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const fs = require('fs');

// ─── Colour palette ───────────────────────────────────────────────────────────
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// ─────────────────────────────────────────────────────────────────────────────
//  CONTENT
// ─────────────────────────────────────────────────────────────────────────────
const content = [];

// ── COVER INFO ────────────────────────────────────────────────────────────────
content.push(
  new Paragraph({
    children: [new TextRun({ text: "RS TAGGED QUESTIONS", bold: true, size: 40, color: DARK_BLUE, font: "Calibri" })],
    alignment: AlignmentType.CENTER,
    spacing: { before: 400, after: 120 },
  }),
  new Paragraph({
    children: [new TextRun({ text: "Forensic Medicine and Toxicology", bold: true, size: 32, color: MED_BLUE, font: "Calibri" })],
    alignment: AlignmentType.CENTER,
    spacing: { after: 100 },
  }),
  new Paragraph({
    children: [new TextRun({ text: "Chapter 3: Medical Law and Ethics", bold: true, size: 28, color: "555555", font: "Calibri" })],
    alignment: AlignmentType.CENTER,
    spacing: { after: 100 },
  }),
  new Paragraph({
    children: [new TextRun({ text: "Comprehensive Exam-Ready Answers", italics: true, size: 24, color: "555555", font: "Calibri" })],
    alignment: AlignmentType.CENTER,
    spacing: { after: 120 },
  }),
  new Paragraph({
    children: [new TextRun({ text: "Source: KS Narayan Reddy's The Essentials of Forensic Medicine & Toxicology, 36th Edition (2026)", italics: true, size: 20, color: "777777", font: "Calibri" })],
    alignment: AlignmentType.CENTER,
    spacing: { after: 400 },
  }),
  new Paragraph({
    children: [new TextRun({ text: "Parikh's Textbook of Medical Jurisprudence, Forensic Medicine & Toxicology", italics: true, size: 20, color: "777777", font: "Calibri" })],
    alignment: AlignmentType.CENTER,
    spacing: { after: 600 },
  }),
);

// ═══════════════════════════════════════════════════════════════════════════════
//  SECTION 1 — LONG ESSAYS
// ═══════════════════════════════════════════════════════════════════════════════
content.push(pageBreak(), h1("SECTION 1: LONG ESSAYS"));

// ─────────────────────────────────
//  LE 1 — NMC
// ─────────────────────────────────
content.push(
  h2("1. National Medical Commission (NMC) and its Functions"),
  h3("Introduction"),
  para(body("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).")),

  h3("Composition"),
  para([label("NMC comprises 33 members:"), body("")]),
  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"),

  h3("Four Autonomous Boards Under NMC"),
  para(body("Each Autonomous Board consists of a President, two whole-time members, and two part-time members.")),

  h4("1. Under-Graduate Medical Education Board (UGMEB)"),
  bullet("Grants recognition to medical qualifications at the UG level"),
  bullet("Develops competency-based dynamic curriculum for primary health services, community and family medicine"),
  bullet("Frames guidelines, minimum requirements and standards for setting up medical institutions"),
  bullet("Facilitates faculty training, development, research, and international student/faculty exchanges"),

  h4("2. Post-Graduate Medical Education Board (PGMEB)"),
  bullet("Grants recognition to PG and super-specialty qualifications"),
  bullet("Develops competency-based curriculum for skills, knowledge, attitude, values, and ethics"),
  bullet("Promotes postgraduate courses in family medicine"),

  h4("3. Medical Assessment and Rating Board (MARB)"),
  bullet("Grants permission for establishment of new medical institutions"),
  bullet("Permits starting of new PG courses or increasing seats"),
  bullet("Carries out inspections of medical institutions for assessment and rating"),

  h4("4. Ethics and Medical Registration Board (EMRB)"),
  bullet("Maintains the National Medical Register"),
  bullet("Issues licenses to practice medicine"),
  bullet("Handles disciplinary matters and enforces the Code of Medical Ethics"),
  bullet("Issues warning notices and has power of penal erasure"),

  h3("Powers and Functions of NMC"),
  bullet("Professional Ethics & Etiquette: Promotes professional ethics; assesses healthcare requirements; develops roadmap"),
  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 care"),
  bullet("NEET: Conducts and regulates NEET and common counselling for UG, PG, and super-specialty admissions"),
  bullet("NEXT (National Exit Test): Common final year UG exam; grants licenses to practice; enables registration in State/National Register"),

  h3("Key Differences: NMC vs MCI"),
  makeTable(
    ["Feature", "NMC Act", "MCI Act"],
    [
      ["Governing body", "NMC", "MCI"],
      ["Member appointment", "All appointed/nominated by Central Government", "Largely elected from medical faculty/State Councils"],
      ["Search Committee", "Provided for under Section 5", "Not provided"],
      ["Autonomous Boards", "Four boards constituted", "No such boards"],
      ["Exit exam", "For all candidates (NEXT)", "Only for FMGE candidates"],
    ]
  ),
);

// ─────────────────────────────────
//  LE 2 — INFAMOUS CONDUCT
// ─────────────────────────────────
content.push(
  pageBreak(),
  h2("2. Infamous Conduct — Definition, Examples & Disciplinary Action by State Medical Council"),

  h3("Definition"),
  definitionBox('"Any conduct of the registered medical practitioner which might reasonably be regarded as disgraceful or dishonorable by his professional brethren of good repute and competency."'),
  para(body("Also called serious professional misconduct — it is a violation of the Code of Medical Ethics as prescribed by the NMC/State Medical Council. No duty of care or damage to a patient needs to be present (unlike negligence).")),

  h3("Examples of Infamous Conduct"),
  bullet("Adultery or improper sexual association with a patient or patient's relative"),
  bullet("Dichotomy (fee splitting): Secretly sharing professional fees with another doctor without the patient's knowledge"),
  bullet("Covering: Assisting an unregistered/unqualified person to practice medicine by lending one's name"),
  bullet("Advertising: Self-promotion through paid advertisements, pamphlets, or posters"),
  bullet("Issuing false certificates: Signing certificates with false statements (e.g., false fitness/sickness certificates)"),
  bullet("Performing criminal abortion (not covered under MTP Act)"),
  bullet("Selling scheduled drugs/controlled substances without legal authority"),
  bullet("Abuse of alcohol/drugs while on duty — death of patient under such a doctor amounts to infamous conduct (NMC Gazette, August 2023)"),
  bullet("Betrayal of professional secret"),
  bullet("Violating the Hippocratic Oath / Code of Medical Ethics 2002"),

  h3("Differences: Infamous Conduct vs Professional Negligence"),
  makeTable(
    ["Trait", "Professional Negligence", "Infamous Conduct"],
    [
      ["Offence", "Absence of care and skill / willful negligence", "Violation of Code of Medical Ethics"],
      ["Duty of care", "Must be present", "Need not be present"],
      ["Damage to person", "Must be present", "Need not be present"],
      ["Trial by", "Courts (Civil or Criminal)", "State Medical Council"],
      ["Punishment", "Fine or Imprisonment", "Erasure of name or Warning"],
      ["Appeal", "To higher Court", "To State and Central Governments"],
    ]
  ),

  h3("Disciplinary Action by State Medical Council"),
  h4("Initiation of Proceedings — Three Ways:"),
  bullet("Information that a practitioner has been convicted of a cognizable offence or found guilty of serious professional misconduct"),
  bullet("A complaint made by any person or body against the practitioner"),
  bullet("Suo moto (on the Council's own initiative)"),
  para(body("The Council has the same powers as Civil Courts under the Code of Civil Procedure, 1908.")),

  h4("Step-by-Step Procedure of Enquiry:"),
  numbered("The Registrar submits the complaint to the President of the Council", "1"),
  numbered("Matter referred to Sub-committee / Executive Committee for investigation and legal advice", "2"),
  numbered("If no prima facie case: complainant is informed accordingly", "3"),
  numbered("If inquiry warranted: a Notice is issued to the practitioner specifying the charge, asking for a written reply and appearance on the appointed day", "4"),
  numbered("At the hearing, both complainant (or legal adviser) and practitioner must be present", "5"),
  numbered("After conclusion of evidence, a vote is taken and judgment given", "6"),
  numbered("If majority confirms guilt, Council votes again on punishment: Erasure of Name or Warning Notice", "7"),

  h4("Punishment Options:"),
  bullet("Warning Notice: Formal caution; practitioner remains on register; lesser punishment"),
  bullet("Penal Erasure ('Professional Death Sentence'): Name removed from Medical Register permanently or for a specified period; deletion published widely in press and medical publications"),

  h4("Appeal:"),
  bullet("To the State Government, and further to the Central Government"),
  bullet("Restoration of name is possible after directed by the Council or on appeal"),
);

// ─────────────────────────────────
//  LE 3 — MEDICAL NEGLIGENCE
// ─────────────────────────────────
content.push(
  pageBreak(),
  h2("3. Medical Negligence — Definition, Ingredients, Civil vs Criminal, Precautions & Defenses"),

  h3("Definition"),
  definitionBox('"Professional negligence is defined as absence of reasonable care and skill, or willful negligence of a medical practitioner in the treatment of a patient, which causes bodily injury or death of the patient."'),
  para(body("Medical negligence is part of the law of torts — a civil wrong for which the sufferer can seek compensation.")),

  h3("Ingredients / Elements of Negligence — The 4 D's"),
  makeTable(
    ["Element", "Description"],
    [
      ["1. Duty", "Existence of a duty of care. Arises when a doctor-patient relationship is established."],
      ["2. Dereliction (Breach)", "Failure to conform to the standard of care — by omission or commission."],
      ["3. Direct Cause", "A direct causal link between the breach of duty and the damage. Damage must be a foreseeable result of the breach."],
      ["4. Damage", "Actual injury, harm, or death to the patient as a result of the breach."],
    ]
  ),

  h3("Types of Medical Negligence"),
  bullet("Civil Negligence"),
  bullet("Criminal Negligence"),
  bullet("Corporate Negligence"),
  bullet("Contributory Negligence"),

  h3("Civil Negligence"),
  h4("When it arises:"),
  bullet("Patient (or relative) brings suit in Civil Court for compensation"),
  bullet("Doctor brings suit for fees and patient alleges negligence as defense"),

  h4("Standard of Care:"),
  bullet("Practitioner must possess a reasonable degree of knowledge and skill — neither the highest nor the lowest"),
  bullet("Specialist must maintain higher standards than a GP"),
  bullet("GP treating a case in a specialized field is held to specialist standards"),
  bullet("Standard is judged at the time of the incident, not at the time of trial"),
  bullet("Degree of competence varies by status: house-surgeon ≠ consultant surgeon"),

  h3("Criminal Negligence"),
  bullet("Requires gross negligence — disregard for life and safety amounting to a crime against the State"),
  bullet("Most cases involve drunkenness or drug use by doctors"),
  bullet("Practically limited to cases where the patient has DIED"),
  bullet("Error of judgment alone does NOT constitute criminal negligence"),
  para([label("Punishment: ", MED_BLUE), body("Section 106 BNS — imprisonment up to 2 years and/or fine (medical practitioner during a medical procedure)")]),

  h3("Differences: Civil vs Criminal Negligence"),
  makeTable(
    ["Trait", "Civil Negligence", "Criminal Negligence"],
    [
      ["Offence", "No specific criminal law violation needed", "Must have specifically violated a criminal law"],
      ["Negligence", "Simple absence of care and skill", "Gross negligence, inattention, lack of competency"],
      ["Conduct compared to", "Generally accepted simple standard", "Not compared to a single test"],
      ["Consent", "Good defense; cannot recover damages", "Not a defense; can still be prosecuted"],
      ["Litigation", "Between two parties", "Between State and doctor"],
      ["Trial by", "Civil Court", "Criminal Court"],
      ["Evidence standard", "Strong evidence sufficient", "Guilt proved beyond reasonable doubt"],
      ["Punishment", "Liable to pay damages (compensation)", "Imprisonment with or without fine"],
    ]
  ),

  h3("Contributory Negligence"),
  para(body("When the patient's own negligence contributes to or causes the injury, compensation is reduced proportionately.")),
  h4("Examples:"),
  bullet("Patient fails to follow post-operative instructions"),
  bullet("Patient conceals drug allergy or previous illness"),
  bullet("Patient discontinues medication prematurely against advice"),
  bullet("Diabetic patient ignores dietary advice, leading to wound infection"),

  h3("Vicarious Liability (Respondeat Superior — 'Let the master answer')"),
  para(body("A doctor/hospital is held liable for negligent acts of employees committed in the course of their duties.")),
  h4("Examples:"),
  bullet("Hospital is liable for a nurse's medication error"),
  bullet("Consultant surgeon is liable for acts of residents under his direct supervision"),
  para([label("Condition: ", MED_BLUE), body("There must be a master-servant (employment) relationship; the act must occur in the course of employment.")]),

  h3("Res Ipsa Loquitur ('The thing speaks for itself')"),
  para(body("Facts themselves prove negligence — no expert testimony needed. Burden of proof shifts to the doctor.")),
  h4("Examples:"),
  bullet("Leaving surgical swabs or instruments inside the body cavity after surgery"),
  bullet("Operating on the wrong patient or wrong limb"),
  bullet("Incompatible blood transfusion"),
  bullet("Burns to anesthetized patient from a cautery or heating pad"),

  h3("Therapeutic Misadventure"),
  definitionBox("An unavoidable, unforeseeable adverse outcome during the proper performance of a recognized medical/surgical procedure. It is neither negligence nor infamous conduct."),
  h4("Examples:"),
  bullet("Anaphylactic shock after penicillin even after negative sensitivity test"),
  bullet("Cardiac arrest under properly administered anesthesia"),
  bullet("Peripheral nerve injury after a correctly placed injection"),

  h3("Precautions Against Medical Negligence"),
  numbered("Obtain informed written consent of the patient", "1"),
  numbered("Establish good rapport and communication with the patient", "2"),
  numbered("Keep full, accurate, and legible medical records", "3"),
  numbered("Employ ordinary skill and care at all times", "4"),
  numbered("Confirm diagnosis by laboratory tests", "5"),
  numbered("Take skiagrams (X-rays) in bone/joint injuries or when diagnosis is doubtful", "6"),
  numbered("Sensitivity tests before potentially allergenic drugs (e.g., penicillin)", "7"),
  numbered("Do not prescribe outside one's competence — refer to a specialist", "8"),
  numbered("Maintain confidentiality of medical records", "9"),
  numbered("For sterilization operations, obtain consent of both husband and wife", "10"),
  numbered("Establish hospital injury prevention programs", "11"),
  numbered("Insist on continuing medical education and participate in medico-legal seminars", "12"),

  h3("Defenses Against Medical Negligence"),
  bullet("Consent: Patient gave valid informed consent (not a defense in criminal negligence)"),
  bullet("Error of judgement: Bona fide clinical error with due care taken"),
  bullet("Unavoidable accident: Result was unforeseeable and unavoidable"),
  bullet("Contributory negligence: Patient's own negligence contributed to harm"),
  bullet("Volenti non fit injuria: Patient voluntarily undertook the risk"),
  bullet("Expert opinion / Bolam test: Treatment followed a respectable body of medical opinion"),
  bullet("Therapeutic misadventure: Unforeseeable adverse outcome of a properly performed procedure"),
  bullet("Limitation of action: Suit filed beyond the limitation period"),
);

// ─────────────────────────────────
//  LE 4 — DUTIES OF RMP
// ─────────────────────────────────
content.push(
  pageBreak(),
  h2("4. Duties of a Registered Medical Practitioner"),

  h3("General Duties"),
  bullet("Maintain a high standard of professional conduct"),
  bullet("Render service to any patient in emergency without regard to payment"),
  bullet("Not refuse treatment on grounds of religion, caste, race, nationality, or politics"),
  bullet("Maintain confidentiality of all patient information (professional secret)"),
  bullet("Keep up-to-date with advances in medical knowledge"),

  h3("Duties Toward Patients"),
  bullet("Exercise due care and skill in treating patients"),
  bullet("Obtain valid informed consent before any examination or procedure"),
  bullet("Provide proper diagnosis and appropriate treatment"),
  bullet("Prescribe drugs and treatments that are evidence-based and appropriate"),
  bullet("Refer to a specialist when the case is beyond one's competence"),
  bullet("Not abandon a patient once treatment has started"),

  h3("Duties Regarding Medical Records (Code of Medical Ethics 2002 / NMC Regulations 2023)"),
  bullet("Maintain accurate, complete, and legible medical records"),
  bullet("Preserve records for 3 years (medical institutions); 2 years (individual practitioners) after completion of treatment"),
  bullet("Make records available to the patient or authorized representative on written request"),
  bullet("Issue medical certificate with true, accurate information — false entries amount to infamous conduct"),
  bullet("Not destroy records during medico-legal proceedings"),
  bullet("Electronic Health Records (EHR) are acceptable if they meet integrity and security standards"),

  h3("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"),

  h3("Duties Toward the Profession"),
  bullet("Not indulge in infamous conduct"),
  bullet("Not advertise or self-promote"),
  bullet("Maintain the dignity of the profession"),
  bullet("Not disparage colleagues in front of patients"),
);

// ─────────────────────────────────
//  LE 5 — CONSENT
// ─────────────────────────────────
content.push(
  pageBreak(),
  h2("5. Consent in Medical Practice — Definition, Types, Informed Consent, Rules & Consumer Protection Act"),

  h3("Definition"),
  definitionBox('"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."'),

  h3("Benefits of Taking Consent"),
  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"),

  h3("Classification of Consent"),
  makeTable(
    ["Type", "Description", "Example"],
    [
      ["Implied", "Inferred from patient's actions without words", "Holding out arm for an injection; attending the clinic"],
      ["Verbal (Express)", "Stated orally by the patient", "Patient orally agreeing to an examination"],
      ["Written (Informed Express)", "Documented on a consent form", "Signing consent form before surgery"],
    ]
  ),

  h3("Ingredients of Informed Consent (Full Disclosure)"),
  bullet("Nature of the procedure — what is to be done, in simple understandable language"),
  bullet("Purpose and likely benefits of the procedure"),
  bullet("Material risks and complications associated with the procedure"),
  bullet("Alternative treatments available"),
  bullet("Consequences of not undergoing the procedure"),
  bullet("Opportunity for the patient to ask questions"),
  para([label("Note: ", MED_BLUE), body("The doctor need not disclose risks of which he himself is unaware, or risks a person of average intelligence would be aware of, or in emergency situations.")]),

  h3("Rules of Consent"),
  numbered("Must be given voluntarily — free of coercion, fraud, or undue influence", "1"),
  numbered("Person must be of sound mind", "2"),
  numbered("Person must be of legal age (18 years in India)", "3"),
  numbered("For minors (under 18): consent from parent or legal guardian", "4"),
  numbered("For unconscious/mentally ill patients: consent from next of kin; emergency — implied consent operates", "5"),
  numbered("Must be informed — patient must understand what they are consenting to", "6"),
  numbered("Consent is specific — for a particular procedure; cannot be used for a different procedure", "7"),
  numbered("For sterilization: both husband and wife's consent should be obtained", "8"),
  numbered("Spouse's consent NOT required for the other's operation — wife's consent is sufficient for her own surgery", "9"),
  numbered("Consent can be withdrawn at any time before the procedure begins", "10"),
  numbered("Consent is NOT a defense against criminal negligence", "11"),

  h3("Consent in Special Situations"),
  makeTable(
    ["Situation", "Applicable Rule"],
    [
      ["Emergency", "Implied consent — life-saving treatment can be given without explicit consent"],
      ["Infectious disease / public health risk", "Compulsory treatment under law — law itself provides the consent"],
      ["Loco parentis (hostels/schools)", "Headmaster/warden can consent for inmates under 12 years; above 12 need own consent"],
      ["Prisoner", "Can be treated without consent in the interest of society"],
      ["Unconscious patient (Section 92 BNS/IPC)", "Acts in good faith for benefit of a person unable to consent are not offences"],
      ["Organ donation (kidney)", "Donor must be informed of procedure and risks; donation not accepted if risk to donor's life"],
      ["Body donation after death", "Not binding on spouse/next of kin"],
    ]
  ),

  h3("Consumer Protection Act and Medical Practice"),
  para(body("The Consumer Protection Act, 1986 (updated; now Consumer Protection Act, 2019) applies to medical services.")),
  bullet("Medical services come under the definition of 'service' under the Act"),
  bullet("Complaints can be filed against private practitioners (not government hospitals providing free services)"),
  bullet("Simple procedure — no court fee required for complaints up to Rs. 5 lakhs"),
  bullet("Three-tier system: District Forum → State Commission → National Commission"),
  bullet("Relief available: Compensation, removal of deficiency in service"),
  para([label("Landmark Case: ", MED_BLUE), body("Indian Medical Association v VP Shanta (1995) — Supreme Court held that medical services are covered under the Consumer Protection Act.")]),
);

// ═══════════════════════════════════════════════════════════════════════════════
//  SECTION 2 — SHORT ESSAYS
// ═══════════════════════════════════════════════════════════════════════════════
content.push(pageBreak(), h1("SECTION 2: SHORT ESSAYS"));

// SE 1 — State Medical Councils
content.push(
  h2("1. Functions of the State Medical Council"),
  bullet("Registration: Maintain State Medical Register of all qualified practitioners; register graduates of recognized universities"),
  bullet("Disciplinary Control: Issue warning notices; remove names (penal erasure) for serious professional misconduct"),
  bullet("Restoration: Direct restoration of names removed from the register"),
  bullet("Grant of Certificates: Issue registration certificates; grant 'Good Standing Certificates' for doctors going abroad"),
  bullet("Reciprocity: Grant reciprocal registration to practitioners registered in other state councils"),
  bullet("Supervision of Ethics: Enforce Code of Medical Ethics in their jurisdiction"),
  bullet("Referral: Cases beyond state jurisdiction forwarded to the Ethics and Medical Registration Board (NMC)"),
);

// SE 2 — Warning Notice
content.push(
  h2("2. Warning Notice"),
  definitionBox("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."),
  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"),
  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'"),
);

// SE 3 — Privileged Communication
content.push(
  h2("3. Privileged Communication"),
  definitionBox("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."),
  h3("Types"),
  bullet("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."),
  bullet("Qualified Privilege: Statements made in good faith, in the public interest, without malice. Protection exists only when made without malice."),

  h3("When a Doctor is Bound to Disclose"),
  numbered("Court order (subpoena/summons): When summoned to give evidence in court", "1"),
  numbered("Notifiable diseases: Cholera, plague, typhoid, etc. — must be reported to health authorities", "2"),
  numbered("Medico-legal cases: Injuries from firearms, explosives, suspicious circumstances — must be reported to police", "3"),
  numbered("Industrial/factory injuries", "4"),
  numbered("Births and Deaths: Reporting to the Registrar of Births and Deaths", "5"),
  numbered("Infectious diseases in schools or hostels", "6"),
  numbered("Medical fitness for employment", "7"),
  numbered("Consent of patient: Patient himself permits disclosure", "8"),

  h3("Examples"),
  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"),
);

// SE 4 — Medical Negligence (Short Essay)
content.push(
  h2("4. Medical Negligence"),
  definitionBox("Medical negligence is the absence of reasonable care and skill, or willful negligence of a doctor in treatment, causing bodily injury or death."),
  h3("The 4 D's — Elements"),
  bullet("Duty: Existence of a duty of care"),
  bullet("Dereliction: Breach of that duty (omission or commission)"),
  bullet("Direct Cause: Causal link between breach and damage"),
  bullet("Damage: Actual injury or death"),

  h3("Types"),
  makeTable(
    ["Type", "Key Feature", "Forum"],
    [
      ["Civil", "Simple absence of care; compensation sought", "Civil Court"],
      ["Criminal", "Gross negligence; imprisonment up to 2 years (Sec 106 BNS)", "Criminal Court"],
      ["Corporate", "Hospital/institution's systemic failure", "Civil/Criminal Court"],
      ["Contributory", "Patient's own negligence contributes", "Court reduces compensation"],
    ]
  ),
  h3("Key Legal Doctrines"),
  bullet("Res Ipsa Loquitur: The facts speak for themselves; burden shifts to doctor (e.g., wrong limb surgery)"),
  bullet("Respondeat Superior / Vicarious Liability: Employer liable for employee's negligence"),
  bullet("Bolam Test: Doctor not negligent if followed a practice accepted by a responsible body of medical opinion"),
);

// SE 5 — Res Ipsa Loquitur
content.push(
  h2("5. Res Ipsa Loquitur"),
  definitionBox('Latin: "The thing speaks for itself." Legal doctrine allowing the court to infer negligence from the very nature of an injury, without expert testimony on negligence.'),
  h3("Three Conditions for Application (Ybarra v Spangard)"),
  numbered("The event would not ordinarily occur unless there was negligence", "1"),
  numbered("The instrumentality causing injury was under exclusive management and control of the defendant", "2"),
  numbered("The plaintiff did not contribute to the injury", "3"),
  h3("Effect"),
  para(body("Normally, the plaintiff must prove negligence. With res ipsa loquitur, the burden shifts to the defendant (doctor) to explain or disprove negligence.")),
  h3("Classic Medical Examples"),
  bullet("Leaving surgical swabs, sponges, or instruments inside the body cavity after surgery"),
  bullet("Operating on the wrong patient or wrong organ/limb"),
  bullet("Transfusion of incompatible blood group"),
  bullet("Burns from heating pads or cautery on anesthetized patients"),
  bullet("Fracture of a limb during manipulation under anesthesia"),
  bullet("Broken hypodermic needle left inside the patient"),
  bullet("Permanent nerve paralysis after a routine injection into a safe site"),
);

// SE 6 — Contributory Negligence
content.push(
  h2("6. Contributory Negligence"),
  definitionBox("When the patient's own negligence contributes to or causes the injury complained of, the compensation is reduced proportionately to the patient's share of fault."),
  h3("Examples"),
  bullet("Patient does not follow post-operative instructions and develops complications"),
  bullet("Patient conceals important medical history (drug allergy, previous illness)"),
  bullet("Patient discontinues medication prematurely against advice"),
  bullet("Patient refuses recommended investigations (e.g., X-ray after fracture), leading to poor outcome"),
  bullet("A diabetic patient does not follow dietary advice, leading to surgical wound infection and gangrene"),
  bullet("Patient delays seeking treatment unreasonably"),
  h3("Legal Significance"),
  para(body("The total damages are apportioned between the doctor and the patient according to their respective degrees of fault. It can reduce or sometimes eliminate the doctor's liability.")),
);

// SE 7 — Therapeutic Misadventure
content.push(
  h2("7. Therapeutic Misadventure"),
  definitionBox("An unforeseen, unavoidable adverse outcome that occurs during the proper performance of a recognized medical or surgical procedure. It is neither negligence nor infamous conduct."),
  h3("Key Features"),
  bullet("The complication is inherent in the procedure and could not have been avoided even with due care"),
  bullet("It is an act done in good faith, according to established principles"),
  bullet("No duty of care is breached"),
  h3("Examples"),
  bullet("Anaphylactic shock after penicillin injection even after a negative sensitivity test"),
  bullet("Uncontrolled hemorrhage during a properly performed surgery"),
  bullet("Cardiac arrest under properly administered anesthesia"),
  bullet("Peripheral nerve injury after a correctly placed injection"),
  bullet("Death during a routine endoscopy from an unforeseeable vascular anomaly"),
  h3("Distinction from Negligence"),
  makeTable(
    ["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", "Absence of due care"],
      ["Outcome", "No legal liability", "Civil/Criminal liability"],
    ]
  ),
);

// SE 8 — Vicarious Liability
content.push(
  h2("8. Vicarious Liability"),
  definitionBox('Also called Respondeat Superior ("let the master answer"). Liability imposed on a master/employer for the negligent acts of a servant/employee committed in the course of their employment.'),
  h3("Application in Medical Practice"),
  bullet("A hospital is vicariously liable for the negligent acts of its employed doctors, nurses, and paramedical staff"),
  bullet("A consultant surgeon is liable for acts of residents and house surgeons under his direct supervision"),
  bullet("A doctor is liable for acts of his assistants and nurses in his employ"),
  h3("Conditions for Vicarious Liability"),
  numbered("There must be a master-servant relationship (employment)", "1"),
  numbered("The wrongful act must have been committed in the course of employment", "2"),
  numbered("The act must have been done to serve the master's purpose", "3"),
  h3("Examples"),
  bullet("Hospital nurse gives wrong medication — hospital is liable"),
  bullet("Anesthesiologist's technician makes an error during a supervised procedure — anesthesiologist and hospital are liable"),
  bullet("Senior surgeon delegates an operation to an unqualified junior who causes harm — senior surgeon is liable"),
  para([label("Limitation: ", MED_BLUE), body("An independent contractor (consultant brought from outside) is generally NOT subject to vicarious liability. Only employees attract vicarious liability.")]),
);

// SE 9 — Consent
content.push(
  h2("9. Consent — Definition, Classification, Informed Consent"),
  para(body("See Long Essay 5 above for comprehensive coverage. Summary below:")),
  definitionBox('"Consent means voluntary agreement, compliance or permission, given after understanding what it is given for, and the risks involved."'),
  h3("Classification"),
  bullet("Implied Consent — inferred from patient's actions (e.g., holding out arm for injection)"),
  bullet("Verbal Express Consent — stated orally"),
  bullet("Written Informed Express Consent — documented on consent form (required for surgery and major procedures)"),
  h3("Informed Consent — Key Elements"),
  bullet("Nature of the procedure"),
  bullet("Purpose and likely benefits"),
  bullet("Material risks and complications"),
  bullet("Alternative treatments available"),
  bullet("Consequences of refusal"),
  bullet("Opportunity to ask questions"),
  h3("Ingredients of Valid Consent (Legal Requirements)"),
  bullet("Voluntary — no coercion or fraud"),
  bullet("Sound mind and legal age (18 years in India)"),
  bullet("After full disclosure (informed)"),
  bullet("For a specific procedure"),
  bullet("Capable of being withdrawn at any time"),
);

// ═══════════════════════════════════════════════════════════════════════════════
//  SECTION 3 — SHORT ANSWERS
// ═══════════════════════════════════════════════════════════════════════════════
content.push(pageBreak(), h1("SECTION 3: SHORT ANSWERS"));

// SA 1 — State Medical Councils
content.push(
  h2("1. State Medical Councils — Functions"),
  para(body("As listed under Short Essay 1. Key functions: Registration, Disciplinary control (warning / penal erasure), Restoration, Good Standing Certificates, Reciprocal registration, Enforcement of Code of Ethics.")),
);

// SA 2 — Hippocratic Oath
content.push(
  h2("2. Hippocratic Oath"),
  definitionBox("The Hippocratic Oath is the ancient code of medical ethics attributed to Hippocrates (460–370 BC), the father of medicine."),
  h3("Key Pledges"),
  bullet("To use treatment to help the sick according to ability and judgment"),
  bullet("To do no harm (Primum non nocere)"),
  bullet("Not to give deadly drugs even if asked"),
  bullet("Not to perform criminal abortion"),
  bullet("Keep a professional secret — 'What I see or hear in the course of treatment, which ought not to be spread abroad, I will keep secret'"),
  bullet("To lead a pure and holy life"),
  bullet("Not to violate the professional relationship with any patient or household member"),
  bullet("To teach medicine to qualified students under proper conditions"),
  para([label("Modern Equivalents: ", MED_BLUE), body("Declaration of Geneva (1948) for physicians; Declaration of Helsinki (1964) for research ethics.")]),
);

// SA 3 — Penal Erasure
content.push(
  h2("3. Penal Erasure (Professional Death Sentence)"),
  definitionBox("Penal erasure is the removal of a medical practitioner's name from the Medical Register as punishment for serious professional misconduct (infamous conduct). Called the 'professional death sentence' as the doctor loses the legal right to practice medicine."),
  h3("Grounds for Erasure"),
  bullet("Serious professional misconduct (infamous conduct)"),
  bullet("Conviction of a cognizable criminal offence"),
  bullet("Entries made in error or as a result of fraud"),
  h3("Procedure"),
  numbered("Complaint received → Registrar submits to President", "1"),
  numbered("Notice to practitioner with charges", "2"),
  numbered("Hearing before the Council", "3"),
  numbered("Majority vote on guilt → vote on punishment", "4"),
  numbered("If erasure ordered → published widely in press and medical publications", "5"),
  h3("Key Points"),
  bullet("Duration: Permanent or for a specific period"),
  bullet("Appeal: To State Government, then Central Government"),
  bullet("Restoration: Possible on direction of the Council or on appeal"),
);

// SA 4 — Infamous Conduct
content.push(
  h2("4. Infamous Conduct — Definition and Four Examples"),
  definitionBox('"Any conduct of the registered medical practitioner which might reasonably be regarded as disgraceful or dishonorable by his professional brethren of good repute and competency."'),
  h3("Four Examples"),
  numbered("Adultery: Improper sexual association with a patient or patient's relative", "1"),
  numbered("Dichotomy (fee splitting): Secretly sharing fees with another doctor without the patient's knowledge", "2"),
  numbered("Covering: Allowing an unregistered/unqualified person to practice under one's name/license", "3"),
  numbered("Issuing false certificates: Deliberately signing untrue or fraudulent medical certificates", "4"),
);

// SA 5 — Adultery
content.push(
  h2("5. Adultery (in Medical Ethics)"),
  definitionBox("In the context of infamous conduct, adultery means a registered medical practitioner engaging in sexual intercourse or having improper association with a patient or a patient's close relative."),
  bullet("It is a serious violation of the trust placed in the doctor"),
  bullet("Amounts to infamous conduct — can result in penal erasure"),
  bullet("One of the most commonly cited examples of infamous conduct under the Code of Medical Ethics"),
  bullet("The doctor-patient relationship demands the highest standards of professional conduct and personal integrity"),
);

// SA 6 — Dichotomy
content.push(
  h2("6. Dichotomy (Fee Splitting)"),
  definitionBox("Dichotomy means a registered medical practitioner secretly dividing professional fees with another doctor without the knowledge and consent of the patient, in return for referrals or recommendations."),
  h3("Examples"),
  bullet("A GP receiving a commission from a specialist for referring patients, without the patient's knowledge"),
  bullet("A surgeon paying a kickback to a referring doctor"),
  bullet("Secret financial arrangements between practitioners that benefit both at the patient's expense"),
  para(body("This amounts to infamous conduct because it compromises patient welfare — referrals are made for financial gain rather than clinical need.")),
);

// SA 7 — Covering
content.push(
  h2("7. Covering"),
  definitionBox("Covering occurs when a registered medical practitioner lends his name or qualifications to enable an unregistered or unqualified person to practice medicine."),
  h3("Examples"),
  bullet("Signing prescriptions for a compounder or unqualified assistant who is actually treating patients"),
  bullet("A retired or inactive doctor allowing an unqualified person to use his registration certificate to establish a clinic"),
  bullet("A doctor who remains nominally 'in charge' of a practice actually run by an unqualified person"),
  para(body("This is infamous conduct as it endangers patient safety by allowing unqualified persons to practice medicine.")),
);

// SA 8 — Professional Secret
content.push(
  h2("8. Professional Secret"),
  definitionBox("Any information given by a patient to a doctor in confidence during the doctor-patient relationship, which the doctor must not disclose to any third party without the patient's consent. Also called medical confidentiality or doctor-patient privilege."),
  h3("General Rule"),
  para(body("A doctor must not disclose any information about a patient obtained during professional attendance.")),
  h3("Exceptions (When Disclosure is Allowed — Privileged Communications)"),
  numbered("Court order (subpoena)", "1"),
  numbered("Notifiable communicable diseases", "2"),
  numbered("Medico-legal cases (gunshot, stab wounds, suspicious deaths)", "3"),
  numbered("Patient gives consent to disclosure", "4"),
  numbered("In the interest of the patient themselves (to next of kin in emergency)", "5"),
  numbered("Births and deaths registration", "6"),
);

// SA 9 — Res Ipsa Loquitur
content.push(
  h2("9. Doctrine of Res Ipsa Loquitur with Examples"),
  para(body("See Short Essay 5 above for full details.")),
  definitionBox('"The thing speaks for itself." Allows the court to infer negligence from the nature of the injury. Burden of proof shifts to the doctor.'),
  h3("Examples"),
  bullet("Surgical sponge left inside abdomen after surgery"),
  bullet("Wrong limb amputation"),
  bullet("Incompatible blood transfusion"),
  bullet("Burns to anesthetized patient from a hot water bottle or cautery"),
  bullet("Broken hypodermic needle retained inside patient"),
);

// SA 10 — Contributory Negligence
content.push(
  h2("10. Contributory Negligence — Definition and Examples"),
  para(body("See Short Essay 6 above for full details.")),
  definitionBox("When the patient's own negligence contributes to or causes the injury, compensation is reduced proportionately."),
  h3("Examples"),
  bullet("Patient does not follow post-operative instructions"),
  bullet("Patient conceals drug allergy — adverse reaction occurs"),
  bullet("Patient discontinues medication prematurely against advice"),
  bullet("Diabetic patient ignores dietary advice — wound infection and gangrene develop"),
);

// SA 11 — Therapeutic Misadventure
content.push(
  h2("11. Therapeutic Misadventure"),
  para(body("See Short Essay 7 above for full details.")),
  definitionBox("Unforeseen, unavoidable adverse outcome during the proper performance of a medical procedure. It is neither negligence nor infamous conduct."),
  h3("Examples"),
  bullet("Anaphylactic shock after penicillin injection despite negative sensitivity test"),
  bullet("Cardiac arrest under properly administered anesthesia"),
  bullet("Peripheral nerve injury after correctly placed injection"),
);

// SA 12 — Medical Records
content.push(
  h2("12. Duties of a Doctor in Maintaining Medical Records (Code of Medical Ethics 2002 / NMC Regulations 2023)"),
  numbered("Maintain accurate, complete, and legible medical records", "1"),
  numbered("Preserve records for 3 years in medical institutions; 2 years for individual practitioners after completion of treatment", "2"),
  numbered("Make records available to the patient or authorized representative on written request within 72 hours", "3"),
  numbered("In medico-legal cases: preserve records until the case is disposed of", "4"),
  numbered("Issue death certificate stating the true cause of death", "5"),
  numbered("False entries in records = infamous conduct", "6"),
  numbered("Electronic Health Records (EHR) are acceptable if they meet integrity and security standards", "7"),
  numbered("Records must not be written in abbreviations not commonly understood", "8"),
);

// SA 13 — Types of Consent
content.push(
  h2("13. Types of Consent in Medical Practice"),
  makeTable(
    ["Type", "Description", "Example"],
    [
      ["Implied", "Inferred from patient's actions without words", "Holding out arm for injection"],
      ["Verbal Express", "Stated orally", "Patient orally agreeing to examination"],
      ["Written Informed Express", "Documented on consent form", "Signing consent form before surgery"],
    ]
  ),
);

// SA 14 — Informed Consent
content.push(
  h2("14. Informed Consent"),
  definitionBox("A process by which a patient is given adequate information about a proposed treatment (nature, purpose, risks, benefits, alternatives, and consequences of refusal) in understandable language, and then voluntarily agrees or refuses."),
  h3("Requirements"),
  bullet("Adequate information given in understandable language"),
  bullet("Nature, purpose, risks, benefits, alternatives, consequences of refusal — all disclosed"),
  bullet("Patient given opportunity to ask questions"),
  bullet("Consent given voluntarily without coercion"),
  bullet("Both an ethical obligation AND a legal requirement"),
  para([label("Consequence of failure: ", ACCENT), body("Failure to obtain informed consent can amount to assault or battery.")]),
);

// SA 15 — Rules of Consent
content.push(
  h2("15. Rules of Consent"),
  numbered("Voluntarily given — no coercion, fraud, or undue influence", "1"),
  numbered("Sound mind", "2"),
  numbered("Legal age (18 years in India)", "3"),
  numbered("Informed — after full disclosure of nature, risks, benefits", "4"),
  numbered("Specific to the procedure — cannot be used for a different procedure", "5"),
  numbered("For minors — parent/guardian consents", "6"),
  numbered("Emergency — implied consent operates", "7"),
  numbered("Can be withdrawn at any time before the procedure begins", "8"),
  numbered("Consent is NOT a defense against criminal negligence", "9"),
);

// SA 16 — Loco Parentis
content.push(
  h2("16. Loco Parentis"),
  definitionBox('Latin: "In the place of a parent." A person or institution acting in the place of a parent, assuming parental rights, duties, and responsibilities.'),
  h3("Medical Relevance"),
  bullet("In schools and hostels, the headmaster/warden acts in loco parentis"),
  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 be treated without consent if they remain"),
  h3("Clinical Significance"),
  para(body("Relevant when a child is injured or falls ill at school and parents are not immediately reachable. The school/hostel authority can authorize emergency treatment in loco parentis.")),
);

// SA 17 — Section 92 IPC / BNS
content.push(
  h2("17. Section 92 IPC (Corresponding BNS Provision)"),
  definitionBox('"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."'),
  h3("Exceptions — Where Section 92 Does NOT Apply"),
  numbered("Acts that intentionally cause death or are likely to cause death", "1"),
  numbered("Acts causing grievous hurt voluntarily", "2"),
  numbered("Acts likely to cause grievous hurt for purposes other than preventing death or curing grievous disease/infirmity", "3"),
  numbered("Amputation or other operations without consent (except to save life)", "4"),
  h3("Medical Examples of Section 92 in Practice"),
  bullet("Performing emergency surgery on an unconscious accident victim without consent"),
  bullet("Giving blood transfusion to an unconscious patient who had not previously refused"),
  bullet("Emergency tracheotomy on a child whose parents cannot be reached"),
);

// SA 18 — Euthanasia
content.push(
  h2("18. Euthanasia — Definition and Types"),
  definitionBox("Euthanasia (from Greek: EU = good; Thanatos = death) means producing a painless death of a person suffering from a hopelessly incurable and excruciatingly painful disease. Also called 'mercy killing.'"),
  h3("Types"),
  makeTable(
    ["Classification", "Type", "Description", "Legal Status in India"],
    [
      ["Based on Action", "Active (Positive)", "An act of commission — e.g., giving large doses of drugs to hasten death", "ILLEGAL"],
      ["Based on Action", "Passive (Negative)", "An act of omission — e.g., withdrawing life support, not delivering CPR", "Permitted under guidelines"],
      ["Based on Consent", "Voluntary", "At the will and request of the patient", "Passive form allowed with guidelines"],
      ["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"],
    ]
  ),
  h3("Legal Position in India"),
  para([label("Supreme Court ruling: ", MED_BLUE), body("Common Cause v Union of India (2018) — 'Right to die with dignity' is a fundamental right under Article 21 of the Constitution. 'Living will' (Advance Directive) is permitted.")]),
  bullet("Active euthanasia remains ILLEGAL in India (amounts to murder or abetment of suicide)"),
  bullet("Passive euthanasia is permitted under strict Supreme Court guidelines"),

  h3("Guidelines for Living Will (Advance Directive)"),
  numbered("Can be executed only by an adult with a sound and healthy mind", "1"),
  numbered("Must be voluntarily executed based on informed consent", "2"),
  numbered("Expressed in clear and unambiguous terms", "3"),
  numbered("Signed before a first-class judicial magistrate", "4"),
  numbered("Must mention circumstances for treatment withdrawal and name of guardian/close relative to authorize passive euthanasia", "5"),
  numbered("The treating physician must ascertain genuineness from the jurisdictional magistrate", "6"),
  numbered("The hospital medical board must authorize withdrawal of treatment", "7"),

  h3("International Position"),
  bullet("Netherlands: First country to legalize passive voluntary euthanasia and assisted suicide (2002) — conditions: incurable disease, unbearable suffering, terminal condition, voluntary request, and a second physician concurs"),
  bullet("Oregon, USA: Death with Dignity Act (1997) permits physician-assisted suicide"),
);

// ─────────────────────────────────
//  FOOTER NOTE
// ─────────────────────────────────
content.push(
  pageBreak(),
  new Paragraph({
    children: [
      new TextRun({ text: "Source References", bold: true, size: 24, color: DARK_BLUE, font: "Calibri" }),
    ],
    spacing: { before: 200, after: 120 },
  }),
  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 — Section 106 (replaced IPC Section 304A)"),
  bullet("NMC Act 2019 and Ethics & Medical Registration Board Gazette Notification, August 2023"),
  bullet("Consumer Protection Act 2019; Indian Medical Association v VP Shanta (1995) SC"),
  bullet("Supreme Court of India — Common Cause v Union of India (2018) — Euthanasia"),
);

// ═══════════════════════════════════════════════════════════════════════════════
//  BUILD DOCUMENT
// ═══════════════════════════════════════════════════════════════════════════════
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