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Brian Sinclair Was 'Ignored to Death'

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On Sept. 21, 2008 Brian Sinclair was found dead. Though he was homeless, disabled, and some say socially excluded because he was Aboriginal, Brian Sinclair's body was not, as you might suspect, found in some anonymous back alley. Rather, a horrified member of the public discovered Brian's body in the waiting room of the Emergency Department at Winnipeg's Health Sciences Centre. According to a Chief Medical Examiner's inquest, Brian Sinclair died after spending 34 hours in the hospital's waiting room, after being repeatedly overlooked by the doctors, nurses and medical aids at the emergency triage desk.

And now, three years later, we learn that criminal charges may be laid in the case. Just last week the media have reported that the Winnipeg police have suggested recommending criminal charges against the Health Sciences Centre and a health care staff member, following their year-long investigation into Sinclair's death. The Winnipeg Police responded by releasing a statement that the investigation into Sinclair's death is ongoing and that a report has not yet been forwarded to Manitoba Justice.

Not surprisingly, the prospect of criminal charges reverberated immediately through all levels of the Manitoba health care system -- and health care facilities and health providers across the country are sitting up and taking notice.

Since the Sinclair tragedy people across Canada have been confronting the disturbing question, 'What led to Brian Sinclair's death?' And, perhaps more seriously, 'Who's to blame?' The explanations so far are varied.

Sinclair's cousin and boyhood friend, Robert Sinclair has told the media that Brian was "ignored to death." In an email to Health Science Centre staff, then Winnipeg Regional Health Authority CEO Dr. Brian Postl (now Dean of the University of Manitoba's Faculty of Medicine) blamed Sinclair's death on health care "system frailties."

Similarly, Sandi Mowat, President of the Manitoba Nurses Union has told the media that rather than any one person having the blame, Sinclair's death was the result of a "systemic issue." Noted criminal defence lawyer, Clayton Ruby was the one who raised the possibility that Brian Sinclair's death may be a criminal matter and called upon the Winnipeg Police Service to investigate.

Whether the police will ultimately lay charges in the Sinclair case or not we are still left with many troubling questions. Sociological studies of "medicalization" provide an explanation.

Brian Sinclair's life of extreme poverty and homelessness became medicalized.

'Medicalization' is the term used by sociologists to describe the tendency to understand aspects of social life as medical issues requiring intervention and control on the part of medicine. In Sinclair's case, he became stigmatized as a homeless person -- mentally ill, an addict; the Health Sciences Centre was often where he went or was taken for help.

The hospital came to be seen as the institution to deal with Sinclair. Many doctors and nurses, the police, paramedics, and perhaps even Brian Sinclair himself, routinely defined his situation this way: they saw -- and treated -- the homelessness before they saw the man.

The tragedy is that when he presented to the Health Sciences Centre with a bladder infection requiring immediate medical intervention, Sinclair was ignored by the hospital staff who probably assumed he was in the emergency department one more time simply because of his homelessness. In this way, medicalization contributed to the death of Brian Sinclair.

Homelessness is but one of many troubling aspects of everyday life which are increasingly being defined as medical issues requiring formal medical care. The reasoning seems to be, 'Something must be wrong with the homeless, they must be alcoholics, or drug users, or mentally ill. The homeless don't fit into our society... so they must be sick... Let the hospitals deal with them.' But an ER is not a reasonable alternative to society's responsibility for providing secure "homes" for the homeless.

When biomedical ideas, images, language, and practices become the lens through which our culture understands questions of life and morality, we have reached the point of medicalization.

Only in a society which has so totally come to understand the human condition in terms of the ideas, images, language, and practices offered by biomedicine can this sort of medicalization of social suffering be possible.

Brian Sinclair's death shows us what's wrong with this approach: The human tragedies of poverty, racism, homelessness, and addiction give way to medical interpretations of reality.

Only in a medicalized society could Brian Sinclair be 'ignored to death' by the doctors and nurses, to whom society has given responsibility for providing care. It seems Brian Sinclair's cousin and boyhood friend, Robert Sinclair, was right; Brian was "ignored to death"... by a society all too quick to define homelessness as a medical issue.

Christopher J. Fries is a health sociologist on Faculty in the Department of Sociology at the University of Manitoba and co-author of Pursuing Health and Wellness: Healthy Society, Healthy People (Oxford University Press).

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