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Mortality: Promoting the

interdisciplinary study of death and
dying
Publication details, including instructions for authors and
subscription information:
http://www.tandfonline.com/loi/cmrt20

Innovations in hospice architecture

a
Ken Worpole
a
Freelance writer , London, UK
Published online: 18 Jan 2008.

To cite this article: Ken Worpole (2008) Innovations in hospice architecture, Mortality: Promoting
the interdisciplinary study of death and dying, 13:1, 88-89, DOI: 10.1080/13576270701783074

To link to this article: http://dx.doi.org/10.1080/13576270701783074

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 88 Reviews

Innovations in hospice architecture. By STEPHEN VERDERBER and BEN

J. REFUERZO, Taylor & Francis, Abingdon, 2006, 216pp., 69, hardback
(ISBN 041532713X).

Death is place-specific, though it occurs within a wider geography of human

mortality. Whereas most people used to die at home, today the majority die in a
hospital. The deathbed, once a hallowed (and often harrowing) place, has become
routinized. In recent years, people have found many hospitals wanting in the
quality of end of life care. Newspapers regularly carry stories, often by well-known
personalities, expressing dismay at the conditions surrounding an ageing parents
banal, institutionalized death. One such person is Stephen Verderber, co-author of
this fine book which was prompted by the experience of his fathers death in an
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American hospital. He bitterly describes his fathers death as tragic, inhumane

and mechanical (p. 2).
Verderber and Refuerzo are both Professors of Architecture. Their book,
elegantly structured, contains sections on the history of the hospice, recent design
trends in the provision of palliative care, and a large number of case studies in the
design and management of new hospice buildings and campuses from around the
world, principally the USA, Canada, the UK, and Japan. These case studies are
illustrated by photographs, site and floor plans, and cross-sections. Thus, the book
is ideal for architects, designers, and commissioning bodies, as well as the
interested lay reader.
Unlike many other buildings, the problem with the hospice is deciding who is
the principal client: the funding body, the hospital trust, the clinicians, the care
staff, or the patients? Whose voice should be heard most clearly? Whose needs
should be at the heart of hospice and hospital design? The authors are rather
cynical about clinicians, who often seem more interested in the illness, not the
person. While it seems to make sense to design around the needs of the
patient, their stay is often sadly brief (Verderber and Refuerzo aptly describe
them as being viewed as clandestine beings); many hospice care staff stay for
years, and for them the building becomes a second home.
Thoughtful design can solve many problems, creating places in which patients,
staff, and visitors feel that they share a space which gives dignity to their condition.
It also helps to integrate the hospice into the neighbourhood, allaying fears of
social rejection. A number of the case studies describe hospices designed for
children, or for those with specific conditions such as AIDS. The attentive use of
natural light, colour, and views of nature, together with the provision of single
room accommodation as well as communal spaces, is vital. Above all, though, a
sense of domestic scale and detail creates a setting which, while it cannot heal, can
induce calm and even a sense of privilege.
The authors are alert to coming challenges. In the USA, hospice provision is
becoming big business, along with familiar patterns of cost cutting and
standardization. In Europe, there are different concerns. While hospices now
attract big name architects and designers in Stockholm I was recently told that
dying in a hospice had become fashionable mainstream palliative care in the
 Reviews 89

bigger, older general hospitals often remains unsatisfactory. The authors have
done an important job well with this study, reminding us that architecture can
make a difference, helping create places at the end of life which offer a sense of
final grace and understanding.

KEN WORPOLE
Freelance writer, London, UK

Deaths door: Modern dying and the way we grieve. By SANDRA M.

GILBERT, W.W. Norton & Company, London, 2006, 580pp., US$29.95,
hardback (ISBN 0393051315).
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At the beginning of this book, the author states her intention to combine memoir
and meditation with exposition and explication (p. xxi). This she certainly does.
A distinctive publication that bridges academic disciplines and boundaries
between autobiography and critique, this volume aims to explore intersections
between personal narrative and the cultural and literary traditions relating to death
and dying.
The book provides a comprehensive overview of the wealth of literary prose on
death and dying. Part One examines some of the more universal elements of
death, each chapter opening with an autobiographical account of the authors
experience of losing her husband and father. The emphasis of Part Two is on
cultural and social aspects of grief and mourning, exploring modern and
medicalized death, and the huge growth in the imagery of death. Finally, Part
Threes focus is upon elegies and poetry, utilizing an extensive range of literary
examples and locating them within their temporal and spatial context.
The first issue this book raises for me is whether attempting to bridge disciplines
is a strength of an academic publication, or a weakness due to its potential
superficiality. For example, in Part Two, which the author describes as being more
sociological and anthropological in scope, she does not engage with the
contributions of theorists, other than Aries and Gorer, in sufficient depth.
Indeed, whilst she is adept at addressing the complex nature of death in
contemporary society by way of many excellent examples, she does not make any
significant addition to existing sociological or anthropological analyses, which may
disappoint social scientists. This book would benefit by limiting itself to a literary
critique, which is where the authors strengths lie.
Second, this book encompasses considerable personal detail including the
authors death-related autobiography, which leads one to question whether this is
appropriate in a scholarly text. In the case of this book, however, I believe it is. This
text is a marvellous illustration of the value of acknowledging and actively including
autobiography, especially when exploring a topic as universal as death. Gilbert has
successfully woven her private firsthand experiences of death into her work, an
accomplishment in itself, and their inclusion sheds light on this extremely emotive
subject. By moving beyond the realm of disembodied academic investigation, the