Part II focuses on cases related to tobacco control. Law, rights talk, and litigation have become regular features of tobacco control movements and public health campaigns aimed at reducing tobacco consumption worldwide, including in Japan and Korea. But are they enough to overcome the resource and information disadvantages tobacco control activists face when taking on the industry? Chapter 6 provides historical background on the tobacco epidemic, the multifaceted reasons the tobacco industry remains politically influential in both countries, the Framework Convention on Tobacco Control, and recent tobacco control measures—including taxation and pricing, limits on advertising, and new responses to electronic nicotine delivery systems.

In theory, compassion lies at the heart of all healthcare. There are, however, many reasons for the erosion of compassion in day-to-day clinical practice: increased demand on services, limited resources, large caseloads, insufficient time to spend with each patient, and a consequent transactional rather than relational approach to each person. Systemic focus on efficiency and throughput can also impede the cultivation of compassion, empathy, understanding, and addressing the individual needs and concerns of each patient and their family. Growing reliance on technology and electronic health records can further depersonalise patient interactions and reduce compassion, despite the many benefits of such technologies. This chapter outlines these and other factors which tend to diminish compassion, reflects on the relevance of overarching values in medical education, focuses especially on the meaning of ‘equanimity’ in this context, and overviews the place accorded to compassion in guides to professional ethics and codes of practice. The role of health systems in limiting compassion and empathy is balanced by evidence supporting the importance and possibilities of compassionate care, especially during times of emergency such as the Covid-19 pandemic in the early 2020s.

This chapter explores why we decided to write this book about compassion in healthcare. Despite choosing our professions in order to help others, many healthcare professionals feel chronically tired, emotionally drained, deeply heart-sore, and ultimately burnt-out. Too often, moments of connection with patients and their families, although magical at the time, also highlight the uncertainties and even the darkness that surrounds them. Commonly, staff struggle to make sense of healthcare systems that seem to value neither ‘health’ nor ‘care’. The message of this book is that we can do better. Perhaps the first step in resolving these matters lies in recognising that while we do not have full control over the shape of the healthcare systems within which we work, or indeed the societies in which we live, we can control how we navigate these contexts, how we respond to them, and how we seek to be in the world. In parallel, we can also seek to change health systems in the direction of more compassionate care. Compassion is always essential in these processes, especially in the settings of health and social care. That is why we wrote this book: to try to make compassionate care a day-to-day clinical reality for everyone: patients, families, and healthcare professionals who constantly seek to do more and better.

This chapter examines the formal relationship between medical professionalism and compassion, looking at codes of ethics and practice guidelines, chiefly for medical professionals but also with reference to other healthcare workers. The chapter starts by exploring the importance accorded to compassion in ethical guidance for doctors in the United Kingdom (UK), Ireland, the United States, Australia, and New Zealand. It then examines guidance specifically aimed at psychiatrists, including documents published by the Royal College of Psychiatrists in the UK, the College of Psychiatrists of Ireland, and the American Psychiatric Association. Many of these guides emphasise the importance of compassion and related values, with the Royal College of Psychiatrists providing particularly detailed suggestions about building and sustaining compassion in mental healthcare. Compassion and related values also feature commonly in codes of practice and ethical guidance for other clinical professionals, such as nurses, midwives, social workers, occupational therapists, and others. This chapter concludes that, taken together, these statements of practice values and ethical principles reflect a welcome and growing emphasis on compassion in guidance for healthcare professionals across many clinical domains.

This chapter explores the “medical revolution” of Tokugawa Japan. At the beginning of this period, medical care by physicians was largely an urban phenomenon, but over the course of some 200 years, medicine became an integral part of everyday life in towns and villages all around Japan. The political authorities had little involvement in the expansion of the medical profession, which instead was driven by commercial and social factors. The development of print culture made medical knowledge more widely available, both to physicians and the larger public, while the tensions of the status system made the medical profession desirable to many, from low-ranking members of the warrior status group to the ambitious sons of villager families. Medical academies established by prominent doctors in cities such as Kyoto, Edo, Osaka, and Nagasaki made it possible for would-be doctors to acquire training in a variety of new medical fields, from obstetrics to so-called Dutch medicine. However, by the early nineteenth century, the proliferation of doctors with varying degrees of training and skill and the increasingly intense competition among them led some localities to adopt new licensing measures designed to weed out “quacks” and ensure the livelihood of established doctors.

The tenth to thirteenth centuries were formative in the creation of what we now know as Chinese cuisine, including its rich regional diversity. The foods that people in the Song, Liao, and Jin ate were dependent on what the natural environment provided or what could be acquired through trade. But food and drink were also products of cultural preferences that evolved over time and came to identify economic, social, and ethnic difference. Song, Khitan, and Jurchen foodways differed significantly, rooted in the experiences of steppe and agrarian life as well as the diversity of cultures. People encountered unfamiliar food and drink in the cities andthrough diplomatic and commercial exchanges between Song and its neighbors. The food and drink people consumed were also deeply tied to the theory and practice of Chinese medicine, which reached new levels of standardization and sophistication during the Song and Jin. How were medical traditions transmitted through texts and teachers? How did the state promote and regulate medical knowledge and practice? The spread of printing and commercial publishing made information about food and medicine more widely available to the literate, and others could gain access to this knowledge through oral and visual transmission.

The years 1968-73 are a key period. The initial Irish response to the 1968 papal encyclical Humanae Vitae – reaffirming traditional Catholic teaching on contraception – was muted, compared with Europe or the United States, reflecting continuing Irish deference to clerical authority; clerical dissent was also limited. By 1972 however, two family planning clinics had opened in Dublin, and the ban on contraception was being challenged in the courts and the Oireachtas (parliament).This was happening against the backdrop of the Northern Ireland Troubles and a debate over minority rights. During the early 1970s there was a possibility that Ireland would come into line with other European countries, where laws against contraception had been liberalised in recent years. The Catholic Hierarchy argued that liberalising contraception would damage public morality, and that argument was repeated by the government. Given the political challenges of enacting legislation to enable even limited access to contraception, the government preferred to await the outcome of a Supreme Court judgment on the legality of the existing ban.

Central to the history of family planning in Ireland is the interaction between religious observance and expressions of Irishness, and how that changed in response to domestic political and socio-economic developments, and international forces. An Irish identity imagined around rural living, Catholicism, large families, traditional gender roles, and sexual puritanism, combined with a belief that Ireland could withstand the changes that were underway in twentieth-century western society in relation to sexual behaviour – drove the sustained hostility to legalising contraception. The 1980s was the decade when it became evident that the tide had turned. The number of married women in the workforce rose significantly, and fertility fell sharply. By the early 1990s Irish fertility was still the highest in Europe, but only by a small margin, and it was lower than in the United States. And yet the decline of this imagined Irishness was not unopposed; indeed, many lamented its passing. it is significant that the moral legislation enacted in the first decades after independence survived until the closing decades of the twentieth century, which might suggest that Ireland was exceptional.

From the early 1970s government proposals for legislation permitting access to contraception reveal a consistent dilemma for politicians: how to make contraception available to married couples while restricting access by single people. Records of consultative meetings organised by the Department of Health, suggest that by the late 1970s there was consensus, sometimes grudging, among the main churches, medical groups, and the trade union congress that contraception should be available on a restricted basis, but it was also recognised that it would prove difficult to prevent access by single people. These consultations also reveal a determination on the part of doctors and pharmacists to protect their professional interests, and an incapacity to provide family planning through the public health system. The 1979 Family Planning Act legalised access to contraception, ‘for bona fide family planning purposes’ – terminology that was not defined, and it privileged ‘natural methods’, providing state support to promote them in order to placate the Catholic hierarchy. Its restrictive nature ensured that contraception remained a matter for political contention.

Hunger is an embodied experience which impacts the physical and mental state. This chapter explores the impact of starvation. The physical effects of starvation on the body are wasting, swelling (edema), susceptibility to disease, and eventually death. The mental effects of starvation include behavioral changes, food obsession, and irritability. All of these were observed by individuals in the ghetto who recorded this as diarists or in some cases physicians studying the impact of the lack of food on their patients. This also chapter explores food fantasy resulting from hunger and humor which arose in response to food deprivation.

This chapter explores the practice of dissection in the first and second centuries AD, based largely on the evidence of Galen but drawing a picture beyond his activities alone. Divided into sections according to the contexts of and motivations for dissection, it begins with private dissections for practice and research. It next turns to performative dissections, beginning with those for public display. These public dissections occurred at different scales, and this section considers their contents, their diverse practitioners, and the size and make-up of their various audiences, including a discussion of venues, such as auditoria, and their capacities. The chapter then turns to examples of dissection specifically for medical advertisement, including evidence for public surgery, and then to two instances of dissection in the context of formal competition, one attested textually, the other epigraphically. Finally, it zeroes in on the competitive motivations of Roman dissection and its use in the adjudication of medical and philosophical debates, as well as in the jockeying between rivals.

Chapter 2 traces the Act’s early, formative years. We explain how its meaning was negotiated as women arrived in doctors’ surgeries seeking services that they now believed to be lawful and how doctors worked to understand and apply the new law. We explore how, over time, different interpretations of the Act coexisted, fell out of use or became entrenched in professional codes, internal policy and procedure documents, official guidance and medical curricula. The chapter ends in 1974 with the publication of two important texts discussing the workings of the Abortion Act in these early years: the sensationalist media expose Babies for Burning and the highly influential and authoritative Lane Report.