Resumen de La arquitectura de la experiencia de la muerte: una aproximación al espacio del final de la vida
The progressive hospitalization of death transformed the ritual of farewell, the role of the dying, the behaviour of family members, the meaning of the terminally ill patient in the healthcare organization and the denaturalization of the phenomenon of death. As these modifications were manifested, reactions that questioned the attitudes towards the abandonment to which the dying person had been destined started emerging. The first part of the thesis deals with this matters. This context marks the birth of bioethical reflection regarding this problem and modern palliative medicine.
The display of modern palliative medicine is accompanied by a reflection on space as a factor that provides an appropriate framework for the development of this new specialty, while improving the well-being of the patient. The importation of palliative care into our territory was initially committed to these criteria, but began losing strength with the diffusion of this type of care to other centres. Nowadays, it is not exceptional to find units that do not respond to the fundamental principles of palliative medicine, which demonstrates the necessity to adapt and define in the future from a comprehensive approach that responds appropriately to the end-of-life experience. Above all taking into consideration that the alternative space of the assistance, home, is often not a viable environment.
The second part of the thesis examines the nature of the rejection towards the healthcare space, especially when the possibility of recovering health disappears, since it is not justified then to bear the negative side of the institutionalized environment. Although by reviewing the origins of the country's public health system, we confirm that this hostility is based on a deeply rooted cultural substrate. The high mortality in the charity hospitals sowed a difficult antecedent to overcome in the stage of the technification of medicine. As the population overcame their distrust of hospital admission, the assessment of what these buildings represented was transformed. They became healing artefacts. At present, the link between the sick population and the healthcare space has varied. On the one hand, admission times for therapeutic interventions have been reduced, thanks to advances in non-invasive techniques, thus reducing temporary stays in the centre. On the other hand, the increase in chronic pathologies causes many people to maintain a permanent and periodic relationship with the day hospital or the specialized services that control their disease. The sanitary spaces represent a tolerable environment that is preferable not to need for casual users and a familiar place for the usual patients. Besides framing important life episodes, traditionally associated with the domestic space within it (the birth or death of a person), sanitary architecture demands a different character with respect to this paradigm shift that it symbolizes.
The relevance of the architectural space is a determining factor when defining equipment that complements the existing medical architecture. Some built examples show how a greater reflection on the real needs of its occupants can generate an architecture that promotes their appropriation and adaptation to dynamic socio-cultural requirements. Thinking about the conception of the sanitary space, specifically the end of life, incorporating socio-cultural and psycho-emotional criteria of lived experience, can provide a plausible alternative to approach this alien space as an extension of a daily place, in which to frame a proper farewell to the wishes and intimate values of the patient.
