Although Burns and Truog1 acknowledge that “even impeccable efforts at negotiation may sometimes fail,” they nonetheless point to mediation as the last, best hope of the medical community in dealing with the most difficult of surrogate requests for nonbeneficial treatment. Their romantic embrace of mediation is, perhaps, unsurprising. Mediation has been touted in many quarters as the magic band-aid that is ideally constituted to solve the most confounding conflicts of bioethics. But, if by mediation we mean a process in which both sides work to find a creative solution that differs in some way from their initial starting points, then that is not happening in a significant and expanding subset of cases. Rather, in this subset of intractable futility cases, disputant bargaining invariably leads to a predictable outcome. Providers accede to the surrogates' adversarial positioning, and the patient receives the demanded treatment.