Complications: A Surgeon's Notes on an Imperfect Science

by Atul Gawande

In a 1976 essay, the philosophers Samuel Gorovitz and Alasdair MacIntyre explored the nature of fallibility. Why would a meteorologist, say, fail to correctly predict where a hurricane was going to make landfall? They saw three possible reasons. One was ignorance: perhaps science affords only a limited understanding of how hurricanes behave. A second reason was ineptitude: the knowledge is available, but the weatherman fails to apply it correctly. Both of these are surmountable sources of error. We believe that science will overcome ignorance, and that training and technology will overcome ineptitude. The third possible cause of error the philosophers posited, however, was an insurmountable kind, one they termed “necessary fallibility.”