This article argues that The Scarlet Letter (1850) offers a unique insight into American secularism’s inherent pragmatism—a pragmatism that attempts to provide a resolution for the healing arts’ struggle to be knowledgeable and moral at the same time. A “pragmatic secularism” continues to inform a particular brand of modern biomedicine, which can be seen in Atul Gawande’s medical reform text The Checklist Manifesto: How to Get Things Right (2009). Simply put, the pragmatic secularism found in these two very different books is a system of ascertaining right from wrong that relies on nothing more than someone’s work proving effective within the larger community. This article elaborates how these texts have a shared project in which a significant formation of the secular arises from situations that privilege practical applications—especially when urgent circumstances dictate immediate action as the only viable option. Inflected by the concerns of their respective historical moments, Hawthorne’s novel foregrounds the transformation of fringe knowledge into mainstream doing, whereas Gawande’s manifesto focuses on the limits of any kind of knowledge, privileging instead work as an end unto itself. However, the “power to do” exemplified by The Scarlet Letter as the core of the pragmatic secularist’s vocation finds its modern expression in The Checklist Manifesto’s fetishizing of medical work in a deliberate move to ideologically dismantle the pervasive epistemic fetishism undergirding health research and praxis.