Although all human beings share the same biology, the political context of medical practice, like all politics, is notoriously local. So, while some might be surprised to learn that Italy only adopted its first advance directive legislation in the closing days of 2017, such surprise would reflect a kind of naive parochialism. Rome, Italy, is not Washington, DC. The bill, which passed the Italian Senate in December 2017 after 3 decades of debate, assumed the force of law on January 6, 2018. The law establishes a right to refuse tests and treatments, a right to palliative care, and provides for living wills and the naming of medical proxies; assisted suicide and euthanasia remain illegal.1 The protracted legislative course reflects a complex amalgam of culture, religion, language, politics, ethics, and medicine.