This chapter is about ethical decision-making in end-of-life care for older adults, contrasting typical “single-rule” approaches with comprehensive cost-benefit analysis. It discusses key ethical concepts like substituted judgment, the best interest standard, advance directives, daily decision-making, and the durability of preferences. The authors explore the merits of an individualized (i.e., person-centered) approach that prioritizes quality of life, using tools like risk-benefit tables to navigate complex choices and prevent communication breakdowns between families and care teams.