We were delighted to be asked by the editors of the American Journal of Bioethics to provide this editorial in response to Dr. Ariane Lewis’s paper “An Overview of Ethical Issues Raised by Medicole...

This article reports the findings of a survey examining if there are gender and career stage differences between male and female practitioners regarding ethical judgment. The results show that, on average, females adopted a more strict ethical stance than their male counterparts on 7 out of 19 vignettes. Males on the other hand, demonstrated a more ethical stance than their female counterparts on 2 out of 19 vignettes. The results furthermore indicate there is a significant difference in ethical judgment across (...) career stages. Overall, it appears that practitioners in later career stages display higher ethical judgment than practitoners in lower career stages. Implications are provided for both practitioners and academicians. (shrink)

This paper reports on the results from two studies that were conducted eight years apart with different respondents. The studies examined the role of the Mere Exposure Effect on ethical tolerance or acceptability of particular business decisions. The results from Study 1 show there is a significant difference in ethical judgment for 12 out of 16 vignettes between those who have been exposed to such situations compared to those who have not been exposed to them. In those 12 situations, those (...) who have been exposed to such situations adopted a more tolerant stance toward the ethically questionable behavior. The results from Study 2 show there is a significant difference in ethical judgment for 9 out of 16 vignettes between those who have been exposed to such situations compared to those who have not been exposed to them. Again, in those nine situations, those who have been exposed to such situations adopted a more tolerant stance toward the ethically questionable behavior. Interestingly, the 9 situations in Study 2 were 9 of the 12 situations found to be significant in Study 1, and in the same direction, suggesting that we have found consistency in our findings and support for the Mere Exposure Effect. Implications are provided for both higher education and practitioners. (shrink)

A growing public concern regarding ethical business conduct has stimulated marketing research in the ethics area. This study is the first empirical research to investigate the relationship between a code of ethics and sales force behavior. The findings present preliminary evidence that a well communicated code of ethics may be related to ethical sales force behavior. Furthermore, it appears that a sales force that is employed in such an environment can be profiled as being relatively high in job performance and (...) receiving equally high satisfaction from their positions. Suggestions are made for future research and recommendations are offered for marketing practitioners. (shrink)

In the United States, physicians are Increasingly functioning In the consultative role. This change in role Is undoubtedly a result of a surge in the numbers of specialists, the relative decreasing number of primary care physicians, and the emergence of tertiary care centers as primary treatment providers. This change In the style of practicing medicine has led to role confusion In attending physician-patient-consultant relationships.

Demystifying the key ideas of the world's greatest philosophers, and exploring all of the most important branches of thought, including philosophy of science, philosophy of religion, and feminist philosophy in a uniquely visual way, this resource is the perfect introduction to the subject.

Demystifies complex philosophical ideas and debates in a comprehensive format that introduces the major theories of such great philosophers as Socrates, Aristotle, Plato, Friedrich Nietzsche, Epicurus, and Thomas Aquinas.

Until the 1970s the history of sexuality was a marginalized practice. Today it is a flourishing field, increasingly integrated into the mainstream and producing innovative insights into the ways in which societies shape and are shaped by sexual values, norms, identities and desires. In this book, Jeffrey Weeks, one of the leading international scholars in the subject, sets out clearly and concisely how sexual history has developed, and its implications for our understanding of the ways we live today. The emergence (...) of a new wave of feminism and lesbian and gay activism in the 1970s transformed the subject, heavily influenced by new trends in social and cultural history, radical sociological insights and the impact of Michel Foucault’s work. The result was an increasing emphasis on the historical shaping of sexuality, and on the existence of many different sexual meanings and cultures on a global scale. With chapters on, amongst others, lesbian, gay and queer history, feminist sexual history, the mainstreaming of sexual history, and the globalization of sexual history, What is Sexual History? is an indispensable guide to these developments. (shrink)

The purpose of this study was to assess the presence of ethics committees in rural critical access hospitals across the United States. Several studies have investigated the presence of ethics committees in rural health care facilities. The limitation of these studies is in the definition of ‘rural hospital’ and a regional or state focus. These limitations have created large variations in the study findings. In this nation-wide study we used the criteria of a critical access hospital (CAH), as defined by (...) the Medicare Rural Hospital Flexibility Program (Flex Program, 2007), to bring consistency and clarity to the assessment of the presence of ethics committees in rural hospitals. The Flex Monitoring Team conducted a national telephone survey of 381 CAH administrators throughout the United States. The survey covered a wide variety of questions concerning hospitals’ community benefit, impact activities, and whether the hospital had a formally established an ethics committee. About 230 (60%) of the respondents indicated they had a formally established ethics committee or ethics consultation program at their CAH. The prevalence of ethics committees declined as the CAH location became increasingly rural along a rural–urban continuum. Unlike CAHs, all rural Department of Veterans Affairs Medical Centers have ethics committees. The results of this study provide an understanding of the limited presence of ethics committee in rural America and the need to consider new approaches for providing ethics assistance. A virtual ethics committee network may be the most efficient and effective way of providing rural hospitals access to a knowledgeable ethics committee or consultant. (shrink)

Female coital orgasm may be an adaptation for preferentially retaining the sperm of males with “good genes.” One indicator of good genes may be physical attractiveness. Accordingly, R. Thornhill, S. W. Gangestad, and R. Comer (1995) found that women mated to more attractive men reported an orgasm during a greater proportion of copulations than did women mated to less attractive men. The current research replicates this finding, with several design variations. We collected self-report data from 388 women residing in the (...) United States or in Germany. Results support the hypothesis that women mated to more attractive men are more likely to report an orgasm at the most recent copulation than are women mated to less attractive men, after statistically controlling for several key variables. Discussion addresses (a) the inability of the present research to specify the causal link between female orgasm and male attractiveness and (b) the proactive nature of female sexuality documented in recent research guided by an evolutionary perspective. (shrink)

According to Revonsuo, dreams are the output of a evolved “threat simulation mechanism.” The author marshals a diverse and comprehensive array of empirical and theoretical support for this hypothesis. We propose that the hypothesized threat simulation mechanism might be more domain-specific in design than the author implies. To illustrate, we discuss the possible sex-differentiated design of the hypothesized threat simulation mechanism. [Revonsuo].

'Sense perception in current process thought' was the topic of a workshop organized by the 'Whitehead Psychology Nexus' (for more information see below) at Fontareches in spring 2003. This and earlier Fontareches meetings can be characterized by just a few elements: non-dogmatism, interdisciplinarity and overlapping approaches. Although the convergence point is Whitehead's philosophy, this is intended in the sense of an 'eschaton' rather than a 'telos'. The vivid discussions, occurring in a very thoughtful, yet relaxed, atmosphere in the small village (...) of Fontareches in Southern France, have amply testified for the promising paths and synergies that can emerge in such an environment. This year, the core intention was to examine relations between Whitehead's theory of perception and contemporary psychology. The individual contributions can be sorted into the three areas of philosophy, cognitive science, and mental health/psychoanalysis. Unsurprisingly, the question of temporality was addressed -- explicitly or implicitly -- in most of the papers. (shrink)

The search for meaningful work has been of interest to researchers from a variety of disciplines for decades and seems to have grown even more recently. Much of the literature assumes that employees share a sense of what is meaningful in work and there isn’t much attention given to how and why meanings might differ. Researchers have not only called for more research studying demographic differences in definitions of meaning :77–90, 2014), but also more research utilizing mixed methods to study (...) psychological concepts like meaningful work Handbook of multimethod measurement in psychology, American Psychological Association, Washington, 2006). This study specifically examines differences across generational cohorts on their prioritization of sources of meaningful work through qualitative, in-depth interviews followed by a more generalizable, quantitative survey. Findings from the qualitative study show that generational cohorts define the meaning in their jobs differently, and they hold negative perceptions about the lack of desire for meaning in each of the other cohorts. Study 2 maps generational cohorts on the comprehensive model of meaningful work designed by Lips-Wiersma and Morris :491–511, 2009) to reveal that although there are some differences in prioritization of sources of meaningful work, all generational cohorts share similar desire to “develop and become themselves” when asked about their definitions of meaningful work. Implications and future research are discussed. (shrink)

This is the first book to offer a philosophical engagement with microaggressions. It aims to provide an intersectional analysis of microaggressions that cuts across multiple dimensions of oppression and marginalization, and to engage a variety of perspectives that have been sidelined within the discipline of philosophy. The volume gathers a diverse group of contributors: philosophers of color, philosophers with disabilities, philosophers of various nationalities and ethnicities, and philosophers of several gender identities. Their unique frames of analysis articulate both how the (...) concept of microaggressions can be used to clarify and sharpen our understanding of subtler aspects of oppression and how analysis, expansion, and reconceiving the notion of a microaggression can deepen and extend its explanatory power. The essays in the volume seek to defend microaggressions from common critiques and to explain their impact beyond the context of college students. Some of the guiding questions that this volume explores include, but are not limited to, the following: Can microaggressions be established as a viable scientific concept? What roles do microaggressions play in other oppressive phenomena like transphobia, fat phobia, and abelism? How can epistemological challenges around microaggressions be addressed via feminist theory, critical race theory, disability theory, or epistemologies of ignorance? What insights can be gleaned from intersectional analyses of microaggressions? Are there domain-specific analyses of microaggressions that would give insight to features of that domain, i.e. microaggressions related to sexuality, athletics, immigration status, national origin, body type, or ability. Microaggressions and Philosophyfeatures cutting-edge research on an important topic that will appeal to a wide range of students and scholars across disciplines. It includes perspectives from philosophy of psychology, empirically informed philosophy, feminist philosophy, critical race theory, disability theory, philosophy of language, philosophy of science, and social and political philosophy. (shrink)

The authors argue that the consciousness debate inhabits the same problem space today as it did in the 17th century. They attribute the lack of progress to a mindset still polarized by Descartes’ real distinction between mind and body, resulting in a standoff between humanistic and scientistic approaches. They suggest that consciousness can be adequately studied only by a multiplicity of disciplines so that the paramount problem is how to integrate diverse disciplinary perspectives into a coherent metatheory. Process philosophy is (...) well qualified to attempt such a synthesis. The rationale for the volume is summed up in the book's unifying thesis: normal, focal-attentive consciousness is not the sui generis phenomenon it is usually taken to be, but part of a wider spectrum of experience (including marginal, deviant, and non-human experience) that can only be studied by approaches as diverse as phenomenology, psycho- and neuropathology, biology, and zoology. (shrink)

Whitehead claims there is only one type of individual in the universe—the actual entity—but there are necessarily multiple tokens of this type. This turns out to be paradoxical. Nevertheless, a type of individuality that is necessarily plural because, for each token, relations to other tokens are constitutive is something familiar from ordinary language, everyday politics, and, not least, 19th century German social thought. Whitehead’s actual entity generalizes the notion of species-being we find in Fichte, Feuerbach, and Marx. The rationale for (...) the concept of species-being brings to light important social and political implications of Whitehead’s cosmology. (shrink)

At the time of his death in May of 2012, Ralph Pred was working on a critical social theory inspired by process philosophy. In the book manuscript he left unfinished, Syntax and Solidarity, he develops a “radically empirical” sociology that enables him to identify and critically evaluate the different forms that social solidarity has taken in the history of civilization. The purpose of this paper is to draw attention to the importance of his unfinished project. The executors of Pred’s literary (...) estate would be happy to see his project, with due acknowledgment, publicized and continued. Keywords: Active Voice Bias, Concrescence, Middle Voice, Sociogeny, Solidarity, Substance. (shrink)

What remains as an ongoing project, Weeks contends, is creating a theory of the constitution of subjects to account for the processes of social construction. This book presents one such account.

The doctrine of idols is one of the most famous aspects of Bacon's thought. Yet his claim that the idols lead to madness has gone almost entirely unnoticed. This paper argues that Bacon's theory of idols underlies his diagnosis of the contemporary condition as one of ‘universal madness’. In contrast to interpretations that locate his doctrine of error and recovery within the biblical narrative of the Fall, the present analysis focuses on the material and cultural sources of the mind's tendency (...) towards error. It explains the idols in terms of Bacon's materialist psychology and his exposé of the debilitating effects of language and traditional learning. In so doing, it highlights the truly radical nature of the idols. For Bacon, the first step towards sanity was to alert people to the prevailing madness. The doctrine of idols was intended as a wake-up call, preparing the way for a remedy in the form of his new method of inquiry. The paper concludes by indicating how Bacon's method aimed to treat ‘universal madness’, and it suggests that his diagnosis influenced John Locke. (shrink)

The `sexual citizen' is a new phenomenon in the erotic world, and a new player in the political and cultural arena, a product of the new primacy of sexual subjectivity in contemporary societies. Living at the fateful juncture of private claims to space, self-determination and pleasure, and public claims to rights, justice and recognition, the sexual citizen is a hybrid being, who tells us a great deal about the pace and scale of cultural transformation and new possibilities of the self (...) and identity. Consideration of the sexual citizen also offers a new angle on recent debates about citizenship in all its complex dimensions, bringing to the fore issues that have often been occluded in these debates. The article explores these issues through the prism of three significant social developments: the democratization of relationships; the emergence of new subjectivities; and the proliferation of new `stories' about the body, the erotic and intimate life which both signal and encourage the growth of social and cultural capital, and in turn lead to new demands on the institutions of political life. (shrink)

This paper looks at the history of the problem of individuation from Plato to Whitehead. Part I takes as its point of departure Reiner Wiehl’s interpretation of the different meanings of “abstract” in the metaphysics of Alfred North Whitehead and arrives at a corresponding taxonomy of different ways things can be called concrete. Part II compares the way philosophers in different periods understand the relation between thought and intuition. The view mostly associated with ancient philosophy is that thought and sense-perception (...) target different kinds of objects. The view mostly associated with modern philosophy (although it was introduced by the Stoics) is that thought and sense-perception are different ways of targeting the same objects. These differences have specific consequences for theories of individuation, which are assessed historically in Part III and then applied to Whitehead’s difficult texts in part IV. (shrink)

There have been many attempts to retire dualism from active philosophic life, replacing it with something less removed from science, but we are no closer to that goal now than fifty years ago. I propose breaking the stalemate by considering marginal perspectives that may help identify unrecognized assumptions that limit the mainstream debate. Comparison with Whitehead highlights ways that opponents of dualism continue to uphold the Cartesian “real distinction” between mind and body. Whitehead, by contrast, insists on a conceptual distinction: (...) there can no more be body without mind than mind without body (at least at the level of ultimate constituents). Key to this integration is Whitehead’s understanding that mind, at its most rudimentary, is simply the intrinsic temporality of a physical event. Thus, the resulting form of “panpsychism” is more naturalistic than commonly supposed, and it solves both the composition problem (traditionally fatal to panpsychism) and the “hard problem.”. (shrink)

A popular “Reductionist” account of personal identity unifies person stages into persons in virtue of their psychological continuity with one another. One objection to psychological continuity accounts is that there is more to our personal identity than just mere psychological continuity: there is also an active process of self-interpretation and self-creation. This criticism can be used to motivate a rival account of personal identity that appeals to the notion of a narrative. To the extent that they comment upon the issue, (...) proponents of narrative accounts typically reject Reductionist metaphysics that (ontologically) reduce persons to aggregates of person stages. In contrast to this trend, we seek to develop a narrative account of personal identity from within Reductionist metaphysics: we think person stages are unified into persons in virtue of their narrative continuity with one another. We argue that this Reductionist version of the narrative account avoids some serious problems facing non-Reductionist versions of the narrative account. (shrink)

This article provides a broad survey of issues facing rural communities and suggests that medicalization of poverty concepts and interventions need to be tailored to those populations. Rural poverty may be both broader and deeper than in urban areas. Those challenges seem to produce a constellation of health conditions, as rural residents struggle with unemployment and lack of opportunities. Relatedly, rural communities struggle to maintain financially viable hospitals and specialty providers. The article closes by offering a snapshot of rural-specific strategies (...) to address these issues. (shrink)

Although Whitehead’s particular style of philosophizing--looking at traditional philosophical problems in light of recent scientific advances--was part of a trend that began with the scientific revolutions in the early 20th century and continues today, he was marginalized in 20th century philosophy because of his outspoken defense of what he was doing as “metaphysics.” Metaphysics, for Whitehead, is a cross-disciplinary hermeneutic responsible for coherently integrating the perspectives of the special sciences with one another and with everyday experience. The program of such (...) a meta-discipline is challenging to philosophical orthodoxy because it enlarges, rather than narrows, the range of empirical evidence that philosophy must acknowledge. This places Whitehead’s philosophy in a perennial tradition that seeks to resolve fundamental antinomies through synthesis and reconciliation rather than reduction or elimination. (shrink)

Terms for consciousness, used with a cognitive meaning, emerged as count nouns in the 17th century. This transformation repeats an evolution that had taken place in late antiquity, when related vocabulary, used in the sense of conscience, went from being mass nouns designating states to count nouns designating faculties possessed by every individual. The reified concept of consciousness resulted from the rejection of the Scholastic-Aristotelian theory of mind according to which the mind is not a countable thing, but a pure (...) potentiality. This rejection was motivated by an acute sense of the mind’s fallible subjectivity. While conditioned by recent historical events, the 17th century’s pervasive sense of subjectivity also reveals a heavy debt to Hellenistic philosophy, which had been recently rediscovered. But whereas Hellenistic thought, mistrustful of theoria, only reifies conscience, early modern thinking, more mistrustful of praxis and seeking its grounding in theoria, goes a step further and reifies consciousness. Partly modeled on theological ideas, the resulting concept of consciousness is plagued by paradoxes that have becomes notorious for their intractability. But essentially the same model of consciousness underwrites contemporary theory, embroiling contemporary debates in the same controversies that dominated the 17th century. Sidestepping these difficulties by returning to the Scholastic-Aristotelian theory of mind would be a tall order, but it is not impossible. Alfred North Whitehead's theory of consciousness offers an example. His novel theory of time enables Whitehead to rehabilitate the Aristotelian concept of passive mind in a wholly naturalistic way. (shrink)

Given that Deleuze and Guattari came to prominence after May 1968, many readers attempt to determine the political significance of their work. The difficulty that some encounter finding its political implications contrasts with Deleuze and Guattari's commitment to radical causes. In response, Patton and Thoburn elaborate on the Marxist elements in the pair's oeuvre, a line of analysis I continue. Focusing on A Thousand Plateaus, I discuss their references to the theorisation of the ‘dependency theorists’, a group of Marxist-inspired scholars (...) who became influential during the 1960s. Does their engagement with dependency theory provide the basis for a political project? (shrink)

Analyses of between-sex differences have provided a powerful starting point for evolutionarily informed work on human sexuality. This early work set the stage for an evolutionary analysis of within-sex differences in human sexuality. A comprehensive theory of human sexual strategies must address both between-sex differences and within-sex differences in evolved psychology and manifest behavior.

Young men are more distressed by a partner’s sexual infidelity, whereas young women are more distressed by a partner’s emotional infidelity. The present research investigated (a) whether the sex difference in jealousy replicates in an older sample, and (b) whether younger people differ from older people in their selection of the more distressing infidelity scenario. We presented forced-choice dilemmas to 202 older people (mean age = 67 years) and to 234 younger people (mean age = 20 years). The sex difference (...) replicated in the older sample. In addition, older women were less likely than younger women to select a partner’s emotional infidelity as more distressing than a partner’s sexual infidelity. Discussion offers directions for future work on sex differences and age differences in jealousy. (shrink)

A Research Guide to the Ancient World: Print and Electronic Sources is a partially annotated bibliography that covers the study of the ancient world, and closes the traditional subject gap between the humanities and the social sciences in this area of study. This book is the only bibliographic resource available for such holistic coverage.

Those familiar with the contributions of Robert Brenner to understanding of the historical development of capitalism, and his devastating critique of the ‘regulation school’ must, like myself, have felt a sense of anticipation as they began his recent volume on global capitalism since the end of World War Two. While the editor's introduction was pretentious to the point of embarrassment, this unfortunate excursion into naive idolatry should not be attributed to the author himself. However, even those most supportive of Brenner's (...) previous work, could not help but be disappointed by the contents of ‘;Global Turbulence’. (shrink)

This study of Ralph Pred’s Onflow (MIT Press, 2005) expands on Pred’s arguments and raises doubts about the viability of phenomenology. Showing that Pred’s method is indeed phenomenological, I validate his interpretations of William James as phenomenologist and his critique of John Searle in light of James, which documents the extent to which the role of habit in the constitution of experience is neglected by philosophers. In explaining habit, however, Pred himself reverts to non-phenomenological models drawn from James’ postulate of (...) psycho-physical parallelism. Habit, like causation, poses an unmet challenge to phenomenological methods. In his critique of Gerald Edelman, Pred notes that Edelman falls prey to a metaphysical bias inherent in modern Indo-European languages. But Pred’s acuity in exposing a latent linguistic bias in phenomenological data is a two-edged sword. Revealing an invisible dependence of appearance on language, it casts doubt on the project of getting beyond language to "appearances-in-themselves.". (shrink)

ResumoEste artigo aborda o nascimento do movimento de prostitutas no Brasil partindo de uma análise da Pastoral da Mulher Marginalizada, uma iniciativa da Igreja Católica que realizou um trabalho assistencialista e de conscientização política com mulheres prostitutas no Brasil a partir da década de 1970. Minha pesquisa examina as tensões entre as participantes e os agentes da Pastoral que deram origem a um movimento autônomo de profissionais do sexo em meados da década de 1980. Eu argumento que a Rede Brasileira (...) de Prostitutas (RBP) foi influenciada não só pelo clima político da democratização, mas também pelo discurso de autoestima e do valor intrínseco do indivíduo pregado pela Pastoral. Finalmente, eu considero o Primeiro Encontro Nacional de Prostitutas, realizado em 1987, destacando como a RBP acabou rejeitando o tropo da prostituta-como-vítima e as crenças abolicionistas do ramo progressista da Igreja.Palavras-chave: Prostituição. Igreja Católica. Movimentos sociais. Abertura política. AbstractThis article examines the birth of the Brazilian sex-worker movement by foregrounding an analysis of the Pastoral da Mulher Marginalizada, a ministry of the Catholic Church that conducted outreach and political consciousness-raising among prostitutes in Brazil starting in the 1970s. My research explores the tensions between ministry participants and agents that eventually led to the founding of an autonomous movement of sex workers in the mid-1980s. I argue that the Rede Brasileira de Prostitutas (RBP) was influenced not only by the political climate of Brazil’s democratization process, but also by the discourse of self-esteem and the intrinsic value of the individual espoused by the Pastoral. Finally, I consider the Primeiro Encontro Nacional de Prostitutas, held in 1987, highlighting how the RBP came to the trope of the prostitute-as-victim and the abolitionist beliefs of the progressive branch of the Catholic Church.Keywords: Prostitution. Catholic Church. Social Movements. Political opening. (shrink)

Women who are abused by their male intimate partners incur many costs, ranging in severity from fleeting physical pain to death. Previous research has linked the presence of children sired by a woman’s previous partner to increased risk of woman abuse and to increased risk of femicide. The current research extends this work by securing data from samples of 111 unabused women, 111 less severely abused women, 128 more severely abused women, and 26 victims of intimate partner femicide from the (...) Chicago Women’s Health Risk Study to document an ordinal trend in the risk of experiencing more severe forms of violence for women who have children in the household sired by a previous partner. The discussion addresses two potential explanations for this trend and highlights directions for future research. (shrink)

This essay focuses on the manifesto as a utopian genre. Some argue that the manifesto is passé: paradigmatically modernist, unrepentantly masculinist, and thoroughly authoritarian. They see the form as tethered by its foundational text, the Communist Manifesto, to a pre-Fordist political-economic formation and historical subject that are now irrelevant to the conditions of post-Fordist production. According to its critics, the genre is too closely identified with such politically and epistemologically suspect commitments as the vanguard, the party, truth, and the political (...) efficacy of ideology critique. Thus, so the story goes, the Manifesto helped to sow the seeds—in the form of an orthodox Marxism—of its own .. (shrink)

Nicholas Rescher’s way of understanding process philosophy reflects the ambitions of his own philosophical project and commits him to a conceptually ideal interpretation of process. Process becomes a transcendental idea of reflection that can always be predicated of our knowledge of the world and of the world qua known, but not necessarily of reality an sich. Rescher’s own taxonomy of process thinking implies that it has other variants. While Rescher’s approach to process philosophy makes it intelligible and appealing to mainstream (...) analytic philosophy, it leaves behind the more daring ideas of Bergson, James, and Whitehead, all of whom envisioned the primordial reality of process in a radical ontology of becoming. This variant of process thought can be construed as coherent and self-consistent, but not without relinquishing the correspondence theory of truth and embracing challenging ideas that bring us in close proximity to existentialism, apophatic theology, and Buddhism. (shrink)

Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more diverse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a risk management framework which requires (...) researchers to: • Understand the context - as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks - identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks - deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks - decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk - evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult - use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem - get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems. (shrink)