Autonomy, the right to receive or refuse medical treatment is a crucial element of health care ethics (American Nurses Association (ANA), 2011; Plakovic, 2016). Nurses are involved in helping patients and families be aware of when end-of-life is occurring, and in educating the patient and family about end-of-life legislation that helps guide everyone committed to continue the right of patient autonomy when the patient is no longer able to express their wishes. Before the Patient Self Determination Act, we had the famous cases of Karen Ann Quinlan and Nancy Cruzan who were, from a point-of-view, forced to suffer for ten or more years of futile treatment (Miller, 2017). Now, we have advanced directives that allow patients to express their wishes while they are able, yet we still have ethical dilemmas when either those needs are expressed vaguely or not at all. It is in the best interest of the patient and the patient's loved ones for advanced directives to be utilized and kept up to date.