We recently read Dr. Mark Earnest’s poignant piece, Tethered, published in the New England Journal of Medicine (1), which we found both touching and unsettling. The case of Jack—a young man struggling with alcohol use disorder while caring for his ailing mother — reveals not only the tragic intersection of personal suffering and social abandonment, but also the limitations of our current clinical frameworks. Dr. Earnest captures the impossible bind Jack faces, presenting it as a choice between personal progress and familial duty, between self-preservation and care for others—a story of failure when sacrifice is chosen. The narrative is haunting and painfully familiar to those of us working in mental health. However, we would suggest that this framing may present a false dichotomy. While Jack’s situation is undeniably a dilemma, other solutions—more humane and systemic—do exist.