 The philosophical debate on health resource prioritization has been somewhat muted in recent years. A fragile truce has been reached in which it is admitted that we cannot accept either a purely utilitarian CEA approach unalloyed with considerations of fairness, or a purely egalitarian lottery approach unaffected by intuitions concerning the significance of ineffective use of valuable resources. In part this is because of an intractable dilemma that dominates the rationing debate, which we will describe more specifically for the case of disability in the next section. We seem to be stuck between two extremes: allocate in terms of a “neutral” consideration such as “first come first serve” or pure lottery, or open the door to an unlimited number of potentially ethically relevant considerations that, together, make the allocation decision overwhelming difficult and cumbersome. The first option seems irrational, the second impractical.