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  • The Production of Hospice Space: Conceptualising the Space of Caring and Dying by Sarah McGann
  • Barbara Pesut
Sarah McGann. The Production of Hospice Space: Conceptualising the Space of Caring and Dying. Surrey, England: Ashgate Publishing Limited, 2013

In grappling with the complex issue of how to provide high-quality palliative care to an aging population, I have frequently argued for hospice as a philosophy, rather than a place. Dr. Sarah McGann’s book The Production of Hospice Space: Conceptualising the Space of Caring and Dying was a welcome reorientation to my thinking. In this well-written book, McGann sets out to propose conceptual principles that unite the ideas of hospice philosophy and hospice space, arguing for a hospice philosophy that is anchored by space and spatial practices. As the head of the Department of Architecture and Interior Architecture at Curtin University in Australia, and a participant in the design of St. Francis Hospice in Dublin, McGann is well positioned to speak to the relationship between hospice space and hospice philosophy.

The first three chapters are devoted to an analysis of the various places and spaces in which death and dying occur. First, in chapter 1 McGann situates the study by describing the complexity the team encountered upon being challenged with the task of designing St. Francis Hospice. McGann describes setting out to create a building, specifically a place where the design team might like to die. McGann soon learned the task was much bigger – to create space and spatial practices that were capable of supporting the philosophy of hospice. In chapter 2, McGann explores how buildings are created in response to particular questions. Hospitals, for example, were designed to answer the question of how to efficiently care for the sick. However, the mismatch between efficient care of the sick and compassionate care of the dying often results in end-of-life care being seen as something apart from the core business of the hospital, which in turn has a profound effect on the experience of dying. In chapter 3, McGann traces the historical development of hospice and explores modern hospice trends. An apt quote reveals the complexity confronting architectural design of the modern hospice:

Architects are trained to envision that which does not yet exist in physical terms, e.g., a new home for a young, growing family, or a new school. Death and dying create a profound dilemma in this respect, requiring the architect to reverse this process of visualization. Whereas one’s predilection is to create something new where nothing existed before, when confronted with designing for death and dying, the architect is called upon to envision for those who will soon vanish.

(Verderber & Refuerzo, 2006, p. 3)

McGann also explores the origins of the artificial separation between hospice philosophy and hospice space, attributing this to the dying-at-home movement that arose during the 1980s.

The final three chapters investigate the attributes of a “successful” hospice space. In chapter 4, McGann explores hospice spatial practices through the illustration of the design of St. Francis Hospice. Three ideals informed the design: part home/part community centre, part hotel/part hospital, and part home/part garden. Carefully constructed communal and private spaces, boutique hotel – style finishing, extensive views of garden spaces, and careful attention to natural lighting facilitated the realization of these ideals. St. Francis Hospice was conceptualized as an inside-out design, inside-out philosophy, and inside-out community. First, an inside-out design blurs the distinctions between outside space and inside space so that those who enter the building do not get the sense that they are being “incarcerated”. Second, the inside-out philosophy promotes the idea that patients can move seamlessly between the hospice and the community and that entering hospice is not seen as a failure of the family to cope with caregiving demands. Lastly, the inside-out community seeks to balance privacy with a sense of community, avoiding the isolation that is characteristic of dying in institutionalized settings.

In chapter 5, the principles set forth in chapter 4 are now interpreted through Henri Lefebvre’s triad of perceived, conceived, and lived space. Diagrams illustrating how each theme guides hospice spatial practices are...