Uncertainty tolerance in healthcare: towards a normative conception

Abstract

This paper critically analyzes the meaning of uncertainty tolerance (UT), a phenomenon of growing interest in healthcare. Medical practitioners, educators, and researchers have increasingly acknowledged the importance of UT for both clinicians and patients, and called for greater attention to improving it. However, we argue that the prevailing conception of UT is an inadequate normative ideal, due to its narrow understanding of uncertainty as exclusively an aversive state entailing negative outcomes, and of tolerance as merely the endurance of these outcomes. We show how this endurance-based, outcomes-focused conception of UT is both theoretically incoherent and practically unhelpful. We make the case for an alternative conception based not on endurance but adaptation, and focused not on outcomes but moral virtues, which we view as instrumental capacities that enable adaptation. We develop a provisional integrative taxonomy of these key virtues, discuss both the promises and challenges of this new adaptation-based, virtue-focused conception of UT, and identify fruitful directions for future work.