Design project grants dignity and grace to end-of-life care

Gabriel Byrne is heading a practical hospital plan to help make the unbearable as calm and comforting as possible

Gabriel Byrne

HOW will you die? And where? When I was a child, I was taught to pray for a happy death. Implicit was the notion that it would be at home, surrounded by loved ones, having made peace with the world. But the reality is that although most of us would prefer to die at home, seven out of 10 of us will die in some form of care institution, and a fair percentage will die in an acute hospital. And even though we are living longer, and treatment options are expanding, those percentages will remain more or less as they are.

Some years ago I attended the bedside of a friend who was dying in a Dublin hospital. She lived her last hours in a public ward with a television blaring out a football match, all but drowning our final conversation.

I looked around this depressing place, with the cheap curtain separating her from other patients, walls painted nondescriptly institutional, the awful food, the ubiquitous smell of disinfectant mixed with human odour, and I began to think about the physical environment in which we might spend our final hours, that space which – as the late Seamus Heaney said – is "emptied" and "pure change" happens.

I have since come to believe that in hospital aesthetics are as important as function, that both are in fact closely linked. And that an aesthetic environment automatically leads to good practice and better care.

Environment affects recovery in fundamental ways. We register it on both the conscious and unconscious level. Hospital decor tends to be monochromatic. Staff wear white (to indicate sterility), and work in rooms that are white or off-white. Hospitals can be noisy places, trolleys being wheeled, hallway conversations, TV sets on different channels adding to the cacophony. Textures tend to be hard. Concrete walls, stainless steel surfaces. There is little for the senses to draw comfort.

But austerity can be offset by the simple awareness of the power of the sensory. It is well known that colour influences mood. Red, for example, raises blood pressure – yet green and blue are both calming.

The hospital also tends to be a place of long corridors and high ceilings, but judicious placing of furniture and decoration can help create a more intimate space. Art and photographs can take us to a more tranquil place and engage the imagination in powerful ways.

Think about how sound in everyday life can make us feel agitated or serene. Sound has a direct effect on energy and mood, as we well know from listening to music. Light is acknowledged as a prime animator of space – it changes physiology and perspective and affects neural transmitters in the brain. Over 1,000 years ago monasteries were creating elaborate gardens to bring succour to the ill. There is considerable research that indicates restorative effects are manifested and there is a subsequent change in blood pressure, heart activity, and muscle tension when we are exposed to benign sensual stimuli.

The emphasis on infection reduction and functional efficiency shape the design of the modern hospital, but this is very often unsympathetic to the emotional needs of the patient.

Hospital food is usually bland, overlooked and lacking in nutrition. Poor nutrition, as we all know, is a major contributor to illness and hospitals are often the biggest restaurant in town. There seems to be a huge disconnect between our knowledge of diet and its application to the ward. A recent report in Britain revealed that 82,000 meals were thrown away uneaten every day and that 70 per cent of staff would not eat the food served in hospital.

Regarding end-of-life care in particular, the Irish Hospice Foundation (IHF) is currently working on a project called Design & Dignity. It is a wonderfully practical project, offering financial support and design expertise to improve interior and exterior space in our hospitals. Colour, lighting, artwork, acoustics, fabrics, furnishings, structural materials and planting are all part of the larger mosaic of end-of-life care which help lessen stress and loneliness and make the unbearable as full of grace as possible.

Our aim is to fund exemplar projects in public hospitals either through "new build" or with imaginative retrofitting. Already we have succeeded in creating spaces such as family rooms that are tranquil and private in those moments of the first and overwhelming grief.

Our guidelines, launched five years ago by myself for the IHF, are being implemented at 11 hospitals – development projects at three hospitals are complete and work continues on another eight projects all over the country.

All those who heroically work in end-of-life care understand that a committed focus on dying with dignity becomes self-sustaining, as the principles are embedded in the sensitive environment created.

Many of our hospitals have few facilities for the bereaved or provision for different religious traditions. Many mortuaries are grim and dilapidated. The very place where death occurs will never be forgotten by those who are witness and it should retain an importance as a sacred place.

We have an opportunity here to initiate a simple but powerful concept which will be a prototype not just for Ireland but for the rest of the world. Let us, as Colum McCann has written, be the forerunners of some sort of new link between the living and dying.

Our earthly journey is the only one we can be certain of. I believe that by preparing for a good death, we can live a better life.

Gabriel Byrne is patron of the Irish Hospice Foundation, which is currently raising funds for the Design & Dignity projects;