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Examining the key texts that have been published on palliative care architecture, and focusing on the most important hospital and hospice design-research issues that have evolved since the 1980s, this paper highlights a significant inconsistency between those palliative care design developments and the design of palliative care units in recently constructed major hospitals. The architects of hospices, palliative care facilities, and the UK-based Maggie’s Centres strive to make their buildings look like houses to express a collective environment of caring, emphasizing quality of life issues over medical efficiency. This reflects larger changes in the design of therapeutic landscapes since 1980, which endeavor to normalize illness and death by engaging architecture as a tool of distraction. However, as is evidenced by state-of-the art hospitals—a recently-opened, North American health care architecture consortium-designed, 517-bed healthcare center in Montreal, Canada, as well as several European hospitals—such design elements are often omitted from the design of new hospitals.