A counterfactual is a statement about what would have happened to an outcome if a cause had been different, representing the third and highest level of reasoning on Judea Pearl's ladder of causation. Unlike statistical associations or interventions, counterfactuals answer retrospective 'what if' questions, such as 'Would this patient have survived if they had not received the drug?' They require a complete structural causal model (SCM) to compute, as they involve reasoning about the same individual in two mutually exclusive states: the observed factual world and an unobserved hypothetical world.
