In the Italian legal system, any therapy is provided only if patients desire to receive it; their informed consent authorizes every kind of healthcare.
The aim is to promote individual decisional awareness connected with their health. Nevertheless, in the Intensive Care reality, health conditions of the patients are often so serious to require immediate vital intervention. In these situations it's impossible to inform the patients and obtain their consent: the presence of urgent conditions and patient's risk of death bind the doctor to provide the assistance and the essential care.
The owners of their "health" are the only patients: as a general rule, except for minors or legal incompetents, the informed consent has to be obtained only from people concerned; the expressions of will coming from relatives and friends have no legal value. In some cases, however, patients are not able, in that moment, to adequately understand the therapies they need because of sedatives or neurological diseases.
In clinical practice, health care providers communicate and share with the relatives the decisions to be taken, in order to become aware of what that patient "would like to receive", and it's a good practice to obtain a written confirmation that the relatives have been duly informed.
In particularly complex or controversial cases, as long as the severity of the clinical situation permits this, it is possible to ask the Court for a declaration of temporary incapacitation and the consequent nomination of a person (a tutor, a guardian or a supporting administrator) legally able to give informed consent on behalf of the patient.
The full awareness of the clinical conditions and the deep sharing of therapeutic options allow to reach the best balance between medical choices and relatives' expectations.