Thursday 23 April 2020
Rōpū calls for scientific evidence and humane processes for Māori
Te Rōpū Whakakaupapa Urutā calls for scientific evidence and humanity to sit at the heart of decisions around care for whānau in the last moments of their life and laying deceased loved ones to rest.
Associate Professor of Maōri Health and Public Health Physician at the University of Auckland Dr Elana Curtis, and Physician and Senior Lecturer at the University of Auckland Dr Jade Tamatea, are both members of Te Rōpū Whakakaupapa Urutā and say protecting the living is of the utmost importance, but restrictions for caring for whānau in the last moments of their life and tangihanga during Alert Level 4 were not based on scientific evidence.
“Alert Level 4 restrictions were rigid, inhumane and devalued the importance of Māori cultural practices. Tangihanga guidelines were based on the view that Māori are a group who need to be managed within our own cultural practices – that we can’t be trusted to do what is safe,” Dr Curtis said.
“Our rōpū repeatedly called on the Ministry of Health to provide the scientific evidence upon which they based their decisions for tangihanga.”
Te Rōpū Whakakaupapa Urutā has reviewed international pathology reports on COVID-19 and non-COVID-19 deaths to understand the transmission of COVID-19 between the deceased and the living.
“We have reviewed the scientific evidence from international reports and we advocate for guidelines that are more humane and culturally appropriate, while also ensuring that the health and safety of whānau is maintained,” Dr Curtis said.
Dr Jade Tamatea has investigated the Alert Level 4 restrictions on caring for the dying and those in palliative care and their negative impact on whānau ability to be involved in the care for their dying loved ones.
“As we move to Alert Level 3, it is vital that the Ministry of Health uses scientific evidence to inform decisions around enabling whānau to care for and be with terminally ill people in the last moments of their life,” Dr Tamatea said.
“Our recommendations are based on the concepts of Mana whakaora, Mana taurite and Mana motuhake. Combined these require us to ensure the best care for Māori, centred on equity and delivered in a way that enables whānau to make crucial decisions in care.”
Te Rōpū Whakakaupapa Urutā recommendations for Alert Level 3 Care of the dying and Palliative Care guidelines:
Clear and transparent visitation guidelines are needed that are equitably enacted throughout the country, and include care in the hospital, hospices, or residential aged care facilities
Culturally appropriate end of life or palliative care of Māori patients recognises that whānau are central to that care
Safe whānau visitation for palliative care and end of life care to be made possible with robust management of infection control
Whānau should be empowered and enabled to make decisions to move from secondary care settings (hospital care, palliative care) back into their home, if that is right for them.
The provision of adequate and culturally appropriate resources and care packages are needed for Whānau Manaaki (care-givers) to effectively carry out their role in end of life care, if at home.
A ‘whānau bubble’ should be considered to support and provide additional care throughout health care locations.
Te Rōpū Whakakaupapa Urutā recommendations for Alert Level 3 Tangihanga guidelines:
Attending funeral home/ burials/ cremation
Whānau from multiple bubbles can attend a funeral home, burial or cremation.
We recommend that the number of whānau who can be accommodated should be determined by the funeral director’s ability to ensure appropriate physical distancing rather than abiding to an arbitrary number of ten.
Funeral directors are given the opportunity to negotiate with whānau to safely coordinate immediate/close whānau from multiple bubbles in the funeral home for viewing or cremation/burial services. We have been advised by funeral directors that they can and are willing to work with whānau to manage this.
Inter-regional travel is allowed to transport a deceased loved one back to their ancestral urupā accompanied by close whānau members (maintaining bubble and/or physical distancing as required).
Funeral directors can confirm permission to undertake tangihanga activities within our proposed guidelines for Alert Level 3 so that whānau do not incur undue police scrutiny or police opposition to their tangihanga activities.
Whānau be allowed to travel home to their bubbles following burial/cremation.
In early March and before the decision to move to Alert Level 4, iwi such as Te Whānau Ā Apanui and those in Te Tai Tokerau made the decision to close their borders to protect their whānau.
Not long after, most if not all marae committee in Aotearoa made the decision to close their marae.
Due to the absence of guidance from the Ministry of Health, iwi, hapū and marae turned to Te Rōpū Whakakaupapa Urutā for advice and guidance and were proactive and responsive in recognising that tangihanga at marae was a threat.
“The most distressing thing is that all New Zealanders are trusted to go the supermarket on any given day and time. However, despite the leadership role that Māori have shown through out the COVID-19 response, we are not trusted to care for our whānau within our own cultural practices.”
Our Alert Level 3 recommendations for Care of the Dying and Palliative Care guidelines are based on our Care of the Dying and Palliative Care Position Statement, which is available here.
More information about our Alert Level 3 recommendations for Tangihanga guidelines are available here.