Ethical aspects of care of geriatric patients with orthopaedic disorders include patient autonomy, beneficence, and nonmalefecince. Advance directives and surrogate decision-makers are required if the patient has lost decisional capacity. Investor-owned health plans have captured the major share of the United States medical market, but have been shown to deliver lower quality of care than competing methods. A deeply imbedded fear of a government-run health plan with good intentions expressed as bad policy exists. Ageism is one example of how ethical principles may be trampled. The orthopaedic surgeon has a responsibility to maintain and fight for these ethical standards.