But would a pluralistic and piecemeal approach to governing the enhancement uses of medical technologies serve the broader needs of distributive justice with respect to enhancement interventions that are deemed acceptable in particular settings? As the enhanced use their improved capacities to gain power, wealth and status, justice might require that access to those enhancements be afforded more broadly, at least for those willing to bear the corresponding deficits (Sparrow 2016). Some authors have argued that a fair system of allocating enhancement opportunities will require a centralized, global agency akin to the World Trade Organization or the International Monetary Fund, capable of adjudicating all the interests involved (Buchanan 2011). But the assumption behind such proposals remains that “enhancements” will always give people fungible advantages over others, like wealth does. It remains to be seen how true this is.