Insufficient supply prevents many Americans from receiving health care services they might benefit from. Sometimes, as in the case of transplantable organs, both the processes and outcomes of allocating limited resources are highly visible. In other contexts, allocation proceeds more opaquely, as when physicians discharge patients from intensive care units to open beds for other patients (1). The ethics of both rule-based and “bedside” rationing hinge on how well each process promotes fairness, maximizes benefit, and gives priority to patients who are the worst off. Unfortunately, inevitable tensions arise when trying to balance equity, efficiency, and priority. Consequently, some people will feel mistreated.