 Francis Kamm has relied almost exclusively on individual head-to-head examples such as these to explore intuitions about the ethical significance of disability in allocation decisions (Kamm 1993, 2004, 2009a and b). Although her examples are vivid and the discussions often ethically illuminating, at the end of the day, one is left with the sense that relying on our intuitions about these scenarios (and their infinite variations) is a troublingly and indeterminate exercise. The unrealistic simplicity of the cases might create skepticism about how the debate has been framed. Surely, no health care decision, at the individual level, would ever be this stark and devoid of uncertainties. We are never completely sure whether our treatments will improve functioning, even save lives, or whether unintended side effects will end up making the outcome worse. In addition, measuring benefit in terms of QALYs is not an exact science, and the measurement of cost is extremely difficult, especially if, in addition to the direct costs from the provision of the resource, we add indirect costs and opportunity costs. Although the method of testing our intuitions on artificial scenarios, making increasingly nuanced changes in the case to highlight salient considerations, is philosophical illuminating, it may arguably be somewhat artificial.