The text that Gerard de Vries offers us here is made up of three strands. First, on a general level, he introduces us to pragmatism "writ large", as he puts it, in an eloquent and critical way. This strand is taken up further on in the chapter with a plea for more competitiveness in pragmatist approaches of ethical issues. My impression is that De Vries is, until further notice, not impressed by the philosophical and ethical performances of pragmatism "writ small". For the second strand, which is an attempt to show what he means by competitive pragmatism, he refers us to Michel Foucault's analysis of epistemic and moral discourses as sets of power relations. He welcomes his approach because it puts in perspective the established normative frameworks that are used in mainstream ethics, and because it helps us to deal with new problems more adequately. This strand is then linked to the third one, the debate on the ethics of predictive medicine. This debate is used as an illustration of the complex, new issues that philosophy and ethics are asked to address in late modem or "risk" society. This strand is announced in the second section with a description of mainstream medical ethics, elaborated in the middle part with an explanation of Foucault's Birth of the Clinic, which is used as inspiration for and background to the treatment of ethical issues in predictive medicine, that take up the last part of the chapter.