Soru

A 42-year-old man is brought to the emergency department after a high-speed motorcycle collision. He sustains a massive acute subdural hematoma with significant midline shift. Despite emergent neurosurgical decompression, he progresses to a deep coma and requires continuous mechanical ventilation. The neurology team determines that his prognosis for meaningful neurologic recovery is highly unlikely. The patient is legally divorced and does not have an advance directive or a designated healthcare proxy. Several individuals arrive at the hospital and express differing views on the goals of care. His fiancée, who has lived with him for the past four years, insists on proceeding with a tracheostomy and percutaneous endoscopic gastrostomy tube. His 19-year-old biological daughter, who lives in another state and visits rarely, states that her father explicitly told her he would "never want to live on machines" and requests withdrawal of mechanical ventilation. The patient's mother insists on continuing all life-sustaining measures based on her religious beliefs. His ex-wife agrees with the daughter's request. Which of the following is the most appropriate next step in managing this patient's care?