1. Meet with the family and tell them there is no hope of recovery and you will be discontinuing mechanical ventilation.
2. Meet with the family with the goal of ascertaining the patient’s wishes regarding the continuation of active medical treatment and whether the likely outcome of continued treatment — at best, placement in a nursing home with a high level of care — would be consistent with the patient’s wishes.
3. Meet with the family and ask them whether they would like the patient to have a tracheostomy.
4. Meet with the family and tell them you will perform a tracheostomy.