An Ambulance Transports a 74-Year-Old Woman to the Emergency Department

An ambulance transports a 74-year-old woman to the emergency department. She is joined by a friend who discovered the patient, who is confused and disoriented, lying on the floor of her flat. The patient is a widow with an adult daughter. Aplastic anemia was identified in her a year ago. Her illness has not responded well to immunosuppressive medication, necessitating several blood transfusions. The patient has a fever, is confused, and cannot answer to queries. A full blood count reveals severe pancytopenia. The patient wrote an advance directive 9 months ago, designating a friend as her health care proxy. The buddy informs the doctor that the patient does not wish to receive any future blood transfusions. The patient's daughter arrives and adamantly insists that the patient receive a blood transfusion, saying, "I discussed it with my mother a few weeks ago, and we decided that she should have everything done to prolong her life."  Which of the following is the most appropriate next step in patient care?

A) Contact the ethics committee for guidance because transfusion is not an emergency
B) Honor the daughter's wishes because she lives with the mother and knows her better
C) Honor the daughter's wishes, since she is the legal next of kin
D) Honor the friend's instructions as health care proxy and withhold the transfusion
E) Start the transfusion because the physician has a duty to provide emergency care