Questions regarding making and implementing care preferences through advance directives have become increasingly significant as the greying population grows with rising numbers of people experiencing incapacity. Currently, there is no consensus in the format for making advance directives. Recent developments highlighted the use of recording technology as an option to counter the challenges of written forms. Services offering video and audio recording available for online and offline storage are emerging in the United States. These services presumably strengthen a person’s expression of care preferences for healthcare providers in making treatment decisions compared to written advance directives. This article examines the role video advance directives play in advance decision-making and their legal and practical implications to the existing framework. An appreciation of the legal challenges presented by this development facilitates an understanding of their use in contemporary advance directives and enables appropriate recommendations for implementing safeguards in their use.