“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.”
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