Health care and the ethical implications of treatment spaces

Abstract

The recent advertisement in the United Kingdom for nurses to give corridor care1 has revived discussion of the ethical issues associated with the spaces in which health care is delivered. While we are sadly used to seeing, on television screens at least, treatment given in situations of war and disasters—in conditions of extreme deprivation—there are concerns about the normalisation of less than optimal situations for delivery of care in relatively rich countries in peace time. Rachelle Barina has written of the distinction between places and spaces:

‘By place, I mean the material qualities, setting and location of health care delivery. The various places in which health care is delivered are also distinct spaces. By space, I mean not only physical and geographical qualities, but also the ideas, activities and symbols that form, result from, and function within places’.2

The distinction between the implications of old-style Nightingale ward arrangements and more intimate settings is a familiar one, but Barina also writes about the properties of Intensive Care Units, which are not just particular spaces but ones which have symbolic meaning around the use of the ventilator for example. Indeed, this was very evident during the COVID-19 pandemic.

‘Corridor care’ or care in spaces that have been referred to as ‘temporary escalation spaces’3 clearly has implications not only for patients but also for health care providers and for society more generally. As regards patients, concerns raised have included those related to privacy and dignity (although it has to be acknowledged that in a standard ward the use of a curtain may give visual but not verbal privacy). There are also issues about access to necessary equipment. The term ‘corridor’ symbolises a passing through, a way past rooms which one might want to enter. It is in those rooms that it might be imagined that desired resources might be found—but not accessible.

For health care providers, having one's role designated as a ‘corridor carer’ may give rise to diminished job satisfaction and frustration, through recognising that one does not have the wherewithal to give the care to the standard one would want. Sheather and Phillips, reviewing a guide to the ethics of corridor care published by NHS England,4 have argued that ‘[S]afe and good quality care cannot co-exist with treatment in corridors’.5

A key issue here is normalisation. When do ‘temporary escalation spaces’ become a permanent feature? This is an issue for consideration by managers, policy-makers and society more widely Arguably the very exercise of drafting principles for care in these circumstances only makes that outcome more likely.