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How we can give dignity to death

You agree that we need to design better ‘rooms for dying in’. What comes next? writes Christine Murray

I would like to thank you for your response to last week’s Leader on my cousin and his room in an Italian hospice. I was grateful for the condolences, and the assurance that I wasn’t the first to feel there is a lack of dignity in the design of hospital rooms for the terminally ill.

In your messages, you shared personal stories of waiting for death in cramped, noisy rooms with ‘factory’ lighting and no views, and how stressful these environments were for both the family and the dying.

Two architects also wrote in to say that they are currently designing hospices, and asked for photographs of my cousin’s room as an exemplar to show clients. I didn’t take any photographs, but we pictured the Maggie’s Centre, Cheltenham by MJP Architects on this page last week because, although it is not a hospice, its bespoke domestic finish is aesthetically similar to my cousin’s facility in Italy.

Palpable in the dozen or so comments I received (more to be published next week) was the call for a revolution in the design of these ‘rooms for dying in’ – and the certainty that architects could significantly improve the quality of hospice care in this country.

The call for home-like environments in hospitals is not unprecedented. Over the past decade, there has been a complete overhaul in the design of birthing centres – most London hospitals now have dedicated suites designed to set expectant mothers at ease through the inclusion, to varying degrees, of a domestic aesthetic. At the recently completed birth centre at Homerton University Hospital this includes timber floors, curtains and double beds.

According to a paper published in the Cochrane Review, this substantial NHS investment in maternity wards should pay off. A study of 10,684 women revealed that giving birth in a home-like setting significantly reduced the need for medical intervention and pain medication, while showing no adverse effects and increasing maternal satisfaction. From a hospital point of view, less medical intervention means less cost per delivery – in other words, the investment in design showed real and exceptional value for money. Take that, Mr Gove.

I could not find a study of significant scale on the effect of a home-like environment on the terminally ill. But the logic follows that it would show similar results – less reliance on pain medication, a reduction in anxiety, a happier death and a comforted family. As ORMS director John McRae, who designed treatment centres for the Teenage Cancer Trust, comments on the AJ website, ‘It is frustrating that the NHS does not fully embrace the benefits that great patient spaces can make; it would save money in the long term.’

The week after the Budget is perhaps not the best time to launch a campaign calling for the NHS to invest in ‘rooms for dying in’. Then again, if we start now, perhaps we can make inroads by the time the government is willing to spend. Where to begin?

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