[Deaths that save lives: the complexities of medical care for patients with suspected brain death].

The objective of this study was to understand how physicians at the largest emergency department in a large Brazilian city orient care for critical patients with suspected brain death and who are potential organ donors. This ethnographic study was conducted in an emergency care hospital, a reference in traumatology in Latin America, located in downtown Belo Horizonte, Minas Gerais State. The institution took pioneering steps in Brazil with a specific sector where patients with suspected brain death are referred. The fieldwork was performed over the course of nine months, based on targeted observations and interviews with 43 on-duty staff physicians (25 men and 18 women), from 28 and 69 years of age. Data analysis followed the "signs, meanings, and actions" model. The ethnography revealed the process of medical care for patients with suspected brain death, including: intensive care, adherence to protocol, and communicating the patient's status to the family. In the latter case, the dialogue reveals the controversies in the concept of brain death, the sociocultural context, and the emergency care context. It became clear that this process of medical care extrapolates merely normative issues, entering into a complex web of elements, especially the professional's role as mediator of a myriad of interwoven elements and tensions. Between confirmation of the brain death and communicating the situation to the family, ambivalent perceptions emerge, both for the physicians and the family members. The study evidenced how the tenuous definition of what constitutes life and death touches on all of the medical act, with direct implications on care for patients/potential donors and their families.