I discuss the trilemma that consists of the following three principles being inconsistent: 1. The Common Principle: if one distribution, A, necessarily brings a higher total sum of personal value that is distributed in a more egalitarian way than another distribution, B, A is more valuable than B. 2. (Weak) ex-ante Pareto: if one uncertain distribution, A, is more valuable than another uncertain distribution, B, for each patient, A is more valuable than B. 3. Pluralism about attitudes to risk (Pluralism): (...) the personal value of a prospect is a weighted sum of the values of the prospect’s outcomes, but the weight each outcome gets might be different from the probability the prospect assigns to the outcome. (shrink)