The elderly are most often the focus of ethical dilemmas, not only because of the increased frequency of illness, but also because of the reality that death is an impending inevitability. Of all the health care professionals, it is the primary care physician who is best situated to assist the elderly patient in exercising his or her own autonomy in matters concerning health care decisions. Both intrinsic factors, such as the presence of dementia and delerium associated with acute illness, and extrinsic factors, including the family's wishes, the settings of care, and financial consideration, may influence decision making. Limited diagnostic and therapeutic interventions should be addressed as separate entities in the development of the patient care plan.