This study investigates the prevalence of Advance Directives (AD’s) in patients between 18-65 years old. AD’s evolved from legislation passed by California in 1976, the Natural Death Act which legalized living wills, hoping to maintain the patient’s voice in medical decision making.  While ample research has been published on the prevalence of AD’s in the elderly population, there are few studies that evaluate its use in the younger age group.  This research is among the first to retrospectively review AD’s in this population. Data was collected on 497 in-patient records to evaluate AD completion and admitting diagnosis. Overall prevalence of AD’s was 7.6% and female patients were more likely than male patients to complete an AD.  In the younger the age group (18-32), prevalence was as low as 5%. This research is groundbreaking as it demonstrates that the youthful age groups tend to have an even lower prevalence of AD completion than was documented in previous literature. Increasing AD completion rates for all age groups would improve patient autonomy, nursing management and healthcare delivery.  Further nursing research is needed on AD’s as well as nursing strategies to reduce barriers to AD completion.