The Emergency Department is a specific setting where the challenges of delivering ethical care are especially pronounced related to time pressures, urgency and acuity. Whilst ethical principles are designed to be used in any setting, this article develops their application in clinical practice in the Emergency Department. We discuss capacity assessment and best interest decisions, as these can be particularly difficult in the Emergency Department setting, for example in patients with confusional states. We offer some practical guidance on how to address such scenarios. We discuss the notion of ‘frail friendly Emergency Departments’ that are ethically designed and capable to deliver frailty attuned care. This is because if European healthcare systems are to respond to the increasing numbers of older people with frailty, there will need to be a step-change in the provision of urgent care.