Susanne Siepl-Coates
Kansas State University, Manhattan, Kansas

When it has been established that a severely ill person
no longer benefits from major medical interventions,
palliative end-of-life care may be proposed. Along with a


shift in treatment, a move from the clinical setting of the
typical hospital to an environment that is sensitive to the
circumstances of the patient’s suffering and respectful of the
patient’s impending transition may be appropriate. For an
architect of such end-of-life settings questions arise: how can
the physical environment contribute to counteracting typical
feelings such as fear and isolation? How can architecture
support patients, their families and care givers by giving
expression to symbolic and spiritual dimensions of dying
while not disregarding the functional aspects of palliative
care. Can architecture contribute to establishing death as a
celebrated part of life, similar to birth? Is it possible to create
a sense of the sacred in the everyday life of a palliative care perhaps even health care altogether, should be in the future.
Patients on this ward are extremely ill, often close to death,
and typically suffering from extreme physical pain and other
debilitating symptoms. The goal of palliative medicine is
to reduce human suffering and to stabilize, and possibly
improve, the quality of life of the patients during the last
weeks and days of life. Pain reduction and symptom control
are achieved through a holistic care model that includes
medical, psychological, social and spiritual dimensions.
In designing the Göttingen unit, the architect worked closely
with the staff psychologist to give architectural expression
to this holistic model of care. Taking its clue from the word
‘pallium’, Latin for ‘coat’ or ‘cloak’, trellised climbing
plants provide a green protective layer on the exterior of the
palliative ward shielding patient rooms, wooden decks and
adjacent garden rooms.
Careful detailing facilitates ease and comfort of use and
assists patients in their struggle to adapt to the changes in
life circumstance. Furnishings are selected with regard to
materiality and color in order to support the patient’s physical
and psychological well-being. Both inside and out, materials and colors generate a sense of subtle
warmth and create an ambiance that offers a variety of activities and
moods: outward views and inner reflection, stimulation and relaxation,
calmness and movement, communication and silence, activity and
withdrawal. By doing so, psycho-social and spiritual aspects of life are
moved into the foreground, made possible by the spatial organization of
the ward and emphasized through innovative and thoughtful details. Two spaces were given particular attention. The
Room of Sound is intended as ‘a world apart’ and
highly contemplative in nature. A narrow band
of light separates the acacia wood floor surface
from the walls. The walls themselves are made
of soft batik-dyed orange fabric and curve gently,
perhaps reminiscent of a womb. The suspended
ceiling plane is made of joint-less stretched film
upon which moving clouds and the daylight
spectrum of colors can be projected.
Given its intention to provide an experience of
sound, several flat loudspeakers hidden behind
the wall fabric can create soothing soundscapes
which further enhance the wide range of possible
light moods. Curved glass panes offer views of
a small meditative garden where the gentle flow
of spring water flows from a rock into simple
reflective water basin. A small sculpture inside
the window invites silent meditation.
Distinguishing itself radically from institutional
bathrooms, the Bathing Room focuses on feeling
and seeing. The rectangular volume of the space
is softened
by an inner curved wall, which elegantly hides
cabinets and a sink while providing a glow of
indirect lighting for the space.
Reminiscent of a wellness spa rather than
the ward of a hospital, the bath contains a tub
that features water jets and small light sources
incorporated into its inner lining, a ‘rain shower’
as well as a infrared lights to dry off quickly
without the use of towels. On the wall across
from the tub is a large-scale screen upon which a
variety of soothing movies, typically of water or
landscape scenes, can be projected.
To further enhance the experience of this bathing
event, the ceiling is dotted with
tiny sparkling star-like lights, the color of which
can be adjusted to the patient’s wishes. There is
also a stereo to support the mood with appropriate
music as well as the possibility for aromatherapy.
Feeling via the skin, such as experiencing water on
one’s body, is not only a joyful sense perception
but also a sensation that can be experienced up
until the very end.
Focusing on life rather than death, this facility
not only affords the best quality of life possible
under the circumstances but also provides an
instructive example of how the experience of
everyday activities, which as healthy persons
often take for granted, can potentially create a
sacred atmosphere for the transition into death.
Acknowledgements
The author wishes to thank Dirk Eggebrecht,
Dipl. Psych., staff member of the Palliative Care
Center at Universitätsmedizin Göttingen; and
Michael Timm, Dipl. Ing., of bmp architekten,
both of whom gave generously of their time to
share insights into patient and staff needs as well
as considerations about the design of this facility.

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