An NHS suggestion of delaying treatment for smokers and the overweight causes Dalrymple to comment on the impossibility – and the undesirability – of perfect justice:

That ethical decisions sometimes cannot be made that are indisputably correct, that entail no injustice or no inhumanity, is difficult for rationalists and utilitarians to accept. They want every division to be without remainder, as it were. They want a formula that will decide every question beyond reasonable doubt. They want a universal measure of suffering, so that the precise worth (in units of suffering averted) of every medical procedure can be known and compared…

There is a kind of cognitive hubris at play, according to which information alone will resolve all our dilemmas; and if our dilemmas have not been answered, it is only because we do not have enough information yet. The hope or expectation of a dilemma-free world is naïve, where it is not power-hungry.