 In the 1990s philosophers, in particular bioethicists, debated the broad question of the justice of health care resource allocation, and in particular the ethical pros and cons of the dominant rationing strategy based on cost effectiveness analysis (CEA) with benefit characterized in terms of “quality of life”. A dominant theme in this literature was whether a pre-existing health state, or resulting health outcome, should be taken into account when allocating health resources. More specifically, the debate centered on whether a person’s disability should be taken into account, or whether doing so would be discriminatory or unfair. As Dan Brock explained it, this concern was raised because of the confluence of two events—the then recent (1990) passage of the Americans with Disabilities Act (ADA), prohibiting discrimination on the basis of disability, and the 1992 Oregon Medicaid proposal for rationing services, which used both CEA and a quality of life outcome measure to prioritize treatments for persons with specific health conditions and which arguably systematically disadvantaged people with pre-existing disabilities (Brock 1995, 1999, 2004).