Adolescents who are critically, chronically, and terminally ill traditionally have been given little voice in their health care treatment. But over the last three decades attitudes have begun to shift. The legal and medical professions as well as parents and children's advocates have started to recognize that cognitively normal adolescents have decisionmaking capacity and believe these patients ought to have the opportunity to participate in even the toughest of health treatment decisions. Advances directives, if used with sensitivity and care, could prove a valuable means of giving these older pediatric patients a say in their care.