The purpose of this ‘Handbook of Compassion in Healthcare: A Practical Approach’ is to help make compassionate care a day-to-day clinical reality for everyone: patients, families, and healthcare professionals. We do not suggest that current health systems are entirely lacking in compassion. All around the world, clinical care is provided by staff who seek to be professional, compassionate, and patient-centered at all times. The very existence of health centres, doctors’ surgeries, outpatient clinics, acute hospitals, daycare centres, dental practices, physiotherapy centres, and many other healthcare facilities is a testament to basic human compassion, to society’s commitment to help the afflicted, and to our fundamental desire to support each other in times of difficulty. We care. At the same time, it is clear that healthcare settings vary widely in relation to compassion, with some already excelling in compassionate care, but others in need of a more conscious or sustained focus on compassion. Many services do well, but most could do better. Improvement is always possible. Health systems are operated by people, for people. Compassion matters deeply. Compassion can be the key value that improves services further and makes our fundamental caring impulses more apparent, more effective, and more human. Always and everywhere, compassion matters.

This chapter outlines the methodological approach for reconstructing the top of the wealth distribution of early-imperial Italy. Traditional social-table models are deemed inadequate for this purpose. Instead, I advocate for an economic model that assumes the top of the Italian wealth distribution can be represented by a simple mathematical function– a power law.

This chapter assesses wealth inequality among the elites of the Italian civitates, using four sets of wealth proxy data. The analysis reveals significant variation in the implied inequalities, which nonetheless fall within the same range as those implied by other premodern datasets. Interestingly, these levels of inequality do not appear to correlate with the size of the civitas.

The Introduction sets out the theme of the book. It discusses the census qualifications (wealth minimum requirements) that prevailed in the Roman timocratic political system.

This chapter explores the concepts of self-compassion and moral injury, and ways of navigating complex healthcare roles with self-awareness, kindness, and greater compassion. Self-compassion involves recognising our suffering, being moved by it, and offering kindness and understanding towards ourselves. Human beings can be our own worst enemies and toughest critics. Cultivating self-compassion helps to address this tendency, increase resilience, and empower us to show greater compassion towards others. Moral injury stems from situations in which a person must make choices that go against their core values and can corrode compassion. There are many kinds of moral injury, ranging from a single large, conflictual decision to a sustained pattern of smaller but still conflictual decisions that arise on a day-to-day basis. The latter is common in large healthcare systems owing to rapid decision-making, inadequate resources, outsized expectations of healthcare providers, and working conditions that are often not conducive to clear thought: long hours, sleep deprivation, inadequate personal support, and lack of compassion for staff. This chapter examines how to manage the risk of moral injury in these situations, how to boost self-care for staff, and the importance of self-compassion when managing or living with difficult experiences or situations, especially on a recurring basis.

At its heart, compassion is the feeling of being motivated to act in the presence of suffering. From a psychological perspective, the construct is conceived as having two dimensions: state and trait. The compassionate state reflects the feeling of compassion or having a compassionate response in the moment, while a compassionate trait is more stable, reflecting a general tendency towards compassion or towards feeling and responding compassionately most of the time. For people who are expected or required to be compassionate in their everyday life or work, compassion requires sustained courage and a continued willingness to engage with suffering, rather than avoid it. This chapter explores compassion from psychological, evolutionary, and physiological viewpoints. Despite a useful and growing literature in this area, a precise definition of compassion in practice can remain elusive. The meaning of compassion is not written in stone; it flows. As a result, what the concept means in healthcare, and how it works in practice, are, perhaps, made most tangible through providing compassionate care to patients, interacting with families, discussing compassion with colleagues, and teaching students about compassionate healthcare. If compassion is defined flexibly and understood wisely, it can shape care in positive ways, improve outcomes, and change lives.

This chapter introduces a new model to represent the heterogeneity of the Italian civitates. The model is based on the abundant archaeological evidence of the inhabited areas of their administrative centres, using it as a proxy for various economic and socio-political aspects of the civitas. This new variation model surpasses previous ones by being continuous (rather than categorical) and by formally incorporating the uncertainties associated with missing data.