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.

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.

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.