Soru

A 28-year-old woman at 34 weeks gestation is brought to the emergency department by paramedics following a high-speed motor vehicle collision. She has a history of schizophrenia, which had been well-controlled until she discontinued her medications one month ago. On arrival, her blood pressure is 78/40 mm Hg and her heart rate is 142/min. She is combative, actively hallucinating, and screaming, "The government is trying to steal my organs!" A Focused Assessment with Sonography for Trauma (FAST) examination reveals a large amount of free intraperitoneal fluid. Continuous fetal monitoring demonstrates recurrent late decelerations. The patient is unable to demonstrate an understanding of her medical condition or the risks of refusing treatment. Her husband arrives and immediately provides consent for an emergency exploratory laparotomy, cesarean delivery, and any necessary blood transfusions. However, a review of the patient's electronic medical record reveals a valid Advance Directive executed two years ago when she was psychiatrically stable. The document appoints her mother as her healthcare proxy and explicitly refuses the administration of all blood products under any circumstances due to religious beliefs. The mother is contacted by telephone; she confirms the Advance Directive and insists that blood products must be withheld, even if it results in the death of the patient and the fetus. Which of the following is the most appropriate next step in management?