Background Brain stem death is a concept used in cases in which life-support equipment obscures the conventional cardiopulmonary criteria of death. Brainstem death during pregnancy is an occasional and tragic occurrence.Aims To consider the ethical, legal and medical issues raised by maternal brainstem deathMethods Medline and Embase search.Results The death of the mother mandates consideration of whether continuing maternal organ supportive measures in an attempt to attain foetal viability is appropriate, or whether it constitutes futile care. There is no theoretical limit to the duration of time for which maternal somatic function may be sustained. However, successful prolongation of maternal somatic function in pregnancies of less than 16 weeks gestation has not been reported to date. There is no legal imperative to continue maternal somatic support where there is little likelihood of a successful foetal outcome.Conclusion The difficult issues raised by maternal brainstem death mandates a consensus building approach to decision making in this context.