Even in Italy there is a need to address the issue of ownership and the criteria for deciding when the patient becomes incompetent, in compliance with fundamental ethical principles of respect for autonomy and beneficence: advance care directives can serve to enhance patient’s autonomy but, beyond respect for autonomy… advance directives may also contribute to the patient’s good…indeed, by means of advance directives, patients are entitled to refuse treatments when they consider that they would be more harmful than helpful