Te Ao Māori: Māori Nurses' Perspectives on Assisted Dying and the Te Ao Māori Cultural Considerations Required to Guide Nursing Practice

Abstract

The ultimate purpose of this thesis and its research is to contribute to and participate in the end-of-life care discussion in Aotearoa New Zealand and to validate Māori nursing as an authentic research community with its own unique voice, which deserves to be heard. In 2020, end-of-life care in Aotearoa New Zealand took on an added dimension with a majority of New Zealanders voting ‘yes’ to support the End-of-life Choices Act 2019 coming into force in 2021. For Māori nurses working in end-of-life with Māori patients and their whānau (family group), the legalisation of assisted dying under certain circumstances adds a further layer of complication to what is already a complex environment. This thesis explores, through kaupapa Māori (Māori ideology) research principles, the underlying, fundamental concepts that guided ten Māori nurses working in end-of-life care settings. These concepts of whanaungatanga (establishing connections), manaakitanga (generosity and care for others), and kaitiakitanga (guardianship) are lived and breathed by these Māori nurses along with the guiding ethical principles of tika (the right way), pono (honesty) and aroha (generosity of spirit). Taken together, these concepts and guiding principles shaped how these Māori nurses cared for their Māori patients and whānau, and for themselves in the face of long-standing systemic and institutional barriers to equitable Māori health care. These barriers are perpetuated by inequity, poverty and a lack of access to culturally appropriate services for Māori patients and their whānau when at the end-of-life. For Māori nurses working in end-of-life care settings, endemic discrimination, racism and marginalisation also meant their unique contributions and connections with their community have been devalued and ignored for too long by the Western medical model they work within. The qualitative research demonstrates the resilience and practicality with which these Māori nurses navigate the system they work within, and the primacy of caring for and advocating for their Māori patients and whānau. Crucially, the research also makes the case across the whole health sector, as well as in end-of-life care, for comprehensive work to address racism and bias, and the marginalisation of Māori nurses’ voices and experiences. Better education and knowledge about the Māori worldview on death and dying for healthcare professionals can only lead to better care for Māori patients and whānau. Similarly, better funding of and access to appropriate services for Māori patients and whānau, and better support for Māori nurses working in end-of-life care will ensure that value, resourcing and space will exist in the health system for Māori, both carers and patients and their whānau.