Our chapter explores the ethical and systemic challenges faced by healthcare staff when caring for an adolescent patient boarding in the emergency room (ER). We use the case of Samantha, an indigenous adolescent, brought to the ER after trying to elope from her youth treatment center. Samantha’s prolonged stay in the ER highlights significant gaps in healthcare; society’s struggle to address the needs of vulnerable populations; and the healthcare staff’s efforts to fulfill the duties of beneficence, nonmaleficence, and justice. Samantha’s case underscores the need for improved clinical and institutional processes and support systems. We advocate for better access to ethics support, enhanced community resources, and a more inclusive approach to care that considers the unique needs of marginalized individuals. Our case also reflects on the emotional and moral toll experienced by healthcare providers, exacerbated by systemic injustice and an unclear pathway to access our ethics committee at the time. We hope this case provides insights for healthcare systems to develop comprehensive strategies to support adolescents boarding in the ER ensuring their dignity.