How do I make high-stakes decisions when being wrong costs lives?

You decide under a fog you can never fully clear, and the cost of being wrong is measured in lives. Certainty is not available to you, and yet you must still choose. That is a genuinely hard place to stand, and the fact that it weighs on you is what makes you someone who should be standing there. Here is what to hold onto: you will be judged, rightly, on whether you decided well, not on whether the outcome was perfect. With incomplete information, even a sound decision can turn out badly, and a reckless one can get lucky. Your job is not to be right every time, which is impossible. It is to gather what you honestly can, weigh it with care, and choose like someone who knows what is at stake. When the uncertainty threatens to freeze you, separate what you can know from what you cannot. Do everything possible to reduce the fog, then accept the fog that remains and decide anyway. Afterward, review honestly: was the process sound? If it was, you did your duty, whatever the outcome. That is the most any person in your place can carry.