Adolescents in palliative care have complex emotional and developmental needs that make privacy within the built environment a crucial aspect of their comfort, dignity, and sense of control. However, in many paediatric hospice settings, privacy is often compromised by the continuous need for observation and accessibility in care delivery. This study explores how privacy in the built environment is understood and addressed in palliative care for children and adolescents, drawing on both medical and architectural perspectives. It combines a review of existing literature with qualitative analysis of interviews conducted with fourteen medical professionals and eight architects, together with a comparative examination of seven contemporary hospices. The analysis investigates spatial design features, such as bedroom layout, visibility, and zoning, shape the experience of privacy in care environments. While single bedrooms are now widely adopted, the findings of this study emphasise that these features alone may not adequately address the psychosocial and emotional dimensions of privacy. Continuous observation, glazed doors, and the placement of beds directly in line with doorways were identified as elements that can contribute to feelings of exposure and reduced autonomy. The study highlights a persistent gap between clinical functionality and environmental support for psychological well-being. It argues for more age-responsive design strategies, such as thoughtful spatial zoning, adaptable room configurations, and sensitive transitions between public and private areas, to better accommodate the needs of adolescents. Reconsidering how built environments mediate care and control can help create hospice settings that more effectively support privacy, autonomy, and dignity for young people nearing the end of life.