The article discusses the ethical dilemma of treating a critically ill patient who previously refused surgery. A 72-year-old Italian woman with a large neck swelling and a history of refusing thyroid surgery was admitted with acute airway obstruction. Despite her prior refusal, her husband insisted on surgery, creating a conflict between respecting her autonomy and the need for life-saving intervention. The medical team faced the challenge of whether to proceed without her consent, considering legal and ethical guidelines. The patient ultimately died from a massive haemorrhage, highlighting the complexity of decision-making in such cases. The article explores the legal aspects of consent, emphasizing that while competent patients have the right to refuse treatment, in emergencies, necessary treatment may be provided without consent. It also discusses the limitations of informed consent in critical care, where patients may not be able to make informed decisions, and the importance of balancing patient autonomy with clinical judgment. The ethical debate underscores the need for careful consideration of a patient's past preferences, current condition, and the potential for legal and moral conflicts in medical decision-making.The article discusses the ethical dilemma of treating a critically ill patient who previously refused surgery. A 72-year-old Italian woman with a large neck swelling and a history of refusing thyroid surgery was admitted with acute airway obstruction. Despite her prior refusal, her husband insisted on surgery, creating a conflict between respecting her autonomy and the need for life-saving intervention. The medical team faced the challenge of whether to proceed without her consent, considering legal and ethical guidelines. The patient ultimately died from a massive haemorrhage, highlighting the complexity of decision-making in such cases. The article explores the legal aspects of consent, emphasizing that while competent patients have the right to refuse treatment, in emergencies, necessary treatment may be provided without consent. It also discusses the limitations of informed consent in critical care, where patients may not be able to make informed decisions, and the importance of balancing patient autonomy with clinical judgment. The ethical debate underscores the need for careful consideration of a patient's past preferences, current condition, and the potential for legal and moral conflicts in medical decision-making.