Dying in a healthcare setting

Whānau will often gather in large numbers as someone approaches the ārai (veil). Being able to accommodate whānau by having large spaces for them to gather will help them carry out their cultural care customs; these practices will typically involve family gathering at the bedside, having prayers, singing, talking, perhaps eating together (although they will normally do this away from the person that is ill or dying).

Many whānau like to have water (that has been blessed) available outside their room or outside the building so they can observe the cultural practice of whakawātea (spiritually cleansing rituals). Following death, once the tūpāpaku has been removed from the room, the tapu (spiritual restrictions) is lifted via karakia (prayer). This helps to free the whānau of unwanted energies associated with illness or death.

Cultural practices around the care of tūpāpaku need to be taken into consideration in the design and layout of facilities such as hospices.

Kuia K. (hospice staff member) spoke about the importance of planning and building health care facilities that can accommodate the needs of whānau, particularly at the end of life. She commented on the route used to transport tūpāpaku through a hospice, and how this may be a barrier for Māori whānau:

The other downside too is when the person passes away, they’ve got no place to take them out the back way… to take the, the casket away. They almost have to go around to the front… past the other wards... So, they try and improve on that. But you know those are the couple of downsides. So those sorts of things can be the drawbacks of Māori going in there [hospice] you know.

When asked about the importance of discretion while transporting tūpāpaku, Kuia K. talked about the deceased loved one having to go through the Pākehā wards and be looked at by Pākehā, even though they were in a ‘body bag’:

That’s our loved one. You got to take them through all those Pākehā wards, and then to have Pākehā to look at them. Even though they’re in a body bag. Even though they’re closed up, you know.

Recommendations

For health and palliative care services, we recommend:

Being able to accommodate large whānau who gather when someone is close to dying. Put processes in place and develop creative ways of managing large groups of people.
Having designated areas where whānau can prepare and consume food. Making sure the environment accommodates this is part of good whānau-centred health care.
Having someone whakanoa (remove tapu) is expected by kaumātua and Māori whānau, as this can make the environment spiritually comfortable for new inhabitants. Someone in your organisation will need to take responsibility for this.

Caring for kaumātua at end of life

Dying in a healthcare setting

When asked about the importance of discretion while transporting tūpāpaku, Kuia K. talked about the deceased loved one having to go through the Pākehā wards and be looked at by Pākehā, even though they were in a ‘body bag’:

Recommendations