Health Design & Ethics

When Deception Promotes Dignity: The Ethics of Using Illusion to Create Safe Spaces for Persons Living with Dementia

February 14, 2025 / Dochitect / Design for Geriatrics, Health Design & Ethics

Peer-reviewed publication

Publication: The International Journal of Whole Person Care
Publication Title: When Deception Promotes Dignity: The Ethics of Using Illusion to Create Safe Spaces for Persons Living with Dementia
Authors: Teti SL, Deemer DA, Hercules WJ, Anderson DC
Date: February 14, 2025

Abstract

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Caring for persons living with dementia (PLWD) is challenging. Some of the most challenging aspects include managing behavioral and psychologic symptoms of dementia (BPSD). Many patients and families will consider dementia care facilities to better manage BPSD, which can contain design elements that use the physical environment to decrease BPSD by deceiving residents and controlling their behavior—all for their own benefit and safety. This immersive approach to behavior management represents a more holistic way to manage BPSD. Considering the especially vulnerable status of PLWD, these design elements should be thoughtfully implemented, researched post-implementation, and discussed with patients and their loved ones. The design-based approach to managing BPSD demonstrates the obligation healthcare providers and facility designers have to be more holistic in designing care environments for PLWD, especially for those living in dementia care facilities.

Read the full article HERE.

Peer-Reviewed Publications

Who Should Contribute to Decisions About Health Care Space Design?

December 1, 2024 / Dochitect / Health Design & Ethics

Peer-reviewed publication

Publication: AMA Journal of Ethics – American Medical Association
Publication Title: Who Should Contribute to Decisions About Health Care Space Design?
Authors: Anderson DC, Teti, SL
Date: December 1, 2024

Abstract

This commentary on a case considers how and by whom decisions about health care structures and spaces should be made and suggests merits and drawbacks of shared decision-making as one approach to Certificate of Need assessments.

MD Anderson Ethics Seminar: Research, Design & Ethics: A New Frontier Across Multiple Domains

December 11, 2023 / Dochitect / Health Design & Ethics

Presentations

Event: MD Anderson Cancer Center, Houston, TX – Ethics Seminar
Presenters: Stowe Teti, Diana Anderson, William Hercules, David Deemer
Date: December 11, 2023

Bioethics of Built Space

Decisions made in health care architecture have myriad effects on patients, families, and staff. Design is being employed increasingly often to alter specific behaviors, mediate the interactions of those within the health care spaces, and affect patient outcomes.

We propose that advances in design science and understanding of its powerful effects are now such that, in some instances, the built environment in health care should be considered analogous to a medical intervention. As with medical interventions, the intentional use of the built environment to effect perceptual and behavioral changes in patients or residents should be appropriately disclosed, as should harms caused by a building itself. But while some of these effects bear on individuals such that an informed consent process may be sufficient, others have population-level impacts that can persist for generations.

This presentation explores issues related to transparency, informed consent, surrogate authority, and describes the need for further empirical research into the implementation, efficacy, and ethics of these interventions.

Conference Presentations

AMA Journal of Ethics: How Should Organizations Be Held Accountable for Promoting Environments That Foster Social Connection?

November 1, 2023 / Dochitect / Health Design & Ethics

Peer-reviewed publication

Publication: AMA Journal of Ethics
Publication Title: How Should Organizations Be Held Accountable for Promoting Environments That Foster Social Connection?
Authors: David A. Deemer, MD, MA, Erin K. Peavey, MArch, Stowe Locke Teti, MA, William J. Hercules, MArch, Jocelyn Wong, MBE, and Diana C. Anderson, MD, MArch
Date: Online Nov 1, 2023

Abstract
Growing familiarity with health risks of loneliness and isolation underscores the importance of social connection in patients’ lived environments and communities. Deficits in social connection are linked to poor cognitive, mental, and physical health and premature death. Design interventions for physical environments—structures, spaces, and soundscapes, for example—can foster social connection, support, and resilience. This article canvasses urban interventions that can support human health investment and development. This article also suggests that designers of community policies, programs, structures, and spaces should be accountable for promoting social connection to help generate measurable health outcomes, such as longevity.

Click HERE to access the full article.

Peer-Reviewed Publications

McGill School of Architecture Brown Bag Lecture Series: Medicine and Architecture Integrated

March 21, 2023 / Dochitect / Evidence-Based Design, Health Design & Ethics

Presentations

Event: McGill University School of Architecture – Brown Bag Lecture Series
Title: Medicine and Architecture Integrated
Date: March 21, 2023

Dr. Anderson was invited to speak to architecture students as part of the Winter 2023 Brown Bag Lecture Program.

Lectures

Harvard Medical School Center for Bioethics: If Architecture Influences Health Outcomes, How Should Healthcare Systems Respond? Bioethics at the Frontier of the Science of Design

January 20, 2023 / Dochitect / Health Design & Ethics

Presentations

Event: Harvard Medical School Center for Bioethics, Organizational Ethics Consortium
Title: If Architecture Influences Health Outcomes, How Should Healthcare Systems Respond? Bioethics at the Frontier of the Science of Design
Date: January 20, 2023

To register for the event or for more information click HERE.

Lectures

UT Southwestern Ethics Grand Rounds: Exploring the untapped nexus of ethics and health facility design

January 10, 2023 / Dochitect / Health Design & Ethics

Presentations

Event: University of Texas Southwestern Medical Center Ethics Grand Rounds
Title: Exploring the Untapped Nexus of Ethics and Health Facility Design
Date: January 10, 2023

Architecture inherently reflects the normative preferences of its time. This certainly applies to healthcare architecture, where design concepts have intentional and decades-long effects on patients, families, and staff. Employing healthcare architecture to alter behaviors, mediate interpersonal interactions, and affect patient outcomes make it an ethical matter. We propose that advances in design science and our understanding of its powerful effects warrant a shift how we think about space, and that the built environment in health care is analogous to a medical intervention. As such, all responsible stakeholders should openly discuss and thoroughly scrutinize the intentional use of the built environment to affect perceptions and change behaviors of patients, residents to a similar standard as conventional medical therapies. We highlight prominent examples of such architectural interventions, analyze their implementation, and offer perspective on how medicine and architecture can create ethically responsible spaces.Read more about the ethical aspects of healthcare facility design HERE.

Lectures

HERD Editorial: Evidence, Bioethics, and Design for Health

May 5, 2022 / Dochitect / Health Design & Ethics

Peer-reviewed publication

Publication: Health Environments Research and Design
Publication Reference: 2022, Vol. 15(2) 13-21
Author: Hamilton, DK

Editorial Excerpt

I like to tell my students that if there is compelling evidence that if design can improve clinical outcomes and patient safety, then healthcare architects have a moral and ethical responsibility to utilize such evidence. This is only a small step beyond every licensed architect’s obligation to protect the health, safety, and welfare of the public. Similarly, I propose that if credible evidence links design and outcomes, institutional boards and their executives have a moral obligation to engage architects, engineers, designers, and consultants who can and will effectively use such evidence

My colleague, Ray Pentecost, recently told me of a set of conversations he was having with friends about bioethics and responsibility as related to design evidence. It is a self-initiated, multidiscipline, and regionally distributed group including architects, physicians, and ethicists. The group’s overall focus adds a bioethics lens to the application of evidence in the health design field. They have been working for more than 2 years at the intersection of healthcare design and bioethics in order that healthcare environments and the way they are experienced can be markedly improved. The group perceives that despite well-intentioned healthcare administrators, architects, physicians, and others, the idea of connecting a strong, common ethos to a data-driven framework and research informed design for health has been slow to develop in comparison to other professions. Their ideas have slowly grown based on dialogue, publications, and presentations.

Pentecost (2022a) has produced an HERD guest editorial about the Union Internationale des Architectes Public Health Group (UIA/PHG) declaration of 2022 as the Year of Design for Health in our last issue. The group has an article published in Health Facilities Management (Hercules et al., 2022) and a piece in the Hastings Center Review (Anderson et al., 2022) and blog (Anderson et al., 2021). Hearing of their conversations led me to want to hear more. We arranged for some conversations on Zoom to further explore their ideas.

Figure 1. January 9, 2022, L to R, top to bottom; Hercules, Hamilton, Deemer, Pentecost, Anderson, Guenther, and Teti.

Read the full editorial HERE.

Peer-Reviewed Publications

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

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