A patient with a legally binding document that refuses any form of artificial airway support is in a state of declining respiratory function. Despite the administration of oxygen via a mask and maintaining the patient in an upright position, their oxygen saturation continues to drop, and the team is faced with a decision on further interventions. What is the most appropriate action for the healthcare team to take in alignment with the advance directives?
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Proceed with the establishment of an artificial airway, assuming the document does not apply in life-threatening scenarios.
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Respect the advance directives stipulating no artificial airway support and continue with palliative care measures.
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Seek an expedited ethical review to potentially override the documented instructions due to the urgent nature of the situation.
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Temporarily provide artificial airway support while seeking consent from next of kin for further directives.
The healthcare team must honor the patient's explicit instructions in the legally binding document, which prohibits any type of artificial airway support, including intubation. Despite the critical nature of the patient's condition, the team is legally and ethically bound to respect the advance directive. Alternative supportive measures that do not involve artificial airway support, such as administering medications to improve breathing or addressing underlying conditions, may be considered. However, if all options have been exhausted, the team should focus on providing palliative care to ensure the patient’s comfort.
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