After initial attempts to treat a critical illness, some patients do not respond or their condition worsens. Sometimes, patients have been started on life-sustaining treatments, such as a breathing machine and CPR, before their wishes or a living will comes to light. In these situations, after careful discussions with doctors, these treatments can be stopped and other treatments begun to make certain the dying patient is comfortable. Nothing is done to cause the patient's death; removal or withdrawal of life-sustaining treatments is not assisted suicide or euthanasia. Also, this is not withdrawal of care. Hospital staff continues to care for the patient, but with the understanding and acceptance that the patient is dying and should be allowed to do so comfortably. By stopping machines and other life-sustaining treatments, nature is allowed to run its course. In very rare cases, patients will improve after these treatments are stopped. In this unusual situation, further treatments can be provided, short of breathing machines and CPR, to give a chance of recovery. In most cases, however, stopping the machines leads to death. Hospital staff are now very skilled at giving medications to make sure that patients do not experience any sense of pain or shortness of breath after stopping life-sustaining treatments. Family members are usually told they can stay at the bedside to be with their loved one if they want.
When a patient has met the legal criteria for brain death, the patient is legally dead. Modern machines can actually keep the heart beating for days despite the fact that the patient is legally dead. In this situation, neither living wills nor family wishes are needed, since death has already occurred. When the diagnosis of brain death is confirmed, family members should be told and all treatments being used to maintain a heart beat (mechanical ventilator, medications etc.) should be stopped to allow the heart to also stop beating.
When brain death has occurred, some states require hospital staff to ask family members for permission to remove vital organs of the patient, before the machines are stopped, to be donated to other unfortunate patients who need the organs to live. In states where this is not required, family members may wish to offer this "gift of life," especially if they know this is what the deceased loved one would have wanted. Persons in good health can also request that their organs be donated, should they suffer an injury leading to brain death, by filling out an "organ donor" card. In some states this can be stated on the driver's license.