Advance Care Directives (ACDs) are becoming an increasingly popular way for people to state their wishes about the treatment they do or do not want at the end of their lives. This paper records some of the background to their introduction in NSW and reflects on the motivations and backgrounds of those who have been involved in developments to date. These developments came in response to changes in social attitudes and shifted the focus in advance planning for later life from financial and property decisions to encompass personal and medical treatment preferences. The relevant legislation in NSW is the Guardianship Act 1987, which governs substitute medical consent for adults who are unable to consent to their own treatment and enables competent adults to appoint an enduring guardian to be their substitute decision maker for personal and medical decisions. Although proclaimed in 1989, its provisions are still not well understood by the medical profession, much less by the general public. Action is underway on many fronts to increase awareness of all the ways in which people can plan ahead to have their wishes respected if they lose their mental competence.