Brain death is considered equivalent to death in most countries, and its diagnosis means that life-support measures are appropriately discontinued. Caution is needed in predicting a poor prognosis in poorly responsive patients with anoxic–ischemic encephalopathy who do not meet brain-death criteria. In the United States, the Patient Self-Determination Act of 1991 recognizes the right of the patient to leave advance directives regarding CPR or limiting levels of care.
However, in most cases, decision making is delegated to a substitute advocate or durable power of attorney. Members of the health care team should identify and meet with the person charged with decision making early in a patient's course to explain the process by which prognosis is assessed and then follow up to present results of assessments and discuss prognosis and recommendations, including withdrawal of care, when and if appropriate.
New England Journal of Medicine - Vol. 361, No. 6, August 6, 2009