Until this week, I hadn't really thought much about bioethics. Or bioethics in healthcare architecture and design.
Often associated with the ethical implications of biological research and applications in medicine, bioethics is defined by the Hastings Institute as "the interdisciplinary study of ethical issues arising in the life sciences, healthcare, and health and science policy."
What does this have to do with healthcare architecture and design?
Design Decisions Impact Patients
I found the answer to that question from David A. Deemer, M.D., who was the guest this week on a Clubhouse discussion moderated by Angela Mazzi and Megan Mazzocco as part of the Architecting club's weekly "Architects as Healers, Buildings as Medicine" dialog. (If you don't know what Clubhouse is, check out my post about it.)
It's kind of complicated, but Dr. Deemer, a bioethicist and internal medicine resident at the University of Wisconsin Madison, believes that because the decisions healthcare designers make about facility design have an impact on patient outcomes, they have ethical obligations to fulfill. And although there are several schools of thought about bioethics principles, he thinks these three from a credible report on the discipline relate to facility design:
- Respect for persons: Individuals should be treated as autonomous agents and that people with diminished autonomy are entitled to protection.
- Beneficence: Individuals are treated in an ethical manner not only by respecting their decisions and protecting them from harm, but also by making efforts to secure their well-being.
- Justice: About who should receive the benefits of research and bear its burdens, in the sense of "fairness in distribution" or "what is deserved."
The other concept, which Dr. Deemer and his colleagues wrote about earlier this year, is the idea of architecture and design as a medical intervention.
I feel like this is what we've been talking about since the early days of The Center for Health Design (CHD) and the evidence-based design movement. CHD defines evidence-based design is a "process of basing decisions about the built environment on credible research to achieve the best possible outcomes."
That's right in line with the three bioethics principles stated above. So, yes, healthcare architecture and design does involve bioethics.
Here's an example.
Some design interventions in memory care facilities that help prevent Alzheimer's patients from wandering have bioethic implications. But, as Dr. Deemer pointed out, removing windows so they can't see outside and want to go there or using a black mat in front of a doorway because it looks like a hole they don't want to fall into may not be best for the patient.
No one shouldn't be able to look outside. Or be afraid to fall in a hole.
What's New is Old
The notion of designing facilities to protect people from harm is not new. But designing facilities with the three bioethics principals in mind is new.
However, one of the challenges of bioethic design is that architects and designers are working on behalf of their clients and not necessarily for the public. So is it the responsibility of architects and designers to educate their clients about bioethics?
Dr. Deemer thinks so. But he also thinks that the way forward for bioethic design (my term, not his) is a multi-disciplinary approach that may involve discussions between project teams, hospital-based ethicists, institutional review boards, and executive leaders.
It strikes me that Florence Nightingale might have been the first bioethic healthcare designer. In her "Notes on Hospitals" published 1859, she wrote, "It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm."
That we are still talking about and defining what this means is good. Because the past informs the future.
Check out these articles:
- Evidence, Bioethics, and Design for Health, HERD Journal, May 5, 2022.
- Exploring the World of Architecture and Bioethics, Health Facilities Management, February 8, 2022.
- The Bioethics of Built Health Care Spaces, The Hastings Center, January 13, 2021.
And if you want to listen to the conversation on June 6, 2022 with Dr. Deemer on Clubhouse, download the app, create an account, find and become a member of the Architecting Club, and listen to the replay (sounds complicated, but it isn't).