What are the implications of caring for patients with advance directives in emergency care contexts? This paper examines legal and professional perspectives and highlights the challenges that practitioners face. Emergency care contexts necessitate the need for timely decision making regarding care and treatment options. Fundamental to the decision-making process is the need to take into consideration the wishes and preferences of the patient. Advance directives are expressions of choice. They are also legally binding documents and represent the wishes of a patient, but often with little prior knowledge of the patient, practitioners may be unsure whether to act on an advance directive. This paper makes some attempt to examine key components of this debate.