Patents affect the terms on which knowledge is owned and used, and how knowledge is owned and used is crucially important for development. In this article I analyse the trade offs that countries face in pursuing three objectives in governing the ownership and use of knowledge: the desires to (1) examine patent applications quickly, (2) assure high quality in patents granted, and (3) preserve resources. I present the three objectives as a trilemma, whereby only two of three can be maximised simultaneously. I examine diverse national and international responses to the trilemma, and I make the case for emphasising high quality of patent examination as the most important objective. The article thus advances a case for developing countries to invest resources individually and collectively in improving patent quality.