In the Islamic Republic of Pakistan, healthcare is a neglected sector, devoid of legislation. Being a patriarchal society with a high illiteracy rate, especially in the female population, further complicates issues. In this chapter, we show that the expression of patient rights, including in the form of advance directives, does not exist in the laws of Pakistan. In addition, the type of patient autonomy that exists in Pakistan is often referred to as family autonomy. However, family autonomy in Pakistan, as it relates to the patient and the family as a unit managing healthcare decisions, does not often provide room for patient autonomy. Instead, healthcare professionals are often told by family members not to discuss the diagnosis with the patient, let alone be encouraged to take the patient’s preferences into account. This situation, which may be described as a form of familial paternalism, puts healthcare professionals in a difficult situation. In this chapter, we discuss the cultural, religious, legal and societal factors behind the various practices and beliefs surrounding healthcare decisions. Current healthcare practices and possible solutions to the existing situation in Pakistan are also discussed.