Abstract
In the UK today up to 60% of older people now die in hospital, yet, paradoxically, modern hospitals were rarely designed to cater for end of life, palliative care. Recent research has claimed that, ‘If anything, hospitals are even less focused on the needs of the dying nowadays, given medical and technical advances and current emphasis on diagnosis and treatment.’ It is not surprising, therefore, that 54% of all complaints made about treatment in the UK National Health Service (NHS) relate to the care and treatment of the dying. Dying in hospital is today often regarded as a death without dignity or social meaning. In recent times there have been two imaginative responses to this public policy dilemma in the UK: the creation of St Christopher’s Hospice, London, in 1967 by Dr Cicely Saunders, and, more recently, the creation of Maggie’s Cancer Caring Centre, Edinburgh, in 1995 by Charles and Maggie Keswick Jencks. Both initiatives have been emulated or followed by others, and are growing rapidly in number both in the UK and elsewhere in the world. End of life care in specially designed settings with a new ethos of support and friendship – as exemplified in the hospice movement and in Maggie’s Centres – is one of the more positive elements to contemporary attitudes towards dying and death in the 21st century. This paper, which is based on visits to more than 20 hospices in the UK, Ireland & Scandinavia, and to a number of Maggie’s Centres in the UK, outlines one of the core ingredients of their success, which is to embody the ethos of end-of-life care in a dedicated and carefully designed setting. It pays particular attention to the effect which architecture, allied to environmental psychology, can have on affirming the human spirit, and providing meaning at a time of great existential difficulty. The paper will be accompanied by photographs of building exteriors, interiors and gardens from hospices and Maggie’s Centres.

Keywords
death, hospice, end of life care.