The case of Ms. Sykes demonstrates some of the ethical challenges that arise in determining whether a patient should be eligible for an advanced therapy, specifically a ventricular assist device (VAD). Ms. Sykes was in advanced heart failure and denied the VAD by the eligibility committee. The denial was out of concern that she lacked the requisite social support at home, as she had told the team her husband was medically abusive and neglectful. While some members of the team did not believe her reports, others were concerned she was being "doubly victimized" by the husband and then by not receiving the only advanced therapy available to her. Ethics was called to assist the team based on this tension. The haunting aspects of the case are relayed by a clinical ethicist who was early in her career and a senior clinical ethicist who was acting as her mentor at the time. The fairness of the eligibility decision, as well as the appropriate role boundaries of clinical ethicists, are central to what they find haunting.