This chapter describes the use of advance directives and similar instruments in the Philippines and the specific contexts in which these have been applied. Numerous attempts to pass end-of-life advance directive legislation in both houses of congress since the present constitution was ratified in 1987 have resulted in very limited success, although the recent National Mental Health Act has paved the way for legal recognition of patients’ rights to set out preferred treatment options through advance directives – in the context of mental healthcare. This chapter explores the religious and sociocultural reasons that have been offered as an explanation for the seeming indifference on the part of political leaders in relation to end-of-life advance directives. It also examines the circumstances in which healthcare providers and patients have used alternative ways of documenting preferred treatment options. Despite the absence of a formal legal framework and the protection from liability that it could provide, medical institutions have made written advance directive instruments available to patients. The actual utility of such instruments is discussed in relation to the interests of professionals, patients, and their families, and in the specific context of the COVID-19 pandemic.