This chapter describes general principles in ethical decision-making, as well as the patient’s critical role in making decisions that are both medically and morally sound. When the patient no longer has capacity to participate in decision-making, various approaches to advance directives can be implemented. A morally appropriate and legally empowered surrogate decision-maker can be appointed; other advance directives could include DNR orders, a living will, or a durable power of attorney for health care. These may inform the discussion of the goals of care for an individual patient, leading to ethically acceptable actions for the patient, family, and medical team. These principles are then applied and discussed in specific cases: disclosing a diagnosis of dementia, substituted judgment and medical futility, and the provision of nutrition and hydration.