2010 Sample Brief
Designing For Death: Hell, Purgatory and Paradise
End of Life Care Strategy, Department of Health Executive Summary, 2008
Guide to the 2010 Example Brief & Submission Material
Suggested Areas ofo Research
Example Topics/ Projects
Collated Suggested Study Material and Credits
DESIGNING FOR DEATH: HELL, PURGATORY AND PARADISE
The 2010 competition introduces a greater emphasis on the sample brief; designing for Death: Hell, Purgatory and Paradise. A specific prize will be awarded for the most successful response to the sample brief. The brief is not prescriptive, instead we are presenting the topic for investigation and the onus is on the student to develop a relevant proposal.
The sample brief process was introduced in the 2008 competition to make it possible for students without suitable projects to elect to enter the competition. We advise that students that are not using the sample brief also review the document to inform how they prepare their own submission.
Evolution of the Brief
The organisers owe a debt of gratitude to Professor Bas Molenaar of TU Einhoven for informing the topic of the 2010 brief. The proposal evolved from one of his student briefs, a Placebo Hospital. In the Placebo Hospital the Drugs don’t work and the staff are not trained, consequently the building and its environment are the only elements that can influence healing. In discussing how we could evolve the brief for use in the competition we examined conditions that could place contrasting demands on a physical environment, and therefore could conjure an architectural position and response. It was Dr Patrick Hutt that suggested using Death.
… because it’s common, and also a condition that is poorly dealt with in hospital buildings. If anything, it’s a key facility where the building plays an explicitly healing role. There needs to be room for admissions, and also short stays for people needing respite from time at home. While there is an argument for allowing more people to die at home, there are still many who for a number of reasons feel unable to do this. Palliative care is also a highly medical field, with the need to consider analgesia and treat those things which can be treated.
Death and the management of it are processes for which there is not necessarily an established pattern or template. As a subject many find it uncomfortable to discuss or consider and it can be treated with embarrassment. Anecdotally society is not always as shy to engage with the topic; a fellow healthcare architect remarked once:
‘At the Community Care Centre which I helped design I heard that on one or several occasions they would dress the body and leave it in a bed on the ward for a few hours so that everyone there could pay their last respects. This always struck me as being very dignified and considerate. I have heard that this was traditionally done in working class communities so that the neighbours could do the same before the undertaker came.’ By contrast I have encountered other anecdotes alleging that NHS hospital patients in multi-bed bays have had to notify nurses that a patient in the same bay has died without them knowing. More commonly the deceased is removed from there bed, leaving the patients sharing the room with the only notification of their neighbours passing away being the vacated and remade bed.
A hospital should be a good place to die but so often it is not. Can we do more to address the process of dying with dignity in hospitals which is where most people ( statistically) now die, how can dying at home be assisted, or maybe there is a missing building typology to be defined?
Definition of Physiological Death
Physiological death is now seen as less an event than a process: conditions once considered indicative of death are now reversible. Where in the process a dividing line is drawn between life and death depends on factors beyond the presence or absence of vital signs. In general, clinical death is neither necessary nor sufficient for a determination of legal death. A patient with working heart and lungs determined to be brain dead can be pronounced legally dead without clinical death occurring. Precise medical definition of death, in other words, becomes more problematic, paradoxically, as scientific knowledge and technology advance.
The Placebo Hospital
‘Architecture should defend man at his weakest’ Alvar Aalto
Continuing the theme of the Placebo Hospital, a successful project should focus on how the architectural environment addresses the needs of the user (or patient) and the information discovered through research and not the accommodation of medical function. The drugs are replaced by space, light, materiality, views, smell, degree of privacy, interaction and accommodation of custom. Students are advised to look beyond cliche and focus on the detail of how space, and its qualities, can effect state of mind.
END OF LIFE CARE STRATEGY, DEPARTMENT OF HEALTH, EXECUTIVE SUMMARY, 2008
Extract From Executive Summary:
1. Around half a million people die in England each year, of whom almost two thirds are aged over 75. The large majority of deaths at the start of the 21st century follow a period of chronic illness such as heart disease, cancer, stroke, chronic respiratory disease, neurological disease or dementia. Most deaths (58%) occur in NHS hospitals, with around 18% occurring at home, 17% in care homes, 4% in hospices and 3% elsewhere.
2. The demographics of death in relation to age profile, cause of death and place of death have changed radically over the course of the past century. Around 1900 most people died in their own homes. At that time acute infections were a much more common cause of death and a far higher proportion of all deaths occurred in childhood or early adult life.
3. With these changes, familiarity with death within society as a whole has decreased. Many people nowadays do not experience the death of someone close to them until they are well into midlife. Many have not seen a dead body, except on television. As a society we do not discuss death and dying openly.
4. Although every individual may have a different idea about what would, for them, constitute a ‘good death’, for many this would involve:
Being treated as an individual, with dignity and respect;
Being without pain and other symptoms;
Being in familiar surroundings; and
Being in the company of close family and/or friends.
5. Some people do indeed die as they would have wished, but many others do not. Some people experience excellent care in hospitals, hospices, care homes and in their own homes. But the reality is that many do not. Many people experience unnecessary pain and other symptoms. There are distressing reports of people not being treated with dignity and respect and many people do not die where they would choose to.
6. How we care for the dying is an indicator of how we care for all sick and vulnerable people. It is a measure of society as a whole and it is a litmus test for health and social care services.
7. In the past, the profile of end of life care within the NHS and social care services has been relatively low. Reflecting this, the quality of care delivered has been very variable. Implementation of this strategy will make a step change in access to high quality care for all people approaching the end of life. This should be irrespective of age, gender, ethnicity, religious belief, disability, sexual orientation, diagnosis or socioeconomic deprivation. High quality care should be available wherever the person may be: at home, in a care home, in hospital, in a hospice or elsewhere.
GUIDE TO THE 2010 EXAMPLE BRIEF & SUBMISSION MATERIAL
This brief is intended to give inspiration and offer some direction for study, we do provide suggested building types later in the brief but acceptable submissions are not limited to the types suggested. If you are unsure whether your project complies please read this entire brief and then refer to the FAQ/Help of this site.
Students are expected to:
- Study existing systems; investigate the process of dying in different contexts and eras including the present in your chosen country of study
- Compare and contrast different settings and observations
- Take a position based on your research and clearly define it
- Drawing on your research elect to design a building or part of a building of your choice. The building may or may not be a Hospital.
Submission material suggestions:
- Diagrams to present research
- The use of models will be appreciated (photographs to be submitted*)
- 3d virtual models are very useful
- Collages are good for describing texture and materiality
- We suggest selecting a traditional architectural drawing type (section, plan, elevation or axo) and using it to generate a ‘super-drawing’ that will capture many aspects of your proposal.
- Drawings – various media and multi-media
(* Physical models can be displayed at the award event but will not contribute to judges assessments)
MANDATORY SUBMISSION REQUIREMENTS:
- Separate 300-600 narrative document (Strictly no images, in English, MSWord or txt format) describing the design brief and the proposal
- 4 number A3 landscape PDF or JPG graphics (text and Images @ 300 dpi)
- Please clearly state your name and project title and institution on every submission page
- Within the brief include the stage of studies (e.g. RIBA part 1, RIBA part 2 or equivalent year of study in the country of study) at which the project was completed
SUGGESTED AREAS OF RESEARCH:
The following is a list of potential avenues to inspire student investigation.
Results generated by searching the word ‘Death’ on the NHS website:
We invite students to explore all aspects that impact upon the manner in which dying is planned for and managed within institutions and society. How are the human rights of the individual addressed and how can dignity of those surviving the deceased be protected?
Organisations supporting voluntary euthanasia and physician assisted suicide defend the right to decide when your life will end in order to preserve dignity and the rights of the individual.
Dying with Dignity is an organisation set up in Portland, Oregon to defend and educate upon the law set up in Oregan which made it the first state where physician assisted suicide was legalised. The link contains personal accounts of deaths of family members and friends and as such are emotive and should be considered within the context of the source.
Modern Britain is an extremely diverse society. How is the spectrum of religious and traditional practices prior to and after death assisted or restricted within the complex system of a modern hospital? How is grieving supported traditionally and how could our institutions be informed by this?
What role does a multi-function faith space in a hospital perform? What role could it play?
There has been much coverage of the court appeal concerning the desire of a Hindu man to be cremated on a funeral pyre which had been ruled against on grounds of contravention of the Cremation Act of 1902. Although this concerns posthumous rites it does serve as an example of how religious rites can appear to be at odds with perceived modern practicalities.
Consider the euphoric dancing that follows the sombre march of a Dixieland funeral procession in New Orleans. Mourning and celebration of life. (Apologies for the apparent glibness of this link, it is a very 1973 British interpretation but it does demonstrate the custom aptly)
Architecture and Death
This brief is primarily concerned with the normality and personal aspect of dying. The application of architecture to the extensive subject of death is varied and complicated. As a result the architectural references within this brief are deliberately limited. The examples below are fundamentality concerned with the rituals after death. They might suggest an appropriate style or language, which may or may not influence a proposal when considering the journey taken by a patient nearing death and the experiences of those surviving them after.
skogskyrkogarden Cemetery, Gunnar Asplund and Sigurd Lewerentz : http://www.skogskyrkogarden.se/
Sir John Soane and the Furniture of Death:
Palliative Care, Supportive Care and Hospice Care
The National Council for Palliative Care defines palliative care thus:
Palliative care is the active holistic care of patients with advanced progressive illness. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of the illness in conjunction with other treatments.
- Palliative care aims to:
- Affirm life and regard dying as a normal process
- Provide relief from pain and other distressing symptoms
- Integrate the psychological and spiritual aspects of patient care
- Offer a support system to help patients live as actively as possible until death
- Offer a support system to help the family cope during the patient’s illness and in their own bereavement
- A project that investigates and makes proposals on the aspects of palliative care concerning dying would be an appropriate response to this brief.
St Christophers Hospice in Sydenham was founded in 1967 and was the first hospice to link expert pain and symptom control, compassionate care, education and clinical research. St Christopher’s has been a pioneer in the field of palliative medicine, which is now established worldwide. Architecturally it is modest and sympathetic to function. In contrast the Maggies’ Cancer Centres are proud and bold in their approach.
Letchworth Manor, By Clare Pollard
(Commissioned by the Sue Ryder Care)
This is a human place. You’re here. Breathe out.
We’ll take the path up the door.
Ducklings criss-cross it, heads high, eyes
hungry for grass, water and skies,
one less than yesterday, but still mad-brave.
There are foxgloves, chives and lavender’s proud spikes;
peach roses are full open, blown,
and terribly beautiful.
In the day centre, kind hands serve tea and homemade cake,
snip-snip at fringes, rub poor toes with soothing oils.
In a light space full of beads and paint and glue,
an ex-army man’s taught
to twist a paper flower;
a new friend solves the clue to six across.
There’s been a party on the lawn, balloons
still jerk on strings,
white, pink, blue, green and red –
a day or two of joy still left.
Elsewhere, a man listens to the words for pain;
prescribes all that can be done.
A hand is pressed. People are saying: love, love, love,
and on the terrace, sun sets.
Some days you can see the Black Mountains from here,
but not today.
Only ducklings break the calm with their wild quacks,
and there’s a scent of rosemary –
like sadness mixed with something
new and clear and H1.
United Kingdom Death Statistics
We have included a link at the end of this document to the most recent UK government death statistics which will be useful when considering UK based projects but will be misleading when considering countries outside the UK.
Circulatory diseases (which include heart disease and stroke) have remained the most common cause of death in England and Wales over the last 90 years among both males and females, with the exception of 1918 to 1919.
Male death rates from circulatory disease are higher than those for females: 312 per 100,000 males and 194 per 100,000 females in 2002. Within these, death rates from heart disease were higher than stroke among both males and females.
Cancers are now the second most common cause of death among males and females. Female cancer mortality rates decreased during the 1940s and 1950s, then rose to a peak in the late 1980s, declining again during the 1990s. Among males the pattern was different. Rates increased substantially to the late 1970s and then declined more rapidly from the 1990s.
Death rates for infectious and respiratory diseases declined in the first half of the 20th Century, although the 1918-19 influenza pandemic claimed the lives of 152,000 people in England and Wales alone and 20 to 50 million people worldwide. In the last 50 years death rates from circulatory diseases decreased more rapidly.
Mortality rates by cause of death vary with age and sex. In 2002, for young people aged 15 to 29, mortality rates were highest for injury and poisoning (41 per 100,000 population for men and 10 per 100,000 for women).
In adults aged 30 to 44, the major cause of death differed for men and women. Injury and poisoning was the leading cause of death for men (45 per 100,000 population) and cancers the leading cause of death for women (32 per 100,000 population).
For those aged 45 to 64, cancers were the leading cause of death among both men and women, with mortality rates of 245 per 100,000 for men and 218 per 100,000 for women. Injury mortality rates among men aged 45 to 64 were lower than for those aged 15 to 29 and 30 to 44.
In older people aged 65 to 84, circulatory diseases were the leading cause of death, for both men and women, although rates for all the causes shown in the table were higher than those at younger ages. The highest mortality rates were in people aged 85 and over, with circulatory diseases having the highest rates followed by respiratory diseases and cancers.
Death in a Hospital
Proposal for the patient-path through an acute hospital demonstrating how your architectural proposals effect, anticipate and support the process. All aspects relating to the process of dying should be considered, including:
- Consider conditions and the causes of death – you may choose to focus on one disease
- Ward Space – If the existing condition is Multiple bed how can this be addressed?
- Bedroom Space – If the preferred solution is Single bed rooms how should they be designed? Refer to HBN 04-1 Inpatient accommodation:
- The wider hospital neighbourhood to an ailing patient
- Visitors and family – private consultation spaces
- Fellow patients/friends made on the ward
- The removal and movement of the body after death
- The mortuary (focus on none medical aspects). Refer to HBN 20:
- Spaces for Faith/Multi-Faith
The Health Building Notes (HBNs) are expensive and AfH do not expect students to purchase copies. Architectural practices working in healthcare will have copies and may be willing to give access for study. Copies can also be accessed at the RIBA library at Portland Place (access possible with Photo-ID). We are currently arranging for a range of HBNs to be made available at the desk at the library, please mention the purpose of your visit to the librarian. Students submitting from outside of the UK without access to either of these resources are advised to research locally relevant guidance.
If you choose an existing hospital please demonstrate how you intervention works within it and how it differs from the existing system.
Community Setting: Dying at Home
Design a community based system to support dying at home or a domestic setting.
Your research may point towards developing the possibility for people to die nearer there homes and families, through a new community building typology or intervention into the home and domestically available services. Any such proposal must be supported by research.
Consider conditions and the causes of death – you may choose to focus on one disease, condition or cause of death.
This may lead to the least traditionally ‘architectural’ solution, and may instead rely on the description of a mapped urban system, but we suggest that efforts should be made to bring the project back to spatial and architectural interfaces by consisering the placebo hospital idea introduced earlier in this brief.
We recommend that a student wishing to design a Hospice related building should obtain a copy of Modern Hospice Design by Ken Worpole;
It can be purchased and partially previewed via this website:
Although a ‘statement’ building relying on accepted practice will be acceptable, the judging panel will be guided to reward innovative and challenging design responses to research, which may not be strictly ‘practical’ if argued for robustly.
Consider conditions and the causes of death – you may choose to focus on one disease
It would be interesting to investigate the typology of a hospice within a context and how it integrates with the surrounding community
Other suggested reading – National Care Standards: Hospice care: Revised September 2005ISBN 0 7559 47452. Scottish Executive
Other streams of research and proposal could be, and not limited to:
Death in a Disaster
The management of severe injuries, death and maintaining dignity within a disaster zone: Imagining the architectural response when the existing system breaks down or is under severe stress. If a student chooses to pursue this direction they must bear in mind the placebo hospital angle; medication must be disregarded with focus on the construction, the space and its qaulities.
BBC coverage of the Haiti Eartquake disaster by the BBC:
Image credit: Makeshift tents the day after the earthquake
Photograph: Logan Abassi/MINUSTAH/Getty Images
The UK has an increasing Nursing home population. A greater number of people will die while living in a Nursing Home.
When the two psychologists set up the experiment so that residents on two floors of the 360-bed home for the elderly would experience some changes in their everyday life, they had no idea that they were introducing factors which could prolong life.
Eighteen months later, when Langer and Rodin returned to the home, they were astonished to discover that twice as many of the elderly residents in this ‘choices’ group were alive, compared with the control group on the second floor, who had been given plants that the staff tended, and were told which was their film night. It appeared that taking control made you live longer.
How might the design of nursing homes be developed to better support; an ailing resident, the fellow residents and the friends and family?
IMPORTANT NOTICE: THE SUGGESTED EXAMPLE PROJECTS ARE ONLY SEED IDEAS, STUDENTS ARE ENCOURAGED TO DEVELOP AN UNDERSTANDING AND A POSITION ON THEIR CHOSEN AREA THROUGH PERSONAL STUDY.
Please refer to the FAQ/Help section of the website with any queries.
COLLATED SUGGESTED STUDY MATERIAL AND CREDITS:
Art & Photography
Nantes Triptych, Bill Viola 1992
Georges Mérillon, Nagafc, Kosovo 28 January 1990
Family and neighbours mourn the death of Elshani Nashim (27), killed before an Albanian nationalist protest against the Yugoslavian government’s decision to abolish the autonomy of Kosovo.
Dante and His Poem (1465), Domenico di Michelino, fresco, on the wall of the church of Santa Maria del Fiore in Florence (Florence’s cathedral).
The Hours, CUNNINGHAM, Michael, 1999
Modern Hospice Design: The Architecture of Palliative Care:Ken Worpole
Letchworth Manor, Sue Ryder Care, Clare Pollard 2009
Dante’s Devine Comedy, 14 Century Poem
American Recordings IV , Johnny Cash
Man Comes Around:
Bob Dylan’s Theme Time Radio Hour, Death & Taxes
The Composer is Dead, Lemony Snicket and the San Francisco Philharmonic
Moartea Domnului Lazarescu (The Death Of Mr Lazarescu), PUIU, Cristi, 2005
Ikiru, KUROSAWA, Akira, 1952
La Gueule Ouverte, PIALAT, Maurice, 1974 target=_blank>
BBC Arden House Documentary:
Mortality Statistics for the UK provided by the Office for National Statistics:
Results generated by searching the word ‘Death’ on the NHS website:
Link to the website for the National Centre for Palliative Care:
Wikipedia definition of Death:
Maggie’s Centres (cancer care for life but with some relevant information)
Department of Health Guidance:
End of Life Care Strategy, Department of Health, Executive Summary, 2008
HBN 04-1 Inpatient accommodation:
HBN 20 Mortuary Facilities for mortuary and post-mortem room services:
skogskyrkogarden Cemetery, Gunnar Asplund and Sigurd Lewerentz : http://www.skogskyrkogarden.se/
Sir John Soane and the Furniture of Death: http://www.arplus.com/?p=11347&preview=true