Metastatic cancer and costly precision medicines generate extremely complex problems of health care justice that previous theories of justice cannot address adequately. Fleck argues that what we need is a political conception of health care justice, following Rawls, and a fair and inclusive process of rational democratic deliberation governed by public reason.

While ideally just outcomes are a moral and political impossibility, "wicked" ethical problems can metastasize if rationing decisions are made in ways effectively hidden from those affected by those decisions. As Fleck demonstrates, a fair and inclusive process of democratic deliberation makes these "wicked" problems visible to public reason.