Different types of advance directives invite varying interpretation from emergency care professionals. As informed consent of a patient is not always possible to procure in emergency situations, advance directives can provide useful guidelines for clinicians' decision-making processes regarding individual patient care. Specifically communicated instructions establish a course of aggressive or nonaggressive treatment, while general wishes leave the emergency department physician to assume an innate understanding of individual patients while undertaking an active role in decision-making for that patient's care. This article explores the relationship between advance care directives and the emergency department.