A Friend Brings a 65-Year-Old Man to the Emergency Department

A friend brings a 65-year-old man to the emergency department after discovering him bewildered at his residence. Chronic obstructive pulmonary disease, hypertension, coronary artery disease, and cigarette use are all part of the patient's medical history. He is single and unmarried. According to the buddy, the patient has a sister who lives nearby but is unclear of when they last spoke. The patient's companion has known him for 5 years and describes them as "excellent mates." He informs the doctor that they have talked about death and that he feels the patient would like to "die gently" and would refuse any heroic measures, including "being hooked up to a ventilator." The temperature is 39 ° Celsius (102.2 degrees F) , the blood pressure is 120/80 mm Hg, the pulse rate is 105 beats per minute, and the respirations rate is 24 /minute. On room air, oxygen saturation is 88 percent, and on 2 L of oxygen, it is 93 percent. The patient is drowsy and unable to respond to queries. Bilateral wheeze and reduced breath sounds are seen in the lungs. A right lower lobe infiltration is shown on a chest x-ray. Bronchodilator and antibiotic therapy are started as needed. If the patient does not respond to the initial therapy within the following 2-3 hours, the doctor is concerned about the necessity for intubation. Which of the following is the best course of action?

A) Attempt to contact the patient's sister for consent to intubate
B) Consult the hospital ethics committee
C) Do not intubate based on the friend's report of the patient's wishes
D) Plan to proceed with intubation when the need arises
E) Wait to see if the patient's condition improves on therapy and he can sign consent