How we treat people at the end of life has been described as a measure of our humanity. Good care is a sign that we regard all life - of whatever chronological age - as sacred and deserving of respect. Medical staff, patients and their relatives can be heartened, therefore, by a gentle revolution taking place across 40 hospitals, fuelled by the Hospice friendly Hospitals (HfH) programme of the Irish Hospice Foundation.
The programme, which has been assisting hospitals to develop policies and implement best practice in dealing with death, dying and bereavement, has now released draft design and dignity guidelines relating to the physical environment of hospitals. These are open to public consultation and are aimed at ensuring that as we die, our dignity and that of relatives and staff, is enhanced by a hospital's physical surroundings.
Of the 30,000 or so people who die each year, 60 per cent do so in hospitals. There is a strong relationship between the physical environment and health care. It is vital therefore that superior designs are used in the building and refurbishment of hospitals. Indeed, there is a growing view that single rooms should become the norm, even if only to cut infection rates. While some patients will have such provision in their final days, it is outrageous that many pass away in bustling crowded wards, at only arms length from the next bed, and with little privacy except a curtain. It is unconscionable that there is often little space for relatives at the bedside, that intimate family conversations are impossible, and that our last hours can be intruded upon by unpleasant sounds and smells.
All hospital users benefit from good design, providing access to views, gardens and sunshine, where way-finding is facilitated by excellent signage and where art is integrated into the building. Arrival, seating and waiting areas, entrances, reception, patient accommodation, meeting and therapy rooms, mortuaries and car parks, can all enhance or diminish well-being.
The HfH draft guidelines and the pending Health Information Quality Authority standards and inspection system for nursing homes are pivotal moves in social care. Meanwhile the HfH continues to co-operate with hospitals in their development of hospice principles. As well as design issues, they are grappling with communications, bereavement support, the needs of different cultures, religious services, the relaying of bad news, and literature, all of which can impact on whether we have what is called a good death.