This chapter examines the current semi-normative framework for advance healthcare directives and related practice and discussion in China’s mainland. Without specified legislation acknowledging binding advance healthcare directives, China’s new Civil Code (2021) adopts legal criteria for a person to be deemed lacking in decision-making capacity and for the appointment of substitute decision makers for them. The Code of Ethics (2014) of the Chinese Medical Doctor Association requires Chinese medical practitioners to respect the expressed will of patients when they are capable of making decisions and to ensure patients’ maximum participation in the decision-making process even when they are considered to lack capacity. This chapter presents a doctrinal understanding of such a framework of norms that may potentially affect practices relating to advance healthcare directives. However, the existing evidence reflected by judicial proceedings and medical research papers suggests that the framework has rarely, if ever, been translated into medical practice. The chapter considers the possible legal and social explanations for such a lack of implementation. It also surveys a number of civil society-led pilot projects that promote advance healthcare directives, presenting a wider landscape of the relevant practice in China’s mainland.