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A heart operation can put a very ill patient on the road to a long and healthy life, or it can kill the patient. Major surgery is just one of many instances when treatment can result in a failure more serious than the consequences of doing nothing. The balance of risk requires a responsible attitude from all the many parties to an operation: the patient, the general practitioner, the specialist physician, the surgeon, theatre nurses, and the anaesthetist; supervisors, such as the chief medical officer and chief executive of the hospital; and the funders of the operation.

This article considers the advantages of having an authoritative estimate of the current failure rate for an operation and reflects on the problems that have arisen where there was a lack of interest in doing this.