Recently amended legal regulations established the opportunity of application of advance directives for terminally ill patients in Lithuania. Provisionally, advance directives should enhance patient’s rights while making complex end of life decisions, however, implications for legal and moral responsibility to empower a patient’s autonomy are not clearly established yet. The article discusses the legal and ethical justification of implementation of advance directives and, in their absence, the surrogate decision making for the best interests of the patient and the best representation of the patient’s will. The reflections of recent empirical studies indicate the importance of a patient-centered approach that can provide the hints for harmonization of the national legal system, including a supportive decision-making culture, raising public awareness and confidence, more effective professional communication, and broader public involvement into end-of-life deliberations. Analysis of legal and ethical arguments imposes the conclusion that the specific question of respect of dignity in the end of life is not just a problem of health care management or the quality of health care services, but a fundamental challenge of human rights that should be discussed at the policy decision making level. Overall, we assume that application of advance directives should be elaborated in accordance with the case-law of the European Court of Human Rights (ECHR), the ideals of welfare society, and other national laws as well as public interests.