Finding acceptable solutions for the matters associated with the older driver with dementia necessarily involves the cooperative efforts of patients, physicians, other providers, families, and government agencies. It is a challenge that often does not have a simple answer since the solution that benefits one may not benefit all or, in all likelihood, might adversely affect the other. In addition, because of the progressive nature of dementia, driving discussions should be ongoing and require revisiting as the disease progresses. Since there is currently not a definitive “gold standard” for determining fitness to drive, physicians have to make decisions based on their clinical judgment. Although most can agree that there is a point that a patient is unequivocally unable to safely continue to drive and that recommending driving cessation is absolutely necessary for the sake of patient and public safety, all too often decisions must be made when the best solution is not so clear. Because driving is such an integral part of our culture and quite often essential for obtaining even the most basic needs, many view it as a right rather than a privilege. In addition, a patient does have the right to privacy and confidentiality with regard to his/her relationship with his/her physician. It is this concept that poses one of the greatest ethical dilemmas for physicians and other health-care providers who care for an older driver with dementia as they must balance confidentiality with safety of the patient and public.