Modern Hospice Design – The Architecture of Palliative Care

‘Architecture should defend Man at his weakest’. These words by the Finnish Modernist architect Alvar Aalto are the guiding principle behind Ken Worpole’s book.

Though Worpole is primarily concerned with just one facet of the palliative care experience, it is an important one.

Research has repeatedly shown how powerful an influence the environment can have upon the happiness of both patients and staff. Indeed, many of us have felt the sense of gloom attached to hospitals, and must admit that we implicitly link quality of care with external appearances.

Foucault spoke of the institutionalisation of the infirm as ‘the great confinement’. This confinement in many ways represents the marginalised role of the elderly and terminally ill in today’s society. ‘The appalling treatment of too many elderly people is the best kept secret in Britain’  we have been told, but it isn’t really a secret, but rather a fact that we turn a blind eye to.

The modern hospice movement’s great demand is for a re-evaluation of the way we view the end of life. Most of the developed world faces, if not a crisis, then serious concerns posed by ageing populations, yet as a culture we still find it as difficult as ever to speak objectively of death.

Yet the ‘right to a good death’ is becoming ever more an assumption of modern life, though it is a concept that may conflict with the raison d’etre – to prolong life – of the hospital, in which the vast majority of us now die.
Over 50 per cent of all NHS complaints concern care for a dying patient, and leave no doubt as to the hospice’s station in modern medical care.

Despite his seemingly narrow focus, Mr Worpole shows a great interest in the philosophy of dying, He is deeply concerned by the tendency in modern medicine for the prolongation of life to take precedence over its quality.

In his closing words, he recalls Dame Cicely Saunders, founder of the modern hospice movement, who wrote of the ideal hospice as a place where the sorrow of parting is ‘constantly overcome’; borrowing from T.S. Eliot’s Four Quartets: “not fare well, But fare forward, voyagers.”