 Suppose we are asked to decide between a person in a wheelchair and someone without a severe disability. If the issue is framed crudely in term of “lives worth living” and we decide on stereotypical and ungrounded assumptions about the abject misery of living in a wheelchair, ex ante, then a case could be made that our decision to favor the person without a disability was irrational, unfair, and discriminatory. By contrast, suppose we cast the situation as one in which unavoidable scarcity necessitates a choice that, however it goes, will be regrettable and unfortunate (sometimes called a “tragic choice”: see Calabresi &amp; Bobbitt 1978 and Nussbaum 2000). So framed, we might seem far more ethically justified in appealing to disability, or indeed any other real difference between the two individuals that is, at least in principle, relevant to our judgment. Disability, as we have seen, is an a priori relevant consideration to health care allocation. We might argue that, after all, we have no option but to choose someone (choosing no one would be both wasteful and unfair to both). Against this it might be argued that fairness in such a circumstance can only be achieved by a purely random choice. 