 Consider an example from Gideon Rosen (2004) in which a surgeon orders her patient to be transfused with the wrong type of blood, and suppose that the surgeon was unaware that she was making this mistake. According to Rosen, the surgeon will be blameworthy for harming her patient only if she is blameworthy for being ignorant about the patient’s blood type when she requests the transfusion, and she will be blameworthy for this only if her ignorance stems from some instance in which the surgeon knowingly failed to do something that she ought to have done to avoid her later ignorance. It won’t, for example, be enough that the surgeon’s ignorance is explained by her failure to doublecheck the patient’s medical records. In order to ground blame, this omission on the surgeon’s part must itself have been culpable, which requires that the surgeon knew that this omission was wrong. And if the surgeon wasn’t aware that she was committing a wrongful omission (when she failed to doublecheck her patient’s medical records), then this failure of knowledge on the surgeon’s part must be explained by some prior culpable—that is, knowing—act or omission. In the end, for Rosen, 