Advance refusals of life-sustaining treatment involve three potentially conflicting interests: those of the patient; those of the doctor; and those of the law. The state's interest in protecting life can clash with the patient's right to self determination which, in turn, can conflict with the doctor's desire to act in the patient's best interests. Against this background, we present the case of a patient who was treated (arguably) contrary to his advance refusal but in accordance with English law.