In consequential domains, it is often impossible to compel individuals to take treatment, so that optimal policy rules are merely suggestions in the presence of human non-adherence to treatment recommendations. In these same domains, there may be heterogeneity both in who responds in taking-up treatment, and heterogeneity in treatment efficacy. For example, in social services, a persistent puzzle is the gap in take-up of beneficial services among those who may benefit from them the most. When in addition the decision-maker has distributional preferences over both access and average outcomes, the optimal decision rule changes. We study identification, doubly-robust estimation, and robust estimation under potential violations of positivity. We consider fairness constraints such as demographic parity in treatment take-up, and other constraints, via constrained optimization. Our framework can be extended to handle algorithmic recommendations under an often-reasonable covariate-conditional exclusion restriction, using our robustness checks for lack of positivity in the recommendation. We develop a two-stage, online learning-based algorithm for solving over parametrized policy classes under general constraints to obtain variance-sensitive regret bounds. We assess improved recommendation rules in a stylized case study of optimizing recommendation of supervised release in the PSA-DMF pretrial risk-assessment tool while reducing surveillance disparities.