This chapter explores the ethical complexities of making care decisions for older adults with diminished capacity, using the case of Mr. Kane, a patient with dementia and aspiration risk. It challenges a simplistic interpretation of Maslow’s hierarchy of needs, advocating for a balanced approach to patient needs rather than solely prioritizing safety. The chapter also introduces the concept of a “customized pyramid of needs” to guide person-centered care and navigate the trade-offs between quality and quantity of life. It contrasts a “logical” approach to thinking about a patient’s basic needs with a “biological” approach.