For the last 40 years, American medical patients have utilized “advance medical directives” to communicate their medical treatment desires should a situation arise where they are incapable of expressing their own preferences. These directives encompass a range of complex medical decisions, including end-of-life wishes, allowable and unallowable medical procedures, and who gets to make the medical decisions. Often, the patient’s religious beliefs affect the way he or she makes these decisions. Given this, religious organizations have become increasingly involved in drafting and enforcing these provisions. Difficulties can also arise when the physicians’ religious beliefs affect the advance medical directive or when patient religious beliefs are at a tension with the political tide. This chapter will examine these issues further.