissed' },
    { text: 'Prima facie case? -- YES: Notice issued to the practitioner (charge, written reply, date of hearing)' },
    { text: 'Hearing - Both parties present (complainant + legal adviser + practitioner)' },
    { text: 'Evidence recorded; voting by Council members; JUDGMENT' },
    { text: 'If GUILTY: Vote on Punishment -- Warning Notice OR Penal Erasure' },
    { text: 'APPEAL: To State Govt, then to Central Govt; Restoration possible' },
  ]),
  spacer(),
  h2('Punishments'),
  simpleTable(
    ['Punishment', 'Description', 'Effect'],
    [
      ['Warning Notice', 'Formal caution issued; lesser punishment; name remains on register', 'Practitioner warned; repetition invites heavier punishment'],
      ['Penal Erasure ("Professional Death Sentence")', 'Name removed permanently or for specified period from Medical Register; published widely', 'Cannot practice; erasure circulated in press and medical publications'],
    ]
  ),
  spacer(),
  h2('Powers of State Medical Council'),
  bullet('Has powers equivalent to Civil Court under CPC 1908'),
  bullet('Can call witnesses, examine evidence, issue notices'),
  bullet('Can initiate inquiry suo moto (on its own initiative)'),
  bullet('Can forward cases to NMC\'s Ethics and Medical Registration Board (EMRB) if beyond state jurisdiction'),
  spacer(),
  h2('Restoration of Name'),
  para('After penal erasure, the practitioner\'s name can be restored under the following circumstances:'),
  numbered('On direction of the Council itself after a specified period'),
  numbered('On successful appeal to State Government'),
  numbered('On further appeal to Central Government'),
  spacer(), pageBreak()
);

// ── LONG ESSAY 3: MEDICAL NEGLIGENCE ──
children.push(
  h1('3. Medical Negligence - Definition, Ingredients, Civil vs Criminal, Precautions & Defenses'),
  h2('Definition'),
  quote('Professional negligence is defined as absence of reasonable care and skill, or wilful negligence of a medical practitioner in the treatment of a patient, which causes bodily injury or death of the patient.'),
  para('Medical negligence is part of the law of torts - a civil wrong for which the sufferer can seek compensation.'),
  spacer(),
  h2('The 4 Ds - Ingredients / Elements of Negligence'),
  para('Illustration 3.1: The 4 D\'s of Medical Negligence', { italic: true }),
  spacer(),
  simpleTable(
    ['Element', 'Description', 'Example'],
    [
      ['1. DUTY', 'Existence of a duty of care. Arises when a doctor-patient relationship is established.', 'Admitted patient; doctor examining a patient in OPD'],
      ['2. DERELICTION (Breach)', 'Failure to conform to the standard of care by omission or commission.', 'Wrong drug prescribed; operation site error'],
      ['3. DIRECT CAUSE', 'A direct causal link (causation) between the breach of duty and the damage. Damage must be a foreseeable result.', 'Delayed diagnosis causing preventable complication'],
      ['4. DAMAGE', 'Actual injury, harm, or death to the patient as a result of the breach.', 'Permanent disability; death; disfigurement'],
    ]
  ),
  spacer(),
  h2('Types of Medical Negligence'),
  bullet('Civil Negligence'),
  bullet('Criminal Negligence'),
  bullet('Corporate Negligence'),
  bullet('Contributory Negligence'),
  spacer(),
  h2('Civil vs Criminal Negligence - Comparison'),
  para('Illustration 3.2: Civil vs Criminal Medical Negligence', { italic: true }),
  spacer(),
  twoColFlow(
    [
      'CIVIL NEGLIGENCE',
      'Patient files suit in Civil Court',
      'Doctor files suit for fees',
      'Standard: Preponderance of probability',
      'Outcome: Compensation / Damages awarded',
      'Consumer Protection Act 1986 applies',
      'National Consumer Disputes Redressal Commission (NCDRC)'
    ],
    [
      'CRIMINAL NEGLIGENCE',
      'State prosecutes the doctor',
      'Section 304A IPC / BNS equivalent',
      'Standard: Beyond reasonable doubt',
      'Outcome: Fine and/or imprisonment',
      'Gross recklessness / callous disregard required',
      'Jacob Mathew v. State of Punjab (SC 2005) sets standard'
    ],
    'Civil Negligence', 'Criminal Negligence'
  ),
  spacer(),
  h2('Res Ipsa Loquitur ("The thing speaks for itself")'),
  para('A legal principle applied when negligence is so obvious that it can be inferred from the facts themselves, without requiring expert evidence. Applicable when:'),
  numbered('The act was entirely within the control of the defendant'),
  numbered('The occurrence would not have happened in ordinary circumstances without negligence'),
  numbered('The patient had no contributory negligence'),
  para('Examples: Wrong limb amputated; foreign body (sponge/forceps) left inside after surgery; wrong side operated.'),
  spacer(),
  h2('Precautions for a Doctor to Avoid Negligence'),
  bullet('Maintain proper and complete medical records'),
  bullet('Obtain valid informed consent before every procedure'),
  bullet('Refer to a specialist when the case exceeds one\'s competence'),
  bullet('Do not abandon a patient once treatment has started'),
  bullet('Prescribe drugs carefully; avoid polypharmacy'),
  bullet('Follow established, evidence-based treatment protocols'),
  bullet('Conduct proper pre-operative assessment'),
  bullet('Inform patients about risks and alternatives'),
  bullet('Maintain a professional doctor-patient relationship'),
  bullet('Carry adequate medical indemnity insurance'),
  spacer(),
  h2('Defenses Available to a Doctor'),
  bullet('Error of judgment: Honest mistake made without negligence is not actionable'),
  bullet('Bolitho/Bolam test: Doctor conformed to accepted practice of a responsible body of medical professionals'),
  bullet('Emergency: Treatment given in good faith under emergency; no consent required (Section 92 IPC / BNS)'),
  bullet('Patient\'s contributory negligence: Patient\'s own failure contributed to harm'),
  bullet('Therapeutic privilege: Withholding information that would seriously harm patient'),
  bullet('Statute of limitations: Claim not filed within the prescribed time'),
  spacer(),
  h2('Bolam Test (Landmark Principle)'),
  para('From Bolam v. Friern Hospital Management Committee (1957). A doctor is not negligent if he acts in accordance with a practice accepted as proper by a responsible body of medical professionals, even if other practitioners would have acted differently.'),
  spacer(), pageBreak()
);

// ── LONG ESSAY 4: DUTIES OF A DOCTOR ──
children.push(
  h1('4. Duties of a Doctor'),
  h2('Introduction'),
  para('The duties of a doctor are enshrined in the Code of Medical Ethics promulgated by the Medical Council of India (now replaced by NMC Regulations 2023). These duties define the legal and ethical obligations of a registered medical practitioner and form the basis for determining professional misconduct and negligence.'),
  spacer(),
  h2('Classification of Duties'),
  para('Illustration 4.1: Classification of Duties of a Doctor', { italic: true }),
  spacer(),
  ...flowchart([
    { text: 'DUTIES OF A DOCTOR' },
    { text: 'Duties to Patients | Duties Regarding Medical Records | Duties to Society | Duties to the Profession' },
  ]),
  spacer(),
  h2('Duties to Patients'),
  bullet('Not deny treatment to any patient in an emergency'),
  bullet('Maintain confidentiality and professional secrecy'),
  bullet('Obtain valid informed consent before procedures'),
  bullet('Provide reasonable standard of care'),
  bullet('Not abandon a patient once treatment has started'),
  bullet('Refer to a specialist when the case is beyond one\'s competence'),
  bullet('Prescribe only drugs and treatments with therapeutic value'),
  bullet('Not exploit or mislead patients'),
  spacer(),
  h2('Duties Regarding Medical Records'),
  para('(As per Code of Medical Ethics 2002 / NMC Regulations 2023)'),
  bullet('Maintain accurate, complete, and legible medical records'),
  bullet('Preserve records for 3 years (medical institutions) or 2 years (individual practitioners) after completion of treatment'),
  bullet('Make records available to the patient or authorized representative on written request'),
  bullet('Issue medical certificates with true, accurate information - false entries amount to infamous conduct'),
  bullet('Never destroy records during medico-legal proceedings'),
  bullet('Electronic Health Records (EHR) are acceptable if they meet integrity and security standards'),
  spacer(),
  h2('Duties Toward Society'),
  bullet('Report communicable diseases to health authorities'),
  bullet('Not issue false certificates'),
  bullet('Cooperate with legal authorities in medico-legal matters'),
  bullet('Maintain professional secrecy except in cases of privileged communication'),
  bullet('Participate in disaster management and public health emergencies'),
  spacer(),
  h2('Duties Toward the Profession'),
  bullet('Not indulge in infamous conduct'),
  bullet('Not advertise or self-promote beyond permissible means'),
  bullet('Maintain the dignity of the profession'),
  bullet('Not disparage colleagues in front of patients'),
  bullet('Help in maintaining ethical standards in the profession'),
  spacer(),
  h2('Duty to Refer'),
  para('A doctor has a specific duty to refer when:'),
  numbered('The case requires specialized skill beyond the doctor\'s competence'),
  numbered('The patient is not responding to treatment'),
  numbered('Further investigation requires specialized equipment or expertise'),
  numbered('The patient requests a second opinion'),
  para('Failure to refer when required amounts to negligence.'),
  spacer(), pageBreak()
);

// ── LONG ESSAY 5: CONSENT ──
children.push(
  h1('5. Consent in Medical Practice - Definition, Types, Informed Consent, Rules & Consumer Protection Act'),
  h2('Definition'),
  quote('Consent means voluntary agreement, compliance or permission. Consent signifies acceptance by a person of the consequences of an act that is being carried out. To be legally valid, it must be given after understanding what it is given for, and the risks involved.'),
  spacer(),
  h2('Why Consent Matters'),
  bullet('Protects the patient\'s personal rights - examination or treatment without consent (in non-emergency) is an assault'),
  bullet('Patient can sue for not being informed about the procedure, benefits, or risks involved'),
  bullet('Provides legal protection to the doctor when properly obtained'),
  spacer(),
  h2('Classification of Consent'),
  simpleTable(
    ['Type', 'Description', 'Example', 'Legal Validity'],
    [
      ['Implied', 'Inferred from patient\'s actions without words', 'Holding out arm for injection; attending the clinic', 'Valid for minor, routine procedures'],
      ['Verbal (Express)', 'Stated orally by the patient', 'Patient orally agreeing to an examination', 'Valid but difficult to prove'],
      ['Written (Informed Express)', 'Documented on a consent form', 'Signing consent form before surgery', 'Best legal protection for major procedures'],
    ]
  ),
  spacer(),
  h2('Ingredients of Informed Consent (Full Disclosure) - PARQ Principle'),
  para('Illustration 5.1: Components of Informed Consent', { italic: true }),
  spacer(),
  ...flowchart([
    { text: 'INFORMED CONSENT' },
    { text: 'Nature of the procedure - explained in simple understandable language' },
    { text: 'Purpose and likely benefits of the procedure' },
    { text: 'Material risks and complications associated (known risks)' },
    { text: 'Alternative treatments available' },
    { text: 'Consequences of NOT undergoing the procedure' },
    { text: 'Opportunity for patient to ask questions and receive answers' },
    { text: 'VALID INFORMED CONSENT OBTAINED' },
  ]),
  spacer(),
  h2('Rules of Valid Consent'),
  numbered('Voluntarily given - no coercion, fraud, or undue influence'),
  numbered('Sound mind - patient mentally competent to understand and decide'),
  numbered('Legal age - 18 years in India'),
  numbered('Informed - after full disclosure of nature, risks, benefits'),
  numbered('Specific to the procedure - cannot be used for a different procedure'),
  numbered('For minors - parent/guardian consents'),
  numbered('Emergency - implied consent operates (Section 92 IPC)'),
  numbered('Can be withdrawn at any time before the procedure begins'),
  numbered('Consent is NOT a defense against criminal negligence'),
  spacer(),
  h2('Consent in Special Circumstances'),
  simpleTable(
    ['Situation', 'Who Gives Consent', 'Legal Basis'],
    [
      ['Minor (< 18 years)', 'Parent or legal guardian', 'Guardian consent'],
      ['Emergency (unconscious patient)', 'Implied consent operates; duty to treat', 'Section 92 IPC / BNS'],
      ['Mentally ill patient', 'Guardian/legal representative', 'Mental Healthcare Act 2017'],
      ['Prisoner', 'Prisoner himself (not jailer)', 'Fundamental rights preserved'],
      ['Voluntary admission (alcohol/drugs)', 'Patient himself', 'Personal autonomy'],
      ['Loco parentis (hostel inmate < 12 yrs)', 'Headmaster/warden', 'In loco parentis doctrine'],
    ]
  ),
  spacer(),
  h2('Consumer Protection Act and Medical Services'),
  para('The Consumer Protection Act 1986 (now updated to Consumer Protection Act 2019) made paid medical services amenable to consumer complaints. Key points:'),
  bullet('Medical services rendered for consideration = "service" under CPA'),
  bullet('Deficiency in service = medical negligence'),
  bullet('Complainant: Patient or legal heir'),
  bullet('Forum: District / State / National Consumer Disputes Redressal Commission (NCDRC) based on compensation amount'),
  bullet('Free services in government hospitals were initially exempt; later brought under CPA partially'),
  spacer(),
  h2('Indian Medical Association v. V.P. Shantha (1995)'),
  para('Landmark Supreme Court case: Held that medical services fall within the ambit of the Consumer Protection Act. Doctors and hospitals providing services for consideration are liable under the Act.'),
  spacer(), pageBreak()
);

// ────────────────────────────────────────────────────────────────────────────
// SECTION 2: SHORT ESSAYS (EXPANDED)
// ────────────────────────────────────────────────────────────────────────────

children.push(
  new Paragraph({
    children: [new TextRun({ text: 'SECTION 2: SHORT ESSAYS', bold: true, font: 'Arial', size: 36, color: '1F4E79' })],
    alignment: AlignmentType.CENTER, spacing: { before: 200, after: 300 }
  })
);

// ── SHORT ESSAY 1: STATE MEDICAL COUNCIL ──
children.push(
  h1('1. State Medical Council (SMC)'),
  h2('Introduction'),
  para('A State Medical Council (SMC) is a statutory body constituted under the respective State Medical Registration Act. It is the primary registering authority for medical practitioners within a state and plays a key role in maintaining professional standards and disciplinary control.'),
  spacer(),
  h2('Constitution / Composition'),
  bullet('President (elected by members of the Council)'),
  bullet('Vice-President'),
  bullet('Elected members - usually doctors from the state'),
  bullet('Nominated members - by the State Government (including representatives of universities)'),
  bullet('Registrar - secretary and administrative officer of the Council'),
  bullet('Honorary Treasurer'),
  spacer(),
  h2('Functions of State Medical Council'),
  simpleTable(
    ['Function', 'Details'],
    [
      ['Registration', 'Maintains the State Medical Register; registers qualified practitioners; issues registration certificates'],
      ['Renewal', 'Annual renewal of registration; issues renewal certificates'],
      ['Disciplinary Control', 'Conducts inquiries into complaints of professional misconduct; awards warning notices or penal erasure'],
      ['Privileged Communication', 'Receives communications under privilege; protects practitioners who act in good faith'],
      ['Referral to NMC', 'Cases beyond state jurisdiction forwarded to the Ethics and Medical Registration Board (NMC/EMRB)'],
      ['Education', 'Recommends standards; liaises with universities for medical education quality'],
    ]
  ),
  spacer(),
  h2('Disciplinary Process of SMC'),
  para('Illustration 1.1 (SE): SMC Disciplinary Process Flowchart', { italic: true }),
  spacer(),
  ...flowchart([
    { text: 'COMPLAINT filed with SMC (patient / court / suo moto)' },
    { text: 'Registrar submits complaint to President of SMC' },
    { text: 'Referred to Sub-Committee / Executive Committee' },
    { text: 'Legal advice sought; preliminary inquiry conducted' },
    { text: 'NO prima facie case => Complainant informed; Dismissed' },
    { text: 'YES prima facie case => Notice to practitioner (charge + reply date)' },
    { text: 'Formal Hearing: Both parties present; evidence examined' },
    { text: 'Vote taken; Judgment pronounced' },
    { text: 'GUILTY => Warning Notice OR Penal Erasure' },
    { text: 'APPEAL => State Govt => Central Govt => Restoration possible' },
  ]),
  spacer(),
  h2('Powers of State Medical Council'),
  bullet('Powers of a Civil Court under the Code of Civil Procedure 1908'),
  bullet('Can summon and examine witnesses'),
  bullet('Can take evidence on affidavit'),
  bullet('Can demand production of documents'),
  bullet('Can initiate inquiry suo moto (on its own initiative)'),
  bullet('Can refer matters to NMC (EMRB) if beyond its jurisdiction'),
  spacer(),
  h2('Importance'),
  para('The SMC acts as the first line of disciplinary authority for medical practitioners. It ensures that only qualified, registered practitioners practice within the state and that ethical standards are maintained. The two-tier system (SMC at state level, NMC/EMRB at national level) provides adequate checks and balances.'),
  spacer(), pageBreak()
);

// ── SHORT ESSAY 2: WARNING NOTICE ──
children.push(
  h1('2. Warning Notice'),
  h2('Definition'),
  quote('A warning notice is a formal caution issued by the State Medical Council or the Ethics and Medical Registration Board (NMC) to a medical practitioner found guilty of professional misconduct, where the severity does not warrant removal from the register.'),
  spacer(),
  h2('Nature and Characteristics'),
  bullet('It is a lesser punishment than penal erasure'),
  bullet('The practitioner continues to remain on the Medical Register'),
  bullet('The warning is formally noted against the practitioner\'s name on the register'),
  bullet('Serves as a formal recorded reprimand and deterrent against future misconduct'),
  bullet('Repetition of the offence after a warning will attract more severe punishment including penal erasure'),
  bullet('The practitioner is directed "not to repeat the offence"'),
  spacer(),
  h2('When is a Warning Notice Issued?'),
  para('A warning notice is typically issued when:'),
  numbered('The misconduct is of a less serious nature (first offence; minor violation)'),
  numbered('The offence does not endanger patient safety directly'),
  numbered('There are mitigating circumstances (e.g., inexperience, remorse)'),
  numbered('The Council believes corrective direction rather than erasure is appropriate'),
  spacer(),
  h2('Warning Notice vs Penal Erasure - Comparison'),
  para('Illustration 2.1 (SE): Warning Notice vs Penal Erasure', { italic: true }),
  spacer(),
  simpleTable(
    ['Feature', 'Warning Notice', 'Penal Erasure'],
    [
      ['Severity', 'Lesser punishment', 'Most severe ("Professional Death Sentence")'],
      ['Effect on Register', 'Name remains; warning noted', 'Name removed permanently or for specified period'],
      ['Practice rights', 'Can continue to practice', 'Cannot practice until restored'],
      ['Publication', 'Not widely published', 'Published in press and medical journals'],
      ['Reversibility', 'Remains on record but no bar to practice', 'Restoration requires formal appeal or council direction'],
      ['Trigger', 'Minor/first offence; mitigating factors', 'Serious/repeated misconduct'],
    ]
  ),
  spacer(),
  h2('Legal Basis'),
  para('Warning notices are authorized under:'),
  bullet('State Medical Registration Acts (respective state laws)'),
  bullet('National Medical Commission Act, 2019 (through EMRB)'),
  bullet('Code of Medical Ethics (MCI/NMC Regulations)'),
  spacer(), pageBreak()
);

// ── SHORT ESSAY 3: PRIVILEGED COMMUNICATION ──
children.push(
  h1('3. Privileged Communication'),
  h2('Definition'),
  quote('A privileged communication is a statement made in good faith under circumstances where the public interest requires that the speaker be protected from civil or criminal action for disclosure.'),
  spacer(),
  h2('Types of Privilege'),
  simpleTable(
    ['Type', 'Description', 'Examples'],
    [
      ['Absolute Privilege', 'Statements made in courts of law, Parliament, or before statutory bodies. The speaker cannot be sued even if the statement is false, provided it is germane to the proceedings.', 'Doctor\'s testimony in court; statements in Parliament'],
      ['Qualified Privilege', 'Statements made in good faith, in the public interest, without malice. Protection exists only when made without malice.', 'Medical certificate to employer; report to insurance company at patient\'s request; notification of communicable disease'],
    ]
  ),
  spacer(),
  h2('Circumstances When a Doctor MUST Disclose (Privileged Communication)'),
  para('Medical confidentiality is overridden in the following situations:'),
  numbered('Court order (subpoena/summons): When summoned to give evidence in court'),
  numbered('Notifiable diseases: Cholera, plague, typhoid, malaria etc. must be reported to health authorities'),
  numbered('Medico-legal cases (MLC): Injuries from firearms, explosives, suspicious circumstances - must be reported to police'),
  numbered('Industrial/factory injuries: Under Factories Act'),
  numbered('Births and Deaths: Reporting to the Registrar of Births and Deaths'),
  numbered('Infectious diseases in schools or hostels'),
  numbered('Medical fitness for employment'),
  numbered('Consent of patient: Patient himself permits disclosure'),
  spacer(),
  h2('Flowchart: When to Disclose vs When to Maintain Secrecy'),
  para('Illustration 3.1 (SE): Doctor\'s Communication - Disclose or Protect?', { italic: true }),
  spacer(),
  ...flowchart([
    { text: 'DOCTOR receives request to disclose patient information' },
    { text: 'Is it a Court Order / Legal Summons?' },
    { text: 'YES => Disclose (Absolute Privilege; legal compulsion)' },
    { text: 'NO => Is it a notifiable disease / MLC / public health emergency?' },
    { text: 'YES => Disclose (Qualified Privilege; public interest)' },
    { text: 'NO => Does patient give written consent to disclosure?' },
    { text: 'YES => Disclose (Patient\'s own consent)' },
    { text: 'NO => MAINTAIN CONFIDENTIALITY (Professional Secrecy)' },
  ]),
  spacer(),
  h2('Examples of Privileged Communication'),
  bullet('Medical certificate given in good faith to employer about a patient\'s fitness'),
  bullet('Report sent to insurance company at patient\'s request'),
  bullet('Communication between doctor and patient\'s next of kin in emergency'),
  bullet('Information given to public health officer regarding a communicable disease'),
  bullet('Statement made before a Judicial Magistrate'),
  bullet('Report to police regarding a gunshot wound (MLC)'),
  spacer(),
  h2('Consequences of Breach of Confidentiality'),
  bullet('Civil action for damages (breach of confidence)'),
  bullet('Professional misconduct proceedings (SMC / EMRB)'),
  bullet('Warning notice or penal erasure'),
  bullet('Criminal prosecution if disclosure was malicious and harmful'),
  spacer(), pageBreak()
);

// ── SHORT ESSAY 4: MEDICAL NEGLIGENCE (short) ──
children.push(
  h1('4. Medical Negligence'),
  h2('Definition'),
  quote('Medical negligence is the absence of reasonable care and skill, or wilful negligence of a doctor in treatment, causing bodily injury or death.'),
  para('Medical negligence is classified under the Law of Torts (civil wrong). When gross enough, it attracts criminal liability under Section 304A IPC (BNS equivalent).'),
  spacer(),
  h2('The 4 D\'s - Elements of Negligence'),
  para('Illustration 4.1 (SE): The 4 D\'s of Medical Negligence', { italic: true }),
  spacer(),
  ...flowchart([
    { text: '1. DUTY - Doctor-patient relationship established; duty of care arises' },
    { text: '2. DERELICTION - Breach of duty (act of omission or commission)' },
    { text: '3. DIRECT CAUSE - Causal link between breach and harm' },
    { text: '4. DAMAGE - Actual injury / death / harm suffered by patient' },
    { text: 'ALL 4 Ds present => NEGLIGENCE ESTABLISHED => Legal Liability' },
  ]),
  spacer(),
  h2('Civil vs Criminal Negligence - Key Distinctions'),
  simpleTable(
    ['Aspect', 'Civil Negligence', 'Criminal Negligence'],
    [
      ['Initiator', 'Patient/relative', 'State (police/prosecution)'],
      ['Forum', 'Civil court / Consumer forum', 'Criminal court (Magistrate/Sessions)'],
      ['Standard of proof', 'Balance of probabilities', 'Beyond reasonable doubt'],
      ['Punishment', 'Compensation/damages', 'Fine / Imprisonment (Sec 304A IPC)'],
      ['Degree of fault', 'Simple lack of due care', 'Gross/reckless disregard for safety'],
    ]
  ),
  spacer(),
  h2('Res Ipsa Loquitur'),
  para('Latin: "The thing speaks for itself." Applicable when the act of negligence is so self-evident that expert evidence is not required. Conditions:'),
  bullet('The negligent act was entirely within the defendant\'s control'),
  bullet('The harm would not ordinarily occur without negligence'),
  bullet('No contributory negligence by the patient'),
  para('Classic examples: Sponge/forceps left inside after surgery; wrong limb amputated; anesthetic gas given instead of oxygen.'),
  spacer(),
  h2('Landmark Indian Cases'),
  simpleTable(
    ['Case', 'Court / Year', 'Significance'],
    [
      ['Jacob Mathew v. State of Punjab', 'SC 2005', 'Defined standard for criminal negligence; set the "gross negligence" threshold; guidelines for arrest of doctors'],
      ['Indian Medical Association v. VP Shantha', 'SC 1995', 'Brought medical services under Consumer Protection Act'],
      ['Spring Meadows Hospital v. Harjol Ahluwalia', 'SC 1998', 'Hospitals liable for acts of their employed doctors (vicarious liability)'],
      ['Martin F D\'Souza v. Mohd. Ishfaq', 'SC 2009', 'Police not to arrest doctors without prior advice of a committee; reinforced Jacob Mathew guidelines'],
    ]
  ),
  spacer(), pageBreak()
);

// ── SHORT ESSAY 5: PENAL ERASURE ──
children.push(
  h1('5. Penal Erasure'),
  h2('Definition'),
  quote('Penal Erasure (also called "Professional Death Sentence") refers to the permanent or temporary removal of a registered medical practitioner\'s name from the Medical Register by the State Medical Council or Ethics and Medical Registration Board (NMC), as a punishment for serious professional misconduct.'),
  spacer(),
  h2('Legal Basis'),
  bullet('Under the Indian Medical Council Act, 1956 (now replaced by NMC Act 2019)'),
  bullet('Under respective State Medical Registration Acts'),
  bullet('Under NMC Act 2019, the EMRB has powers of penal erasure at the national level'),
  spacer(),
  h2('Grounds for Penal Erasure'),
  bullet('Serious professional misconduct (e.g., criminal abortion, sexual misconduct with patients)'),
  bullet('Conviction for a criminal offence involving moral turpitude'),
  bullet('Falsifying medical certificates or records'),
  bullet('Practicing without registration or covering unqualified persons'),
  bullet('Repeated misconduct after a prior warning notice'),
  bullet('Gross negligence causing serious harm or death'),
  spacer(),
  h2('Process Leading to Penal Erasure'),
  para('Illustration 5.1 (SE): Penal Erasure Process', { italic: true }),
  spacer(),
  ...flowchart([
    { text: 'SERIOUS COMPLAINT received by SMC / EMRB (NMC)' },
    { text: 'Prima facie inquiry: Sub-committee / Executive Committee' },
    { text: 'Formal Notice issued to practitioner' },
    { text: 'Formal Hearing: Evidence, witnesses, legal representation' },
    { text: 'VERDICT: GUILTY by majority vote of Council' },
    { text: 'Second vote: Warning Notice OR PENAL ERASURE' },
    { text: 'PENAL ERASURE: Name removed from Medical Register' },
    { text: 'Deletion published in press and medical journals' },
    { text: 'APPEAL: State Govt > Central Govt; Restoration if directed' },
  ]),
  spacer(),
  h2('Consequences of Penal Erasure'),
  bullet('Cannot legally practice medicine during the period of erasure'),
  bullet('Title "Dr." cannot be used professionally'),
  bullet('Name removed from the State and National Medical Register'),
  bullet('Publication of erasure in newspapers and medical publications (public awareness)'),
  bullet('Any prescription or certificate issued after erasure is illegal'),
  bullet('May be prosecuted under IPC for practicing without registration (S. 15 IMC Act)'),
  spacer(),
  h2('Restoration of Name'),
  numbered('On the direction of the Council after the specified period'),
  numbered('On successful appeal to the State Government'),
  numbered('On further appeal to the Central Government'),
  para('Note: Restoration is NOT automatic. It requires a formal application and Council or Government direction.'),
  spacer(), pageBreak()
);

// ── SHORT ESSAY 6: PROFESSIONAL SECRECY ──
children.push(
  h1('6. Professional Secrecy'),
  h2('Definition'),
  quote('Professional secrecy (medical confidentiality) is the ethical and legal duty of a doctor to maintain the privacy of information obtained in the course of professional relationship with a patient, and not to disclose it to any third party without the patient\'s consent or legal justification.'),
  spacer(),
  h2('Basis and Importance'),
  bullet('One of the fundamental duties of a doctor under the Hippocratic Oath: "Whatever I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge"'),
  bullet('Enshrined in the Code of Medical Ethics (MCI / NMC Regulations 2023)'),
  bullet('Protects the patient\'s right to privacy (Article 21, Constitution of India)'),
  bullet('Encourages patients to seek medical help without fear of exposure'),
  bullet('Builds trust in the doctor-patient relationship'),
  spacer(),
  h2('Exceptions to Professional Secrecy (When Disclosure is Justified)'),
  para('Illustration 6.1 (SE): Exceptions to Professional Secrecy', { italic: true }),
  spacer(),
  simpleTable(
    ['Exception', 'Basis / Law', 'Example'],
    [
      ['Court summons / legal order', 'Code of Criminal Procedure; Court discretion', 'Doctor summoned to testify in criminal trial'],
      ['Notifiable diseases', 'Epidemic Diseases Act; state public health laws', 'Reporting cholera, plague, AIDS (for public health)'],
      ['Medico-legal cases (MLC)', 'Section 39 CrPC / BNSS; police requirement', 'Gunshot wound, poisoning, suspicious injury'],
      ['Patient\'s own consent', 'Patient autonomy', 'Insurance report at patient\'s request'],
      ['Industrial injuries', 'Factories Act / ESI Act', 'Reporting occupational disease to employer/ESIC'],
      ['Birth and death registration', 'Registration of Births and Deaths Act 1969', 'Issuing death certificate to Registrar'],
      ['Infectious disease in institutions', 'School/hostel regulations; public health', 'Reporting TB in school to health authorities'],
      ['Mental health emergency', 'Mental Healthcare Act 2017', 'Informing family of suicidal patient'],
    ]
  ),
  spacer(),
  h2('Consequences of Breach'),
  bullet('Civil suit for damages (invasion of privacy)'),
  bullet('Professional misconduct proceedings before SMC/EMRB'),
  bullet('Warning notice or penal erasure'),
  bullet('Possible criminal prosecution (where malicious intent proven)'),
  spacer(),
  h2('Third Party Situations'),
  para('A doctor may be morally obligated but legally cautious about disclosure when:'),
  bullet('A patient discloses intent to harm a specific third party (Tarasoff duty - warn/protect)'),
  bullet('A patient is HIV positive and a named spouse is at risk'),
  bullet('In India, the MTP Act and HIV/AIDS Prevention and Control Act 2017 have specific disclosure provisions'),
  spacer(), pageBreak()
);

// ── SHORT ESSAY 7: THERAPEUTIC MISADVENTURE ──
children.push(
  h1('7. Therapeutic Misadventure'),
  h2('Definition'),
  quote('Therapeutic misadventure (also called therapeutic accident or medical accident) is an untoward or fatal outcome of a medical or surgical intervention performed by a qualified practitioner in good faith, following standard practice, where the complication was unforeseeable and unavoidable despite due care.'),
  para('-- KS Narayan Reddy, 36th Edition'),
  spacer(),
  h2('Essential Features'),
  bullet('Treatment was performed by a QUALIFIED practitioner'),
  bullet('Performed in GOOD FAITH and with the intent to benefit the patient'),
  bullet('All standard PRECAUTIONS were taken'),
  bullet('The complication was TRULY UNFORESEEABLE under normal circumstances'),
  bullet('The complication was UNAVOIDABLE even with due care'),
  bullet('No duty of care was breached - the standard of care was maintained'),
  spacer(),
  h2('Examples of Therapeutic Misadventure'),
  simpleTable(
    ['Procedure', 'Misadventure'],
    [
      ['Penicillin injection (after negative sensitivity test)', 'Anaphylactic shock and death'],
      ['Properly performed elective surgery', 'Uncontrolled hemorrhage from unrecognized coagulopathy'],
      ['General anesthesia (correctly administered)', 'Malignant hyperthermia; cardiac arrest'],
      ['Correctly placed injection', 'Peripheral nerve injury due to anatomical variant'],
      ['Routine endoscopy', 'Death from unrecognized vascular anomaly'],
      ['Blood transfusion (correct cross-match)', 'Acute hemolytic reaction due to rare antigen incompatibility'],
      ['Lumbar puncture', 'Brainstem herniation in unrecognized raised ICP'],
    ]
  ),
  spacer(),
  h2('Therapeutic Misadventure vs Medical Negligence'),
  para('Illustration 7.1 (SE): Distinguishing Therapeutic Misadventure from Negligence', { italic: true }),
  spacer(),
  simpleTable(
    ['Aspect', 'Therapeutic Misadventure', 'Medical Negligence'],
    [
      ['Standard of care', 'All reasonable precautions taken', 'Breach of standard of care'],
      ['Foreseeability', 'Truly unforeseeable complication', 'Foreseeable and preventable complication'],
      ['Intent/Good faith', 'Act done in good faith for patient benefit', 'Absence of due care'],
      ['Practitioner qualification', 'Qualified practitioner', 'May involve unqualified or careless practice'],
      ['Legal outcome', 'NO legal liability', 'Civil/Criminal liability'],
      ['Insurance', 'Professional indemnity usually covers', 'May not cover if gross negligence found'],
    ]
  ),
  spacer(),
  h2('Medico-Legal Importance'),
  para('Therapeutic misadventure is forensically important because:'),
  numbered('Families may file negligence claims after adverse outcomes'),
  numbered('Post-mortem may be ordered to determine cause of death (natural vs. therapeutic accident)'),
  numbered('The forensic pathologist must assess whether standard care was followed'),
  numbered('A distinction between misadventure and negligence is critical for legal outcomes'),
  para('The Bolam test (UK) and Jacob Mathew guidelines (India) are used to differentiate misadventure from negligence.'),
  spacer(), pageBreak()
);

// ── SHORT ESSAY 8: VICARIOUS LIABILITY ──
children.push(
  h1('8. Vicarious Liability'),
  h2('Definition and Maxim'),
  quote('Vicarious liability (Respondeat Superior - "let the master answer") is the legal liability imposed on a master/employer for the negligent acts of a servant/employee committed in the course of their employment.'),
  spacer(),
  h2('Conditions for Vicarious Liability'),
  para('All three conditions must be satisfied simultaneously:'),
  numbered('There must be a master-servant relationship (employment/control relationship)'),
  numbered('The wrongful act must have been committed in the course of employment'),
  numbered('The act must have been done to serve the master\'s purpose (within the scope of work)'),
  spacer(),
  h2('Application in Medical Practice'),
  para('Illustration 8.1 (SE): Vicarious Liability in Healthcare', { italic: true }),
  spacer(),
  ...flowchart([
    { text: 'NEGLIGENT ACT by Healthcare Worker' },
    { text: 'Is there an Employment / Master-Servant relationship?' },
    { text: 'Was the act done during the COURSE OF EMPLOYMENT?' },
    { text: 'Was the act done to serve the EMPLOYER\'S PURPOSE?' },
    { text: 'ALL YES => EMPLOYER / HOSPITAL LIABLE (Vicarious Liability)' },
    { text: 'Independent contractor? => NOT vicariously liable' },
  ]),
  spacer(),
  h2('Examples of Vicarious Liability in Medicine'),
  simpleTable(
    ['Person Negligent', 'Who is Vicariously Liable?'],
    [
      ['Employed hospital nurse gives wrong medication', 'Hospital (employer)'],
      ['Junior resident makes error under consultant\'s supervision', 'Consultant + Hospital'],
      ['Anesthesiologist\'s technician makes intraoperative error', 'Anesthesiologist + Hospital'],
      ['Senior surgeon delegates operation to unqualified junior', 'Senior surgeon + Hospital'],
      ['Hospital pharmacist dispenses wrong drug', 'Hospital'],
      ['Employed physiotherapist injures patient during therapy', 'Hospital / Clinic'],
    ]
  ),
  spacer(),
  h2('Independent Contractor - Exception'),
  para('A visiting/consulting specialist brought in as an independent contractor (not an employee) is generally NOT subject to vicarious liability for the hospital. The specialist bears personal liability.'),
  para('However, the hospital may still be liable under its CORPORATE NEGLIGENCE if it failed to properly credential or supervise the specialist.'),
  spacer(),
  h2('Corporate Negligence'),
  para('A hospital can be independently (not vicariously) liable for:'),
  bullet('Failure to ensure that its physicians are competent (credentialing failure)'),
  bullet('Failure to maintain proper equipment'),
  bullet('Failure to have adequate staffing levels'),
  bullet('Failure to enforce safety rules and protocols'),
  para('Landmark case: Darling v. Charleston Community Memorial Hospital (USA); Spring Meadows Hospital v. Harjol Ahluwalia (India, SC 1998) - hospital held vicariously liable for doctor\'s negligence.'),
  spacer(), pageBreak()
);

// ── SHORT ESSAY 9: INFORMED CONSENT ──
children.push(
  h1('9. Consent - Definition, Classification, Informed Consent'),
  h2('Definition'),
  quote('Consent means voluntary agreement, compliance or permission, given after understanding what it is given for, and the risks involved. Treatment without valid consent (outside emergency) is legally equivalent to assault.'),
  spacer(),
  h2('Classification of Consent'),
  simpleTable(
    ['Type', 'Description', 'Example', 'When Used'],
    [
      ['Implied', 'Inferred from patient\'s conduct; no words needed', 'Arm extended for injection; walking into OPD', 'Minor examinations, venepuncture'],
      ['Verbal (Express)', 'Orally stated agreement', 'Patient says "Yes, you can examine me"', 'Routine outpatient procedures'],
      ['Written (Informed)', 'Documented on a signed consent form', 'Surgical consent form signed in presence of witness', 'Surgery, anesthesia, invasive procedures'],
    ]
  ),
  spacer(),
  h2('Informed Consent - Components'),
  bullet('Nature of the procedure - explained in simple, understandable language'),
  bullet('Purpose and likely benefits'),
  bullet('Material risks and known complications'),
  bullet('Alternative treatments available'),
  bullet('Consequences of refusal / not undergoing the procedure'),
  bullet('Opportunity to ask questions'),
  spacer(),
  h2('Who Can Give Consent?'),
  simpleTable(
    ['Patient Category', 'Who Gives Consent'],
    [
      ['Competent adult (>18 yrs)', 'Patient himself/herself'],
      ['Minor (<18 yrs)', 'Parent or legal guardian'],
      ['Mentally ill patient', 'Guardian / legal representative (MHA 2017)'],
      ['Unconscious patient (emergency)', 'Implied consent; no consent needed (S.92 IPC)'],
      ['Prisoner', 'Prisoner himself (jailer CANNOT consent)'],
      ['Loco parentis (hostel < 12 yrs)', 'Headmaster / warden'],
      ['Drunk/intoxicated patient (emergency)', 'Implied consent; treat without consent'],
    ]
  ),
  spacer(),
  h2('Validity of Consent - Rules'),
  numbered('Freely given - no coercion, undue influence, or fraud'),
  numbered('By a person of sound mind'),
  numbered('Over legal age (18 years)'),
  numbered('After adequate information and understanding'),
  numbered('Specific to the procedure'),
  numbered('Can be withdrawn before the procedure starts'),
  numbered('Consent does NOT cover criminal negligence'),
  spacer(),
  h2('Invalid Consent Situations'),
  bullet('Consent given under fear or threat'),
  bullet('Consent given by intoxicated/mentally incompetent patient'),
  bullet('Consent obtained by misrepresentation or fraud'),
  bullet('Consent by minor without guardian'),
  bullet('Consent obtained without disclosure of material risks'),
  spacer(), pageBreak()
);

// ── SHORT ESSAY 10: EUTHANASIA ──
children.push(
  h1('10. Euthanasia'),
  h2('Definition'),
  quote('Euthanasia (from Greek: "eu" = good + "thanatos" = death) is the intentional termination of life of a person suffering from incurable, painful, or terminal illness, performed at the person\'s request or without it, to relieve unbearable suffering.'),
  para('Also called "mercy killing."'),
  spacer(),
  h2('Classification of Euthanasia'),
  para('Illustration 10.1 (SE): Classification of Euthanasia', { italic: true }),
  spacer(),
  simpleTable(
    ['Classification', 'Type', 'Description', 'Legal Status in India'],
    [
      ['Based on Action', 'Active (Positive)', 'Act of commission - e.g., giving large doses of drugs to hasten death', 'ILLEGAL (equivalent to murder)'],
      ['Based on Action', 'Passive (Negative)', 'Act of omission - e.g., withdrawing life support, not delivering CPR', 'Permitted under Supreme Court guidelines'],
      ['Based on Consent', 'Voluntary', 'At the will and explicit request of the patient', 'Passive form allowed with guidelines (SC 2018)'],
      ['Based on Consent', 'Involuntary', 'Against the will of the patient (compulsory)', 'ILLEGAL'],
      ['Based on Consent', 'Non-voluntary', 'Patient incapable of making wishes known (e.g., irreversible coma)', 'Passive form may be permitted with hospital board approval'],
    ]
  ),
  spacer(),
  h2('Physician-Assisted Suicide (PAS)'),
  para('Physician-Assisted Suicide: The doctor provides the means (e.g., prescription for lethal drug) but the patient performs the final act. Distinct from euthanasia where the doctor performs the act directly.'),
  bullet('ILLEGAL in India'),
  bullet('Legal in: Oregon (USA) - Death with Dignity Act 1997; Netherlands; Belgium; Canada; Switzerland'),
  spacer(),
  h2('Legal Position in India'),
  para('Illustration 10.2 (SE): Euthanasia and Indian Law', { italic: true }),
  spacer(),
  ...flowchart([
    { text: 'EUTHANASIA - Legal Status in India' },
    { text: 'ACTIVE EUTHANASIA: ILLEGAL (amounts to murder under IPC/BNS or abetment of suicide)' },
    { text: 'PASSIVE EUTHANASIA: Allowed ONLY under strict Supreme Court guidelines' },
    { text: 'Common Cause v. Union of India (SC 2018): "Right to die with dignity" = Fundamental Right under Article 21' },
    { text: 'Living Will (Advance Directive) PERMITTED' },
    { text: 'Must be executed by competent adult; signed before 1st Class Judicial Magistrate' },
    { text: 'Hospital Medical Board must authorize withdrawal of treatment' },
    { text: 'ALLOWED: Passive voluntary / non-voluntary euthanasia with guidelines' },
  ]),
  spacer(),
  h2('Guidelines for Living Will (Advance Directive)'),
  numbered('Can be executed only by an adult with a sound and healthy mind'),
  numbered('Must be voluntarily executed based on informed consent'),
  numbered('Expressed in clear and unambiguous terms'),
  numbered('Signed before a first-class judicial magistrate'),
  numbered('Must mention circumstances for treatment withdrawal and name of guardian/close relative to authorize passive euthanasia'),
  numbered('The treating physician must ascertain genuineness from the jurisdictional magistrate'),
  numbered('The hospital medical board must authorize withdrawal of treatment'),
  spacer(),
  h2('International Position'),
  simpleTable(
    ['Country', 'Law', 'What is Permitted'],
    [
      ['Netherlands', 'Termination of Life on Request Act (2002)', 'First country to legalize voluntary euthanasia and PAS; strict conditions: incurable disease, unbearable suffering, voluntary request, second physician concurs'],
      ['Belgium', 'Belgian Act on Euthanasia (2002)', 'Active voluntary euthanasia; extended to minors (2014)'],
      ['Oregon, USA', 'Death with Dignity Act (1997)', 'Physician-assisted suicide only (patient self-administers)'],
      ['Canada', 'Bill C-14 (2016); amended 2021', 'Medical Assistance in Dying (MAID) for adults with grievous irremediable medical conditions'],
      ['India', 'Supreme Court guidelines (2018)', 'Only passive voluntary euthanasia with advance directive and medical board approval'],
    ]
  ),
  spacer(),
  h2('Distinction: Euthanasia vs Palliative Care'),
  para('Palliative care aims to relieve suffering without intentionally hastening death. It is NOT euthanasia. The "double effect" principle in palliative care allows analgesics/sedatives that may incidentally shorten life if the primary intent is relief of suffering.'),
  spacer(), pageBreak()
);

// ── SHORT ESSAYS 11-17 (Additional Short Answers) ──
children.push(
  h1('11. Consumer Protection Act and Medical Practice'),
  h2('Overview'),
  para('The Consumer Protection Act 1986 (updated to CPA 2019) brought medical services within the ambit of consumer protection law in India following the landmark Supreme Court ruling in Indian Medical Association v. VP Shantha (1995).'),
  spacer(),
  h2('Key Provisions Applicable to Medical Practice'),
  bullet('"Service" under CPA: Medical services rendered for a fee/consideration constitute a "service"'),
  bullet('"Deficiency in service": Medical negligence constitutes a deficiency in service'),
  bullet('"Consumer": Patient or legal heir who avails of medical service for consideration'),
  bullet('Free services (charitable / government hospitals where no fee charged): Initially excluded; partially included after subsequent rulings'),
  spacer(),
  h2('Consumer Redressal Forums (CPA 2019)'),
  simpleTable(
    ['Forum', 'Pecuniary Jurisdiction (Claim up to)'],
    [
      ['District Consumer Disputes Redressal Commission (DCDRC)', 'Up to Rs. 1 Crore'],
      ['State Consumer Disputes Redressal Commission (SCDRC)', 'Rs. 1 Crore to Rs. 10 Crore'],
      ['National Consumer Disputes Redressal Commission (NCDRC)', 'Above Rs. 10 Crore'],
    ]
  ),
  spacer(),
  h2('Advantages over Civil Courts'),
  bullet('Faster resolution; time-bound proceedings'),
  bullet('No court fees (nominal filing fees only)'),
  bullet('Simple procedure; complainant need not hire lawyer'),
  bullet('Burden of proof lighter than in criminal proceedings'),
  spacer(), pageBreak()
);

children.push(
  h1('12. Section 92 IPC / BNS - Good Faith Acts Without Consent'),
  h2('Text of Section 92 IPC'),
  quote('Nothing is an offence by reason of any harm which it may cause to a person for whose benefit it is done in good faith, even without that person\'s consent, if the circumstances are such that it is impossible for that person to signify consent, or if that person is incapable of giving consent, and has no guardian or other person in lawful charge from whom it is possible to obtain consent in time.'),
  spacer(),
  h2('Applicability'),
  para('Section 92 protects medical practitioners who perform emergency treatment without consent when:'),
  numbered('The patient is unconscious or incapable of giving consent'),
  numbered('No guardian or relative is available to give consent in time'),
  numbered('The act is done in good faith for the patient\'s benefit'),
  numbered('The act follows accepted medical standards'),
  spacer(),
  h2('Exceptions - When Section 92 Does NOT Apply'),
  numbered('Acts that intentionally cause death or are likely to cause death'),
  numbered('Acts causing grievous hurt voluntarily (when less harmful alternatives exist)'),
  numbered('Acts likely to cause grievous hurt for purposes other than preventing death or curing grievous disease/infirmity'),
  numbered('Amputation or irreversible operations without consent (except to save life)'),
  spacer(),
  h2('Practical Application'),
  bullet('Emergency appendectomy on unconscious patient - protected'),
  bullet('Blood transfusion to Jehovah\'s Witness who has not explicitly refused - protected in emergency'),
  bullet('Life-saving surgery when patient is in shock - protected'),
  bullet('Elective cosmetic surgery without consent - NOT protected'),
  spacer(), pageBreak()
);

children.push(
  h1('13. Loco Parentis'),
  h2('Meaning'),
  quote('Loco parentis (Latin: "in the place of a parent") refers to a person or institution that assumes parental rights, duties, and responsibilities for a child, in the absence of the natural parent.'),
  spacer(),
  h2('Medical Relevance'),
  bullet('In schools and hostels, the headmaster/warden acts in loco parentis for students under their care'),
  bullet('For hostel inmates BELOW 12 years: headmaster/warden CAN give consent for medical treatment'),
  bullet('For hostel inmates ABOVE 12 years: their OWN consent is required'),
  bullet('Exception: If an inmate above 12 refuses treatment and is likely to spread a communicable disease, they can be asked to leave, OR treated without consent if they remain on premises'),
  spacer(),
  h2('Clinical Application'),
  para('When a child is injured or falls ill at school and parents are not immediately reachable:'),
  numbered('School/hostel authority can authorize emergency medical treatment'),
  numbered('The authority acts in loco parentis'),
  numbered('Covers only emergency / necessary treatment, NOT elective procedures'),
  para('Once the parent is reachable, parental consent supersedes loco parentis consent.'),
  spacer(),
  h2('Comparison: Consent by Different Authorities for Minors'),
  simpleTable(
    ['Authority', 'Age of Minor', 'Type of Consent Possible'],
    [
      ['Parent / Legal Guardian', 'Any age', 'All medical treatment'],
      ['Headmaster / Warden (in loco parentis)', 'Below 12 years', 'Any treatment when parent unreachable'],
      ['Minor himself/herself', 'Above 12 years', 'Own consent valid for treatment'],
      ['Court (if parent refuses life-saving treatment)', 'Any age', 'Court can override parental refusal for life-saving care'],
    ]
  ),
  spacer(), pageBreak()
);

children.push(
  h1('14. Doctrine of Informed Consent'),
  h2('Definition'),
  quote('Informed consent is a process (not merely a form) by which a patient is provided adequate information about a proposed medical intervention - its nature, purpose, risks, benefits, and alternatives - so that the patient can make a voluntary, autonomous, and intelligent decision.'),
  spacer(),
  h2('Legal Framework'),
  bullet('Canterbury v. Spence (USA 1972): "Reasonable patient standard" - disclosure of information a reasonable patient would consider material'),
  bullet('Sidaway v. Board of Governors (UK 1985): "Reasonable doctor standard" (Bolam principle applied to disclosure)'),
  bullet('Montgomery v. Lanarkshire Health Board (UK 2015): Shifted to "reasonable patient standard" in UK'),
  bullet('Samira Kohli v. Dr. Prabha Manchanda (India, SC 2008): Indian Supreme Court adopted consent principles; performed hysterectomy without consent = medical negligence'),
  spacer(),
  h2('Components - PARQ Principle'),
  bullet('P - Procedure: Nature and scope clearly explained'),
  bullet('A - Alternatives: All alternative treatments mentioned'),
  bullet('R - Risks: All material/serious risks disclosed'),
  bullet('Q - Questions: Patient given opportunity to ask questions'),
  spacer(),
  h2('Therapeutic Privilege'),
  para('A recognized exception where the doctor may withhold information if disclosure itself would cause serious harm to the patient (e.g., severe anxiety, self-harm risk). This exception is narrowly construed and controversial.'),
  spacer(), pageBreak()
);

children.push(
  h1('15. Rules of Consent'),
  h2('Summary'),
  para('For consent to be valid in medical practice, all of the following conditions must be met:'),
  spacer(),
  numbered('Voluntarily given - no coercion, fraud, or undue influence'),
  numbered('Sound mind - patient mentally competent to understand and decide'),
  numbered('Legal age - 18 years in India'),
  numbered('Informed - after full disclosure of nature, risks, benefits, and alternatives'),
  numbered('Specific to the procedure - cannot be used for a different or more extensive procedure'),
  numbered('For minors - parent/guardian must consent'),
  numbered('Emergency - implied consent operates; Section 92 IPC applies'),
  numbered('Withdrawal - consent can be withdrawn at any time before the procedure begins'),
  numbered('No defense against crime - consent is NOT a defense against criminal negligence'),
  spacer(),
  h2('Validity Flowchart'),
  para('Illustration 15.1 (SE): Is the Consent Valid?', { italic: true }),
  spacer(),
  ...flowchart([
    { text: 'CONSENT OBTAINED - Validity Check' },
    { text: 'Adult (>18 yrs) + Sound mind + No coercion?' },
    { text: 'Adequately informed of procedure, risks, alternatives?' },
    { text: 'Specific to this procedure?' },
    { text: 'Freely signed / given without fraud?' },
    { text: 'ALL YES => VALID CONSENT' },
    { text: 'ANY NO => INVALID => Equivalent to assault / battery (except emergency)' },
  ]),
  spacer(), pageBreak()
);

children.push(
  h1('16. Loco Parentis (Detailed)'),
  para('(See Short Essay 13 above for full coverage. Additional points below:)'),
  spacer(),
  h2('Loco Parentis in Other Contexts'),
  bullet('Foster parents: Act in loco parentis for foster children'),
  bullet('Military boarding schools: Commanding officer may act in loco parentis'),
  bullet('Orphanages: Superintendent can consent to medical treatment of children in care'),
  bullet('Government-recognized institutions: State can act in loco parentis for destitute minors'),
  spacer(),
  h2('Legal Basis in India'),
  bullet('No single statutory law; based on common law principles and judicial interpretation'),
  bullet('Guardians and Wards Act 1890: Defines guardian\'s powers'),
  bullet('Juvenile Justice Act 2015: State as guardian for children in conflict with law or need of protection'),
  spacer(), pageBreak()
);

children.push(
  h1('17. Section 92 IPC (Repeated / Additional Detail)'),
  para('(Primary coverage in Short Essay 12. Additional medicolegal scenarios:)'),
  spacer(),
  h2('Medicolegal Scenarios'),
  simpleTable(
    ['Scenario', 'Section 92 Protection?', 'Reasoning'],
    [
      ['Emergency amputation to save life (unconscious patient)', 'YES', 'Good faith; life-saving; no guardian available'],
      ['Blood transfusion to unconscious trauma patient', 'YES', 'Good faith; life-threatening situation'],
      ['Psychiatric treatment of violent patient refusing consent', 'Partial - MHA 2017 applies', 'Mental Healthcare Act 2017 has specific provisions superseding Section 92 for mental illness'],
      ['Elective surgery performed without consent during exploration', 'NO', 'Not an emergency; patient could have been awakened / family consulted'],
      ['Castration for alleged criminal tendency', 'NO', 'Intentional grievous hurt; not covered by Section 92'],
    ]
  ),
  spacer(),
  h2('Corresponding Provision under BNS (Bharatiya Nyaya Sanhita)'),
  para('The Bharatiya Nyaya Sanhita 2023, which replaces the IPC, carries forward the equivalent provision protecting acts done in good faith for a person\'s benefit even without consent in emergency circumstances. The principles remain the same under BNS.'),
  spacer(), pageBreak()
);

// ── SOURCE REFERENCES ──
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  }),
  bullet('KS Narayan Reddy\'s The Essentials of Forensic Medicine and Toxicology, 36th Edition (2026), Chapter 3: Medical Law and Ethics'),
  bullet('Parikh\'s Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology'),
  bullet('PC Dikshit - Textbook of Forensic Medicine and Toxicology'),
  bullet('Bharatiya Nyaya Sanhita (BNS) 2023 - Replaces Indian Penal Code (IPC) 1860'),
  bullet('National Medical Commission Act, 2019'),
  bullet('Consumer Protection Act, 2019'),
  bullet('Mental Healthcare Act, 2017'),
  bullet('Jacob Mathew v. State of Punjab - Supreme Court of India, 2005'),
  bullet('Common Cause v. Union of India - Supreme Court of India, 2018'),
  bullet('Indian Medical Association v. VP Shantha - Supreme Court of India, 1995'),
  bullet('Samira Kohli v. Dr. Prabha Manchanda - Supreme Court of India, 2008'),
);

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