Is it ethically justifiable to honor a patient’s request for ongoing blood transfusions for an incurable, relapsed leukemia, particularly in the context of scarcity? Our patient was a thirty-two-year-old Black man who had been hospitalized for six months. Despite daily blood and platelet transfusions, he remained too frail for cancer-directed therapy or discharge home. The clinical team considered ongoing transfusions to be a futile endeavor, especially given their state’s acute shortages of blood products. For the patient however, these transfusions were anything but futile: they were a form of life support, akin to hemodialysis, that allowed him to spend as much time as possible with his young family.

While this case initially appeared relatively straightforward using a utilitarian approach, the consultants have been haunted by our eschewing of alternative viewpoints, particularly in the context of the patient’s race and socioeconomic status. Should we have set aside our “usual commitments to professional polish and position” in favor of a more robust appreciation of the ethical, social, cultural, and economic dimensions of this case? By ignoring or downplaying important social considerations and our patient’s unique attributes, we actually may have tipped the balance towards less fairness and equity.