Soru

A 55-year-old man with a two-year history of amyotrophic lateral sclerosis is admitted to the intensive care unit for acute hypercapnic respiratory failure secondary to aspiration pneumonia. He was intubated in the emergency department. Prior to admission, he was wheelchair-dependent but communicated effectively using a speech-generating device. On hospital day three, the patient is awake, alert, and communicating via a letter board. He consistently and clearly requests to be extubated, communicating that he understands this will likely result in his death and that he does not want to live dependent on a machine. His wife, who is his legally designated healthcare proxy, is highly distressed. She demands that the medical team continue mechanical ventilation, stating, 'He is just overwhelmed right now; you cannot let him die.' A formal psychiatric evaluation concludes that the patient does not have major depressive disorder and possesses full decision-making capacity. Which of the following is the most appropriate next step in management?