Soru

A 62-year-old woman is evaluated in the emergency department for worsening respiratory distress secondary to severe aspiration pneumonia. She has a history of advanced Alzheimer disease and is currently unarousable, lacking decision-making capacity. She is receiving high-flow oxygen and is hemodynamically stable, but her work of breathing is progressively increasing. The attending physician holds a family meeting to discuss goals of care and the potential need for mechanical ventilation. Several family members are present and strongly disagree on the plan of care. Her husband of two years insists that she be intubated and treated aggressively. Her eldest son from a previous marriage presents a legally binding document designating him as the patient's Financial Power of Attorney, and he supports the husband's decision. The patient's sister presents a valid advance directive executed five years ago designating her as the Medical Power of Attorney (Healthcare Proxy); she states that the patient clearly expressed she would never want to be kept alive on a ventilator and requests a 'Do Not Intubate' order. What is the most appropriate next step in the management of this patient?