The article discusses the ethical dilemma of a critically ill patient who had previously refused surgery. A 72-year-old Italian woman with a complex medical history was admitted to the hospital with minor hemoptysis. She had a history of asthma, oesophageal varices, and recurrent pulmonary embolisms. She had previously refused surgery for her thyroid condition and sclerotherapy for her oesophageal varices. She was admitted with acute upper airway obstruction due to haemoptysis and was resuscitated, intubated, and ventilated. A diagnosis of a large thyroid goitre was made, which was causing upper airway obstruction and tracheal erosion. The patient was unable to give consent for surgery due to her previous refusal and her current unconscious state. The family and some clinical team members wanted surgery to proceed, but there was a conflict over the ethics of operating without consent on a patient who had previously refused surgery. The patient died from massive haemoptysis, and a postmortem examination showed a malignant thyroid tumour that had infiltrated the trachea and eroded a major pulmonary vessel. The article discusses the legal and ethical issues surrounding consent for critically ill patients. It highlights the importance of assessing a patient's mental capacity to make decisions about their treatment. It also discusses the concept of "necessary treatment" for patients who are unable to give consent. The article argues that in some cases, surgery may be necessary to save a patient's life, even if the patient had previously refused surgery. It also discusses the role of the family in decision-making and the legal implications of operating without consent. The article also discusses the concept of informed consent and the importance of respecting a patient's autonomy. It argues that while informed consent is important, it may not always be possible to obtain it in critically ill patients. The article also discusses the limitations of informed consent in cases where a patient is incapacitated or unable to make decisions for themselves. It emphasizes the importance of considering the patient's best interests and the potential benefits of treatment in such cases. The article concludes that while informed consent is important, it may not always be possible to obtain it in critically ill patients, and that in some cases, surgery may be necessary to save a patient's life.The article discusses the ethical dilemma of a critically ill patient who had previously refused surgery. A 72-year-old Italian woman with a complex medical history was admitted to the hospital with minor hemoptysis. She had a history of asthma, oesophageal varices, and recurrent pulmonary embolisms. She had previously refused surgery for her thyroid condition and sclerotherapy for her oesophageal varices. She was admitted with acute upper airway obstruction due to haemoptysis and was resuscitated, intubated, and ventilated. A diagnosis of a large thyroid goitre was made, which was causing upper airway obstruction and tracheal erosion. The patient was unable to give consent for surgery due to her previous refusal and her current unconscious state. The family and some clinical team members wanted surgery to proceed, but there was a conflict over the ethics of operating without consent on a patient who had previously refused surgery. The patient died from massive haemoptysis, and a postmortem examination showed a malignant thyroid tumour that had infiltrated the trachea and eroded a major pulmonary vessel. The article discusses the legal and ethical issues surrounding consent for critically ill patients. It highlights the importance of assessing a patient's mental capacity to make decisions about their treatment. It also discusses the concept of "necessary treatment" for patients who are unable to give consent. The article argues that in some cases, surgery may be necessary to save a patient's life, even if the patient had previously refused surgery. It also discusses the role of the family in decision-making and the legal implications of operating without consent. The article also discusses the concept of informed consent and the importance of respecting a patient's autonomy. It argues that while informed consent is important, it may not always be possible to obtain it in critically ill patients. The article also discusses the limitations of informed consent in cases where a patient is incapacitated or unable to make decisions for themselves. It emphasizes the importance of considering the patient's best interests and the potential benefits of treatment in such cases. The article concludes that while informed consent is important, it may not always be possible to obtain it in critically ill patients, and that in some cases, surgery may be necessary to save a patient's life.