Health Design & Ethics

The Bioethics of Built Space: Health Care Architecture as a Medical Intervention

May 1, 2022 / Dochitect / Health Design & Ethics

Peer-reviewed publication

Publication: The Hastings Center Report
Publication Reference: March-April 2022, https://doi.org/10.1002/hast.1353
Authors: Diana C. Anderson, Stowe Locke Teti, William J. Hercules, David A. Deemer

Abstract

Decisions made in health care architecture have profound effects on patients, families, and staff. Drawing on research in medicine, neuroscience, and psychology, design is being used increasingly often to alter specific behaviors, mediate interpersonal interactions, and affect patient outcomes. As a result, the built environment in health care should in some instances be considered akin to a medical intervention, subject to ethical scrutiny and involving protections for those affected. Here we present two case studies. The first includes work aimed at manipulating the behavior of persons with neurocognitive impairments, often in long-term care facilities. This is done to ensure safety and minimize conflicts with staff, but it raises questions about freedom, consent, and disclosure. The second concerns design science in service of improved outcomes, which involves research on improving patient outcomes or the performance of health care teams. There is evidence that in some ICU designs, certain rooms correlate to better outcomes, giving rise to questions about equity and fairness. In other cases, a facility’s architecture seems to be putting a finger on the scale of equipoise, raising questions about the intentionality of clinical judgment, freedom of choice, and disclosure. As a result of this innovation occurring outside the boundaries of traditional care delivery and oversight, important ethical questions emerge concerning both the individual patient and patient populations. We discuss, analyze, and make recommendations about each and suggest future directions for these and related issues.

Ethical Obligations at their Nexus with Built Space

February 25, 2022 / Dochitect / Health Design & Ethics

Presentations

Event: Association for Practical and Professional Ethics (APPE) Annual Conference – Annual Conference
Presentation type: Conference presentation and discussion
Presenters: William J. Hercules, MArch, FAIA, FACHA, FACHE, David Deemer, MD, Diana Anderson, MD, MArch, Stowe Lock Teti, MA, HEC-C
Date: February 25, 2022

Learning Objectives
• Understand how the built environment can help resolve the conflicting obligations of isolation for disease mitigation and the need for socialization and autonomy.
• Demonstrate the increasing impact the healthcare built environment is having on health and as a dimension of duty of care.

Conference Presentations

Architecture and Bioethics: A new value proposition for health care facility designers

February 5, 2022 / Dochitect / Health Design & Ethics

Commentaries

Publication: Health Facilities Management Magazine
Publication Date: February 5, 2022
Authors: William J. Hercules, Diana C. Anderson, Stowe Locke Teti, David Deemer
View article

Excerpt:
“Johann Goethe, the 18th Century polymath, once remarked, “Architecture is frozen music,” by which he meant architecture interprets and expresses the values of its time — sometimes in a general epoch and sometimes at a very precise point. Experienced health care architects will appreciate this phenomenon, as current project drivers may have eclipsed those of decades past. It is in precisely this context that designers are studying the decisions and tradeoffs that result from these normative preferences.

In health care architecture, design is being increasingly employed to affect patient outcomes, alter specific behaviors and mediate the interactions of those within health care spaces. The advances in design science have progressed to the point that the built environment in health care can be considered akin to medical interventions. And, as with medical interventions, the nature, risks, benefits and alternatives should be disclosed to patients and caregivers.

The ethics of buildings and construction typically involve environmental impacts and social equity of the built environment. And while these are important, the focus of this article is on the health care setting itself and how it affects patients, families and health care teams. While some of these effects bear on individual patients, such that an informed consent process may be sufficient, others have a population-level impact that will persist for generations, well after the designer’s direct influence.

Focused work in medicine, neuroscience and psychology is being employed to several ends but, to date, there has been little investigation of these practices. This is because the elements affecting control are neither providers nor medications, but the health care facility building itself. Broadly, this raises issues about the nature of the built environment, what constitutes a medical intervention, what architecture is expected to do and, importantly, what obligations emerge from designers’ choices.”

Read the full article HERE.

Commentaries

Architectural Interventions in Healthcare: Ethical Challenges and Opportunities

October 14, 2021 / Dochitect / Health Design & Ethics

Presentations

Event: American Society for Bioethics + Humanities (ASBH) – Annual Meeting
Presentation type: Panel presentation & discussion
Presenters: Stowe Lock Teti, MA, HEC-C, Diana Anderson, MD, MArch, William J. Hercules, MArch, FAIA, FACHA, FACHE, David Deemer, MD
Date: October 14, 2021

Overview

The COVID-19 pandemic continues to provide salient examples of the built environment’s impact on disease morbidity and mortality. While design changes are being proposed to address various high-risk design elements like congregate living quarters, it is uncertain whether or not these changes will be ethically informed. Advances in architectural design and a growing understanding of its powerful effects on health outcomes suggest that healthcare environments should be regarded as medical interventions. This panel will explore the ethical challenges related to architectural design modifications aimed to mitigate disease spread and improve quality of life. Examples will be drawn from proposed changes to long term care facilities and hospitals, as both are confined environments in which vulnerable populations live, in which healthcare is provided, and in which organizations have a duty of care to persons inhabiting those spaces.

Ethical challenges discussed will include: isolation for disease control versus the necessity of human socialization and autonomy, risks posed to staff versus the necessity of care provision, and the relationship between institutional policy and the built environment in disease control and well-being. The panel will inspire and empower attendees from various backgrounds to host compelling discussions with healthcare leaders and clinicians on how to utilize the built environment to improve out comes in their organizations.

Learning Objectives:

Appreciate the increasing impact the healthcare built environment is having on health out comes.
Understand how t he built environment can help resolve t he conflicting obligations of isolation for disease mitigation and the need for socialization and autonomy.
Reflect on t he built environment as a dimension of duty of care.

Conference Presentations

Wolters Kluwer Health: Advances in Brain Health

October 12, 2021 / Dochitect / Design for Geriatrics, Health Design & Ethics

Presentations

Event: Advances in Brain Health, hosted by Wolters Kluwer Health
Panelists: José Biller MD, Jason Karlawish MD, Diana Anderson MD
Date: October 12, 2021

Panel Discussion: Advances in Brain Health

Please join us for an interactive discussion about new and evolving topics in the treatment of neurological diseases and new ways to consider the long-term health of your patients. Join experts as they discuss current topics in neurology, including:

Next steps in the diagnosis and treatment of Alzheimer’s
Long COVID and its relationship with neurological symptoms
Evidence-based design health impacts of the built environment in dementia and other neurological disorder

Panelists:

José Biller, MD, Professor and Chair, Department of Neurology, Loyola University Stritch School of Medicine, Loyola University Medical Center; Editor, Journal of Stroke and Cerebrovascular Diseases

Jason Karlawish, MD, Professor of Medicine, Medical Ethics and Health Policy, and Neurology, University of Pennsylvania; Co-Director, Penn Memory Center; Author, The Problem of Alzheimer’s: How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It

Diana Anderson, MD, M.Arch, ACHA, Founder, Dochitect, Fellow in Geriatric Neurology, VA Boston Healthcare System, Instructor of Neurology, Boston University School of Medicine

Moderator: Susan Dentzer, Senior Policy Fellow, Duke-Margolis Center for Health Policy, Duke University

Panel Discussions

Nursing Home Design and COVID-19: Balancing Infection Control, Quality of Life, and Resilience

October 11, 2021 / Dochitect / Design for Geriatrics, Design for Resiliency, Health Design & Ethics

Presentations

Event: American Health Care Association / National Center for Assisted Living (AHCA/NCAL) 2021 Convention and Expo, Washington, DC
Speakers: Diana Anderson MD M.Arch, Thomas Grey Dip.Arch.B.Arch.Sci.MArch., Desmond O’Neill MD
Date: October 11, 2021

Nursing Home Design and COVID-19: Balancing Infection Control, Quality of Life, and Resilience

Many nursing home design models can have a negative impact on older people, and these flaws have been compounded by COVID-19 and related infection-control failures. There is now an urgent need to examine these models and provide alternative and holistic models that balance infection control and quality of life at multiple spatial scales in existing and proposed settings. Moreover, there is an understanding that certain design models and approaches that improve quality of life will also benefit infection control, support greater resilience, and in turn improve overall pandemic preparedness.

3 Learning Outcomes:
Upon completion, participant will be able to:
1) explain the overall impact of the built environment on nursing home residents in terms of quality of life
2) understand the main built environment related infection control issues that have arisen during COVID
3) explain how certain design approaches and models can be use to balance infection control while improving quality of life

Conference Presentations

Jewish Hospital Foundation’s 2021 Patient Safety Fellowship: Ethics and Design in the Long-Term Care Setting

July 20, 2021 / Dochitect / Design for Geriatrics, Health Design & Ethics

Presentations

Event: Jewish Hospital Foundation’s 2021 Patient Safety Fellowship
Title: Ethics and Design in the Long-Term Care Setting
Date: July 20, 2021

The Jewish Healthcare Foundation’s 2021 Patient Safety Fellowship will offer a unique curriculum to explore the challenges and opportunities facing senior residential living and senior care. After the disruption of COVID-19, options for seniors must embrace creative solutions that help individuals age well and safely in a range of settings. Fellows, working across disciplines — including health care, public policy, public health, tech, architecture, and beyond — will explore existing and conceptional models for transforming our community and healthcare systems that maximize quality of life for seniors and families. New models of care need to be wired for safety, built for continuous improvement, and efficient for providers, seniors, and families.

As part of the 2021 fellowship program, Dr. Anderson lectured around design ethics in clinical and long-term care settings.

Lectures

Hastings Center Bioethics Forum: The Bioethics of Built Health Care Spaces

January 13, 2021 / Dochitect / Health Design & Ethics

Blog Post

Publication: Hastings Center Bioethics Forum
Title: The Bioethics of Built Health Care Spaces
Publication Date: January 13, 2020
Authors: Diana Anderson, Bill Hercules and Stowe Locke Teti

View Blog Post

It is time for the built environment to be considered alongside other parameters of care.

In recent decades, our understanding of the role the environment plays in shaping us and our interactions has expanded immensely. Researchers have examined the profound effect social and environmental factors can have on ethical behavior and decision-making. Yet, design choices in the built health care environment raise substantive bioethical issues that demand the attention of bioethicists and ethical inquiry.

Read the full essay HERE.

Blog Post

LiftOff 2020: Health Equity by Design

December 15, 2020 / Dochitect / Health Design & Ethics

Presentations

Event: Liftoff PGH 2020: A virtual healthcare innovation summit, Pittsburgh, PA
Title: Health Equity & Design / Panel discussion
Date: December 15, 2020

IKM Presents: Health Equity by Design
John Keelan, Dr. Diana Anderson, Juliet Rogers, Dr. Bon Ku

This panel explores the power of design to improve disparities in health. Panelists will upend current health care models, formulating systems that improve outcomes for all patients.

Conference Presentations

The Bioethics of Built Space: On the Shared Responsibilities of Bioethics and Architecture

October 16, 2020 / Dochitect / Health Design & Ethics

Presentations

Session Overview

Over the past fifty or so years, our understanding of the role the environment plays in shaping us and our interactions has expanded immensely. Studies of social determinants of health have illuminated profound effects social factors and environment can have on medical outcomes and well-being. Studies of behavior have demonstrated the powerful effect environmental factors can have on decision-making. It is somewhat surprising, therefore, so little attention has been paid to the bioethics of the built environment in healthcare. We all know intuitively that the spaces we spend time in affect us, and while some intrepid healthcare architects have been exploring the power of environmental factors on behavior for decades, virtually none of this terrain has been contemplated in bioethics.

The physical environment in healthcare architecture has been associated with numerous quality and outcomes issues. As we will show, design choices can result in substantive ethical issues for not just the marginalized and vulnerable, but all of us, leading some to call for a shared decision-making in healthcare architecture that mirrors the movement in clinical medicine. In this panel discussion, we will begin by outlining a series of ethical issues in healthcare design, including the use of illusion, living laboratories, and the prevention or imposition of harm through design. We then examine the state of research practices in healthcare architecture: what has been accomplished, what hasn’t, and the challenges that lie ahead. We conclude by inviting the audience to discuss the role of bioethics in healthcare architecture.

Learning Objectives – At the end of this session, attendees will be able to:

Discuss the role the built environment plays in wellbeing and medical outcomes and provide several examples.
Be familiar with some of the most pressing ethical issues arising out of design decisions in healthcare architecture and be able to describe both evidence-based considerations and theoretical concerns.
Articulate the state of research in healthcare architecture, discuss the challenges of implementing modern research practices in ongoing and future work, and the benefits of solving the issues involved.

Conference Presentations

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