Hina-te-Pō Phase 2

Recommendations for Assisted Dying

Support Workers to be Given Assisted Dying Information

Health professionals, spiritual support workers, hospital liaison coordinator, kai rongoā, funeral directors and allied health professionals need to know the assisted dying process to support whānau who are on the Kaitiakitanga Assisted Dying Pathway.

Moana (hospital liaison coordinator) spoke about the need for everyone who works at her hospital knowing about assisted dying and the process as this will benefit whānau who are trying to access assisted dying information, and whānau who are going to have an assisted death:

I think first of all, the people in the organisation need to know what’s going on. They need to understand the [AD] programme. All staff; all staff need to understand the programme. What’s going on? What’s the process? What’s the pathway? [AD] should be part of the education training on each level. (Moana, Hospital liaison coordinator)

David Brown (assisted dying attending medical practitioner) reflected that other healthcare professionals’ views of assisted dying not being part of palliative care is a narrow view. He commented on the future of assisted dying as possibly becoming a shared experience:

Which is again a very narrow view of what assisted dying is because assisted dying again, in the ideal world, it would be appropriately performed by your own personal doctor that you know, rather than a doctor that you haven’t met before, coming in and doing it. But it doesn’t alter the fact that it is a process of getting to know that person who is helping you at the end of your journey.

And that is really important- it’s not just someone walking in and giving you a pill or an injection or whatever. It’s a much more shared experience and [person’s name] … and enjoyment of actually being able to help someone and [AD doctors can have] some really positive experiences. (David Brown, Assisted dying attending medical practitioner)

Petal (funeral director) commented that assisted dying policy should allow for different medication options being available on the day of the assisted death in case something unexpected happens during the assisted dying procedure:

So, I mean I’m sure they [AD doctor] will have learned from it because it would have been not only harrowing for the family and the person who wanted it, it would have been ah devastating for the doctor you know to say ‘hey listen, well you know we can’t do it – we have to come back’.

And because they didn’t have the paperwork, to use anything else [they couldn’t]. I’m sure they would have learned from it by now that they would make sure that they had paperwork for two [medication delivery] alternatives. . .

Because you know, surely, they would have thought about the fact that, a person who’s at that stage of dying, their veins are going to be shot at any rate. So ah, why would they not have thought about that?

And they didn’t think about it and it’s nobody’s fault apart from, people that are making these decisions and it wouldn’t be just one person there’ll be a whole lot… the Board of whatever, they need to have, alternatives. And I’m sure they probably will now… (Petal, Funeral director)

Kaye (tohunga) suggested many whānau today need educating in the basics of tikanga and tapu associated with death and dying as a way to prepare whānau for bereavement:

Basics. The basics of tikanga. It, regardless of whether death is assisted or not, everyone who’s involved emotionally, and mentally with a dying person is going to go into shock. They’re already in shock through the transition period… that’s why, that’s why in the old days everyone went tapu.

Tapu, the whānau were tapu, tapu – they never ate. And they never slept. Because it was the last time of spending with the person before they crossed. And so… in, it, it, you go into a transition state with the person who’s dying, to become a tūpāpaku. And in that altered state (and that’s why when we come back [to the marae] we have to [go to the] wharekai [to eat and drink] to take off the tapu.

Because the whānau, from the time the person has passed, until the time that they are buried or cremated, they are still in a tapu state; they are not released until they have eaten. (Kaye, Tohunga)

Kumarahou (kai rongoā) suggested the need to remind to whānau that death is part of life.
Whānau need to be prepared for death and to reinstate rituals to prepare for death and say their goodbyes:

What needs to happen right through our society you know… and that’s why we get sick we, we take pills to block it, you know. So, you’re getting sick. ‘Oh well, I’ll take some more (whatever) and, and that will get me through sort of thing’ like this. You know that, that we don’t even know how to be sick. You know and, and we feel powerless; we’re too scared to go and see people who are sick or who are dying you know.

And so, the whole practice of you know, giving people the opportunity to say ‘goodbye’. All that sort of thing, we need to bring that, that, that ritual back, that tikanga back you know. The fact that the family all gathers around the coffin the night before the burial and they sing songs and everything else like that, that’s all part of not just saying ‘goodbye’, but in actual fact moving into a world in which that person’s not going to be physically part of it. (Kumarahou, Kai rongoā)