Acute neurological conditions such as stroke, refractory epilepsy, and neuromuscular respiratory failure strike at patients' most basic abilities to manage their environment and interact with the world around them. Neurologists in the inpatient setting routinely encounter some of the most complex and challenging ethical problems that arise in medical practice. Many of the ethical issues that arise in inpatient neurology reflect common ethical conflicts that arise in medical practice. Beauchamp and Childress have proposed a widely accepted set of primary principles of biomedical ethics; these principles are often helpful in articulating the ethical dilemma posed by clinical situation. Many patients who present acutely with ischemic stroke may lack decision-making capacity as a result of deficits such as aphasia, anosognosia, memory impairments, or delirium. The principles reviewed in this chapter are often helpful in articulating the nature of an ethical dilemma and in arriving at a satisfactory resolution.