In recent years, a number of powerful arguments have been given for thinking that there should be suprastate institutions, and that the current ones, such as the World Trade Organization (WTO), International Monetary Fund (IMF), World Bank, and United Nations Security Council, need to be radically reformed and new ones created. Two distinct kinds of argument have been advanced. One is instrumental and emphasizes the need for effective suprastate political institutions to realize some important substantive ideals (such as preventing dangerous climate change, eradicating poverty, promoting fair trade, and securing peace). The second is procedural and emphasizes the importance of political institutions that include all those subject to their power in as democratic a process as possible, and builds on this to call for democratically accountable international institutions. In this chapter, the author argues that the two approaches need not conflict, and that they can in fact lend support to each other.