This chapter considers why social contract accounts may seem particularly ill-suited to address justice for all persons with impairments or illnesses. Two variants of social contract theory are discussed: contractarianism and contractualism. It is argued that while contractarian theories may be able to address certain basic needs and interests of persons with impairments or illnesses, such theories are, nonetheless, unacceptable if one holds that (nearly all) human beings are owed justice because of their own value or intrinsic worth. Although Rawls did not address justice for those with impairments in his theory in any detail, it is argued that contractualists can develop quite inclusive theories. Two strategies for developing an inclusive contractualism are discussed, both of which focus on a capacity for cooperative contribution possessed by nearly all human beings and in which we can understand the intrinsic value of persons as inhering.