This chapter presents a complex case of clinical ethics consultation involving a patient with end-stage renal disease, frailty, and severe dementia. It explores the ethical challenges faced by the healthcare team, particularly regarding the designation of dialysis as a "nonbeneficial" intervention. The narrative focuses on the tension between medical decision-making, rooted in evidence-based practice, and the values and spiritual beliefs of the patient and her family, especially in light of systemic inequities. By examining the patient’s historical context, including implicit racial bias and structural barriers, the chapter highlights the need for ethics consultations to acknowledge these factors when navigating difficult medical decisions. The case ultimately illustrates the limitations of standard ethical frameworks in addressing the long-standing harms experienced by some patients and calls for a more nuanced approach that incorporates systemic injustices into ethical deliberations.