Waerea Study Resources

Advocacy and Community Engagement

Community voices: Opportunities for Māori communities to voice their opinions and concerns about assisted dying

‘It’s not all just about the dying’. Kaumātua Māori attitudes towards physician aid-in dying: A narrative enquiry.
Malpas, P. J., Anderson, A., Jacobs, P., Jacobs, T., Luinstra, D., Paul, D., Rauwhero, J., Wade, J., & Wharemate, D. (2016).
Palliative Medicine, 31(6), 544–552.
Read it in full here

Kaupapa Māori qualitative study explored attitudes toward physician aid-in-dying among 20 kaumātua (Māori elders) in Auckland, before EoLC Act.

1. Attitudes and understandings of physician-assisted death (PAD) Kaumātua held diverse views influenced by media coverage:

  • Some saw PAD as compassionate relief from suffering (“if they are in pain, then it’s good for them”) and as a human right.
  • Others feared it represents “a further stripping of our tikanga” with spiritual implications, as losing “the mana of a certain individual” affects “the wellbeing of the whole whānau.”

2. Influence of power was attributed to wairua (spirit), karakia (prayer), medical professionals, kaumātua, and whānau. Wairua’s power was pivotal in comforting and guiding end-of-life proceedings.

  • Whānau hold collective responsibility over medical decision-making.
  • Kaumātua were divided on the power of medical professionals, though some believed culturally safe practitioners could appropriately exercise their authority.

3. Significance of kawa (protocol) Kawa provides security, safety, and guidance for everyone involved in dying and death, offering structured cultural protocols for these transitions.

4. Whānau relationships Whānau relationships and roles are pivotal to health, wellbeing, dying, death, and PAD.

  • Emphasis was placed on collective whānau involvement in care and decision-making for the dying.

5. Significance of wairua is essential to all aspects of death and dying.

  • Kaumātua emphasised ihirangaranga (spiritual vibration)
  • Wairua as a living conduit connecting the dying with whānau, tūpuna (ancestors), Atua (God/s), and whenua (land).
  • A major concern was that PAD could “abuse” the cultural, physical, and spiritual dimensions of Te Ao Māori.

 

 

Te Ao Māori: Māori nurses’ perspectives on assisted dying and the Te Ao Māori cultural guide to nursing practice
Manson, L. (2021).  [Master’s thesis, Auckland University of Technology].
Read it in full here

Māori Nurses’ Perspectives on End-of-Life Care and Assisted Dying

This thesis offers valuable insights into Māori nurses’ perspectives about what is important in end-of-life care, which can provide cultural considerations to inform nurses’ practice

Themes found:

1. Patient Choice

  • How contemporary health issues like assisted dying influence patient choice
  • Role of whānau in decision-making


2. Tapuhi Kaitiaki (Māori Nurses’ Practice)

  • Ways Māori nurses draw on and use their skills in end-of-life care
  • Use of whakawhanaungatanga in practice


3. Barriers to Care

  • Systemic issues are preventing the best care
  • Patient safety concerns
  • Work environments requiring change
  • Exacerbation of inequities and gaps in care


4. Cultural Safety of Patients and Whānau

  • Ways Te Ao Māori influences patient and whānau care
  • Silencing of cultural views
  • Need for wraparound services

 

Key Concerns:
The research highlights the complex intersection of assisted dying with Māori cultural values, whānau involvement, and ongoing systemic barriers that compromise culturally safe end-of-life care for Māori patients and their whānau.

Concerns were raised about the limited secularised legislation, particularly the need for whakawhanaungatanga (the process of establishing relationships) and Te Ao Māori (Māori worldview) to be interwoven into the assisted dying journey for Māori. The lack of inclusivity in the drafting of the End of Life Choice Act means that the guiding principles of ethical care for Māori, such as rangatiratanga (autonomy and self-determination), manaakitanga (caring for others and showing kindness), and wairuatanga (holistic wellbeing) are missing from the legislation.

There are limited published works with Māori discussing their experiences and opinions about assisted dying services and the End of Life Choice Act. The following articles are part of this growing body of research:

Check here for future conferences or interesting events that may be happening in Aotearoa New Zealand about assisted dying.