An analysis of 60 ethnographic interviews with family caregivers for frail community-based elderly persons has suggested that ethical dilemmas are an important organizing framework for family caregiving. The present paper explores this conjecture as it relates to the practice of occupational therapy with older clients and their families. Major themes of ethical dilemmas in family caregiving, as derived from the ethnographic data, are described. Verbatim interview data are presented to illustrate the close ties between caregiving activity and the caregiver’s ethical convictions. Occupational therapists are encouraged to seek understanding of their clients’ ethical beliefs in order to maximize the potential for a therapeutic relationship built on mutual understanding and partnership.