Social workers in geriatric settings often face difficult ethical dilemmas. These ethical dilemmas become less clear and more gut wrenching when they involve clients with marginal compe- tence. ' h o case examples are discussed which illustrate the baffling and conflictinn natureof one ethical and moral dilemma often seen in various for& in a psychogeriatric social work practice: autonomy versus beneficence. After the case vresentations, the two competing principles of beneficence and autoiomy are discussed, followed by an examination of the nature of competence. Finally, an in depth exploration of the concept of paternalism will be undertaken and related to the case studies.