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Pou Aroha: An Indigenous Perspective of Māori Palliative Care, Aotearoa New Zealand

  • Tess Moeke-MaxwellEmail author
  • Kathleen Mason
  • Frances Toohey
  • Jaimee Dudley
Reference work entry

Abstract

An indigenous perspective of palliative care is not commonly known. The aim of this chapter is to describe key caregiving strengths of New Zealand Māori whānau (family) to illustrate how they draw on their cultural customs at end of life. Cultural customs are informed by knowledge passed down from tūpuna (ancestors) and the relationship with the whenua (land). End of life cultural care customs ensure the highest quality of care is provided to the ill and dying person and their bereaved whānau. Whānau are critical “pou aroha” (care stalwarts); they carry out the bulk of end of life care. Whānau ensure the best physical, emotional/mental, and spiritual care is received before the person dies, no matter what healthcare setting they are in. A holistic healthcare approach is required at this time as this supports whānau cultural aspirations to prepare the person’s spirit to pass through the ārai (veil) as they transition from the physical realm to the metaphysical realm at time of death. The chapter highlights the need for care that is genuinely holistic and relational as this is most likely to meet the needs of indigenous peoples. The facilitators and barriers associated with providing care are discussed within the context of a set of complex end of life circumstances. Barriers include health inequities, racism, poor access to palliative care and statutory (government) support, inadequate information, and poor communication. Whānau carers often experience high levels of stress and have too few informal family carers to share the care responsibility and the high financial costs associated with end of life care (Gott et al., Palliat Med 29:518–528, 2015a). However, the values of aroha (compassion, empathy, concern), whanaungatanga (relationships and connections), manaakitanga (caring for the mana (status, prestige, authority)) of the dying, kotahitanga (collective decision-making processes), and wairuatanga (spirituality) are introduced as guiding forces that protect and strengthen whānau carers.

References

  1. Angelo J, Wilson L. Exploring occupational roles of hospice family caregivers from Māori, Chinese and Tongan ethnic backgrounds living in New Zealand. Occup Ther Int. 2014;21(2):81–90.PubMedGoogle Scholar
  2. Associate Minister of Health. Healthy aging strategy. Wellington: Ministry of Health; 2016.Google Scholar
  3. Beaglehole E, Beaglehole P. Contemporary Maori death customs. J Polyn Soc. 1945;54(2):91–116.Google Scholar
  4. Best E. The Maori as he was: a brief account of Maori life as it was in pre-European days. Wellington: Dominion Museum; 1934.Google Scholar
  5. Brown W. New Zealand and its Aborigines. London: J. & D.A. Darling; 1851.Google Scholar
  6. Clark D. Between hope and acceptance: the medicalisation of dying. BMJ. 2002;324(7342):905–7.PubMedPubMedCentralCrossRefGoogle Scholar
  7. Dein S. Culture and cancer care: anthropological insights in oncology. Maidenhead: Open University Press; 2006.Google Scholar
  8. Dembinsky M. Exploring Yamatji perceptions and use of palliative care: an ethnographic study. Int J Palliat Nurs. 2014;20(8):387–93.PubMedCrossRefGoogle Scholar
  9. Dieffenbach E. Travels in New Zealand: with contributions to the geography, botany, and natural history of that country, vol. 2. London: John Murray; 1843.Google Scholar
  10. Duggleby W, et al. Indigenous people’s experiences at the end of life. Palliat Support Care. 2015;13:1721–33.PubMedCrossRefGoogle Scholar
  11. Durie M. Whaiora: Māori health development. Auckland: Oxford University Press; 1994.Google Scholar
  12. Durie M. Whaiora: Māori health development. 2nd ed. Auckland: Oxford University Press; 1998, viii, 244.Google Scholar
  13. Dyall L, et al. Pinnacle of life – Māori living to advanced age. N Z Med J. 2011;124(1331):1–12.Google Scholar
  14. Frey R, et al. ‘Where do I go from here’? A cultural perspective on challenges to the use of hospice services’. Health Soc Care Community. 2013;21(5):519–29.PubMedCrossRefGoogle Scholar
  15. Gott M, Williams L, Moeke-Maxwell T. The paradoxes of ‘home’ within a palliative care context. In: Roche M, et al., editors. Engaging geographies: landscapes, lifecourses and mobilities. Cambridge: Cambridge University Press; 2014. p. 137–51.Google Scholar
  16. Gott M, et al. ‘No matter what the cost’: a qualitative study of the financial costs faced by family and whānau caregivers within a palliative care context. Palliat Med. 2015a;29(6):518–28.PubMedPubMedCentralCrossRefGoogle Scholar
  17. Gott M, et al. Te Pakeketanga: living and dying in advanced age – a study protocol. BMC Palliat Care. 2015b;14(74):21.Google Scholar
  18. Gott M, et al. End of life care preferences among people of advanced age: LiLACS NZ. BMC Palliat Care. 2017;16(1):19.CrossRefGoogle Scholar
  19. Gott M, et al. What is the role of community at the end of life for people dying in advanced age? A qualitative study with bereaved family carers. Palliat Med. 2018;32(1):268–75.PubMedCrossRefGoogle Scholar
  20. Hampton M, et al. Completing the circle: elders speak about end-of-life care with aboriginal families in Canada. J Palliat Care. 2010;26(1):6–14.PubMedCrossRefGoogle Scholar
  21. Harris R, et al. Racism and health: the relationship between experience of racial discrimination and health in New Zealand. Soc Sci Med. 2006;63:1428–11.PubMedCrossRefGoogle Scholar
  22. Hiroa TR. The coming of the Maori. Wellington: Thomas Avery & Sons; 1950.Google Scholar
  23. Johnston Taylor E, et al. Māori perspectives on hospice care. Divers Equity Health Care. 2014;11:61–71.Google Scholar
  24. Jones C. Levels of racism: A theoretic framework and a gardener’s tale. Am J Public Health. 2000;90(8):1212–5.PubMedPubMedCentralCrossRefGoogle Scholar
  25. Jones R. Rongoā – medicinal use of plants – the impact of colonisation. In: Te Ara – the encyclopedia of New Zealand. New Zealand: New Zealand Government; 2012.Google Scholar
  26. Kelly L, et al. Palliative care of First Nations people: a qualitative study of bereaved family members.[Erratum appears in Can Fam Physician. 2009 Jun;55(6):590 Note: Gilles, Chris [corrected to Giles, Chris]]. Can Fam Physician. 2009;55(4):394–5.PubMedPubMedCentralGoogle Scholar
  27. Kidd J, et al. Kia mau te kahu whakamaru: health literacy in palliative care. Wellington: Ministry of Health; 2014.Google Scholar
  28. Koti DM. Te Tatau o te Pō: perceptions and experiences of palliative care and hospice – a Māori perspective. Massey University: Manawatū Campus, New Zealand; 2013.Google Scholar
  29. Lange R. Story: Te hauora Māori i mua – history of Māori health – re-European health. In: Te Ara – the Encyclopedia of New Zealand. New Zealand: New Zealand Government; 2011.Google Scholar
  30. Laurenson R, et al. Palliative care patients use of emergency departments. N Z Med J. 2013;126(1372):80–8.Google Scholar
  31. McGrath P, Holewa H. The living model: a resource manual for indigenous palliative care service delivery. Toowong: Researchman; 2006.Google Scholar
  32. McLeod H. The need for palliative care in New Zealand. Technical report prepared for the Ministry of Health. Wellington: Ministry of Health; 2016.Google Scholar
  33. Mcleod R, et al. Foundations of spiritual care professional development programme: evaluation report. Wellington: Hospice New Zealand; 2015.Google Scholar
  34. Mead SM. Tikanga Māori: living by Māori values. Wellington: Huia; 2003 x, 398.Google Scholar
  35. Ministry of Health. The New Zealand palliative care strategy. Wellington: Ministry of Health; 2001.Google Scholar
  36. Moeke-Maxwell T, Nikora LW. Homedeathscapes: Māori end-of-life decision-making processes. In: Kepa M, McPherson M, Manu’atu L, editors. Home: here to stay. Wellington: Huia; 2015.Google Scholar
  37. Moeke-Maxwell T, Nikora LW, Te Awekotuku N. Manaakitanga: ethical research with Māori who are dying. In: Agee M, et al., editors. Pacific identities and well-being – cross-cultural perspectives. London: Routledge; 2013. p. 188–203.Google Scholar
  38. Moeke-Maxwell T, Nikora LW, Te Awekotuku N. End-of-life care and Māori Whānau resilience. Mai J. 2014;3(2):140–52.Google Scholar
  39. National Advisory Committee on Health and Disability. The social, cultural and economic determinants of health in New Zealand: action to improve health. Wellington: National Advisory Committee on Health and Disability; 1998.Google Scholar
  40. Ngata AT. Report of Young Maori conference. Auckland: Auckland University College; 1939.Google Scholar
  41. Ngata P. Death, dying and grief. In: Schwass M, editor. Last words: approaches to death in New Zealand’s cultures and faiths. Wellington: Bridgett Williams Books with the Funeral Directors Association of New Zealand; 2005. p. 29–41.CrossRefGoogle Scholar
  42. Nikora LW, Te Awekotuku N. Tangihanga: the ultimate form of Māori cultural expression – an overview of a research program. In: Agee M, et al., editors. Pacific identities and well-being. Cross-cultural perspectives. New York: Routledge; 2013. p. 169–73.Google Scholar
  43. O’Brien V. Person-centred palliative care: a First Nations perspective. Hamilton, Ontario: McMaster University; 2012.Google Scholar
  44. Oetzel J, et al. Differences in ideal communication behaviours during end-of-life care for Māori carers/patients and palliative care workers. Palliat Med. 2015a;29(8):764–6.PubMedCrossRefGoogle Scholar
  45. Oetzel J, et al. Managing communication tensions and challenges during the end-of-life journey: perspectives of Māori kaumātua and their whānau. Health Commun. 2015b;30(4):350–60.PubMedCrossRefGoogle Scholar
  46. Oppenheim RS. Maori death customs. Wellington: A.H. & A.W. Reed Ltd.; 1973.Google Scholar
  47. Palliative Care Subcommittee. New Zealand palliative care: a working definition. Wellington: NZ Cancer Treatment Working Party; 2007.Google Scholar
  48. Pascoe EA, Smart Richman L. Perceived discrimination and health: a meta-analytic review. Psychol Bull. 2009;135(4):531–54.PubMedPubMedCentralCrossRefGoogle Scholar
  49. Penney L, Fieldhouse W, Kerr S. Te Hononga a Te Hekenga o Te Rā: connections at the going down of the sun: improving Māori access to palliative care/tapuhi hunga roku in Te Tai Tokerau. Kerikeri: Kiwikiwi Research and Evaluation; 2009.Google Scholar
  50. Phillipps WJ. European influences on tapu and the tangi. J Polyn Soc. 1954;63(3):147–63.Google Scholar
  51. Polack JS. Manners and customs of the New Zealanders: with notes corroborative of their habits, usages, etc., and remarks to intending emigrants, with numerous cuts drawn on wood, vol. 2. London: J. Madden & Company; 1840.Google Scholar
  52. Reed AW. An illustrated encyclopedia of Māori life. Wellington: A.H. & A.W. Reed Ltd.; 1963.Google Scholar
  53. Reid P. Contemporary perspectives. In: Schwass M, editor. Last words: approaches to death in New Zealand’s cultures and faiths. Wellington: Bridgett Williams Books with the Funeral Directors Association of New Zealand; 2005. p. 41–9.Google Scholar
  54. Reid P. Good governance: the case of health equity. In: Tawhai V, Gray-Sharp K, editors. “Always speaking”: the Treaty of Waitangi and public policy. Wellington: Huia; 2011.Google Scholar
  55. Reid P, Robson B. Understanding health inequalities. In: Robson B, Harris J, editors. Hauora Māori standards of health IV. Wellington: Te Rōpu Rangahau Hauora a Eru Pomare; 2007.Google Scholar
  56. Slater T, et al. Exploring Māori cancer patients’, their families’, community and hospice views of hospice care. Int J Palliat Nurs. 2015;21(9):439–45.PubMedCrossRefGoogle Scholar
  57. Statistics New Zealand. How is our Māori population changing? 2015. http://archive.stats.govt.nz/browse_for_stats/people_and_communities/maori/maori-population-article-2015.aspx. Accessed
  58. Statistics New Zealand. Ethnic population projections to grow across New Zealand. 2017. https://www.stats.govt.nz/news/ethnic-populations-projected-to-grow-across-new-zealand. Accessed
  59. Tregear E. The Maoris of New Zealand. J Anthropol Inst G B Irel. 1890;19:96–123.Google Scholar
  60. Walker R. Ka whawhai tonu matou: struggle without end. Auckland: Penguin Books; 1990.Google Scholar
  61. World Health Organisation. National cancer control programmes: policies and managerial guidelines. 2nd ed. Geneva: World Health Organisation; 2002.Google Scholar
  62. Hospice New Zealand. Hospice New Zealand standards for palliative care. Wellington: Hospice New Zealand; 2012.Google Scholar
  63. Moeke-Maxwell T, Nikora LW. Wairua manuake: Māori end of life preferences. Forthcoming 2018.Google Scholar
  64. Moeke-Maxwell T, Nikora LW. Wairua manuake: flight of the wairua: Māori end of life preparations. Forthcoming 2018.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Tess Moeke-Maxwell
    • 1
    Email author
  • Kathleen Mason
    • 2
  • Frances Toohey
    • 3
  • Jaimee Dudley
    • 4
  1. 1.School of Nursing, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
  2. 2.School of NursingUniversity of AucklandAucklandNew Zealand
  3. 3.Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
  4. 4.University of AucklandAucklandNew Zealand

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