How the BPR process works

Bioethics Peer Review unfolds through an iterative, consultative process:

  1. Clarify stakeholder values and goals
    Including residents, families, staff, operators, and health systems.

  2. Identify value tensions in the design
    For example: safety vs autonomy, visibility vs privacy, efficiency vs dignity.

  3. Apply relevant evidence and ethical frameworks
    Drawing on geriatrics, architecture, public health, ethics, and operations.

  4. Produce action-guiding analysis
    Highlighting risks, tradeoffs, and ethically defensible alternatives.

  5. Iterate with stakeholders
    As designs evolve and constraints change.

The output is typically annotated design drawings and structured feedback rather than abstract recommendations.

What Bioethics Peer Review is—and is not

BPR is:

  • Advisory

  • Evidence-informed

  • Values-explicit

  • Designed to support better decision-making

BPR is not:

  • A regulatory review

  • A compliance checklist

  • A substitute for architectural or engineering expertise

  • A mandate for specific design outcomes

Its purpose is to make implicit values explicit and to ensure that known clinical and ethical considerations are meaningfully integrated into design decisions.

Pilot applications and feasibility

Bioethics Peer Review has been piloted in two large long-term care facility projects. Informal feedback from health system leaders and design professionals suggests that the process is feasible, decision-relevant, and fills a gap not addressed by existing planning or regulatory mechanisms .

Who Bioethics Peer Review is for

  • Health systems planning long-term care facilities

  • Long-term care operators and administrators

  • Architects and design teams working in healthcare

  • Public agencies and funders evaluating LTC proposals

The BPR Core Research Team

We have the pleasure and privilege of collaborating with individuals, other research teams, healthcare institutions, universities and funding agencies to advance our work. Throughout those valuable partnerships, our core team members each bring unique skills and perspectives to the work.

Bioethics Peer Review

BPR Team: William J. Hercules, Diana C. Anderson, Stowe Locke Teti, David A. Deemer

William J. Hercules, MArch
Healthcare architect with expertise in evidence-based design and systems-level infrastructure.

Diana C. Anderson, MD, MArch
Physician–architect specializing in healthcare design, ethics, and long-term care environments.

Stowe Locke Teti, MA, HEC-C
Clinical ethicist specializing in empirical ethics, consultation models, and decision-making frameworks.

David A. Deemer, MD, MA
Physician ethicist focused on organizational ethics, social connection, and care environments.

Portfolio of Research, Interdisciplinary Collaborations, and Advocacy

The Bioethics of Built Space ASBH Annual Conference Presentation

UT Southwestern Grand Rounds: Exploring the Untapped Nexus of Ethics and Health Facility Design

AIA Conference: Architecture and Wellbeing

Ethics and Conscionable Research

Impactful Deisgn is Always an Intervention

Contact / engagement

Interested in Bioethics Peer Review?
We welcome inquiries from organizations exploring its application to long-term care design projects.

Bill@wjh-health.com

diana.anderson@dochitect.com

stoweteti@gmail.com

daviddeemermd@gmail.com

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