Many contradictions and conflicts undoubtedly exist due to the nature of institutional treatment and the complexity of care of elderly patients. This complexity creates dilemmas which cannot always be solved, but challenges professionals to exercise careful thought,discretion, judgement, and high-level decision making whilst upholding principles and values which make it possible to effect a balance between the interests of the elderly, the family, the caregivers and society. The nurse must serve as an advocate for those patients who cannot represent themselves.