Bricks and Morals: The Ethics of Architecture for Healthcare

Jay I. Meltzer Fellowship in Medical Ethics
The Meltzer Fellowship gives internal medicine residents the unique opportunity to research medical ethics issues and present their findings to their peers. The fellowship program was conceived by Dr. Jay Meltzer, clinical professor of medicine, and designed by Dr. Lerner in collaboration with Dr. Rothman. It is funded by the Vidda Foundation. Each Meltzer Fellow selects one case for an in-depth analysis of its ethical issues and analyzes the relevant literature. The work culminates in a case presentation to the medical center community.

To learn more about the Jay I. Meltzer Fellowship in Medical Ethics click here.

Overview:

As a physician-architect, I propose to address the issue of design ethics as applied to the healthcare environment. Throughout my clinical training, I have noted instances of the harmful effects of unpleasant spaces. Through this presentation, I consider the need for an alliance between design and ethics whereby the architect can assist the physician.

Beyond Traditional Clinical Ethics

Architects working on healthcare projects face ethical choices:

• Do the designs for healthcare facilities include elements which enhance or harm the institution’s duty of care for the patients and families?
• How do architectural designs emphasize the well-being not only of patients, but also those who care for them?
• Do architects acknowledge ethical issues surrounding patient vulnerability and family stress associated with hospitalization?
• To what extent should non-medical needs of family members and visitors be a factor in deciding the merits of specific designs for hospital architecture?

Designing for Basic Rights

Privacy and confidentiality are considered basic rights. Safeguarding personal health information is an ethical and legal obligation. Can privacy be created architecturally when shared patient spaces are still a reality? As we move into an era of high-tech environments, what are the ethical implications of cameras integrated into the patient room design? In the realm of institutional design, some prison buildings have been shown to violate human rights. Healthy design is a growing topic, where natural light and ventilation are considered fundamental for those incarcerated. In contrast, patient and staff spaces within hospitals are still often without access to daylight. Are building codes changing?

Therapeutic Architecture

• Patient and staff satisfaction can be greatly enhanced by well-designed facilities.
• Beyond patient satisfaction, the architecture can be considered in the therapeutic benefit or harm to the patient. The growing field of Evidence-Based Design demonstrates that architectural design itself serves as therapy and the environment can improve healing.
• There exists a relative shortage of compassionate spaces in healthcare facilities and clinical staff is too often excluded from being provided areas for emotional expression.

Architectural design solutions are increasingly recognized as impacting the well-being of those using the spaces, both in causing harm and improving clinical outcomes.