Compared to younger people, older people and those with frailty are more likely to die from acute infections, such as COVID-19, and less likely to survive intensive care. This has prompted calls internationally for advance care planning (ACP) in these vulnerable populations, focusing on documenting individuals’ preferences for resuscitation and hospital admission. We suggest that the benefits of ACP derive more from its process than from the plans it produces and that recognition of this is essential for optimum care provision for patients and their families. Moreover, we argue that an over-emphasis on achieving individual choice, the stated purpose of ACP, may paradoxically undermine good care.