Behavioral Science & Ethics USMLE Step 1 Practice Question

A 72-year-old woman with stage IV pancreatic cancer presents to clinic for follow-up. She has progressive weight loss (albumin 2.8 g/dL) and mild dysphagia but denies pain. Her son, who is her healthcare proxy, insists she participate in a phase II chemotherapy trial, stating "Mom wouldn't want to give up." When you speak with the patient alone, she says clearly and consistently: "I understand my cancer is terminal. I want to focus on spending time with my family and being comfortable. I don't want aggressive treatment." The patient is alert and oriented, demonstrates understanding of her diagnosis and prognosis, and exhibits no signs of cognitive impairment. Which of the following is the most ethically appropriate next step?