Incorporating Te Tiriti o Waitangi principles into the Assisted Dying Service – Mate Whakaahuru.
The Ministry of Health is committed to supporting a Māori world view of health and ensuring quality (culturally and clinically safe), equitable, and effective services for Māori as part of the Assisted Dying Service – Mate Whakaahuru. This includes ensuring:
- effect is given to the Ministry’s obligations under Te Tiriti o Waitangi by ensuring the Assisted Dying Service considers and is inclusive of the interests, views and needs of Māori
- equitable access so that Māori can access the service in ways that meet their needs
- services are provided in a culturally appropriate way that recognises and supports the expression of Māori models of care
- services provide for Māori self- determination and mana Motuhake, meaning services are person-centred and whānau-centred.
Governance and Māori representation
Formal partnerships and representation in governance provide ongoing guidance and direction. The partnerships and governance include:
- Te Apārangi: Māori Partnership Alliance
- The Support and Consultation for End of Life in New Zealand (SCENZ) Group, which includes two Māori members, and a Māori co-chair
- The End of Life Review Committee, which includes a Māori member
The Governance Group for the implementation of the End of Life Choice Act 2019 included representation from the Deputy Director-General, Māori Health Directorate, the Ministry of Health senior Māori Leader, and external membership including the Chair of Te Apārangi.
Incorporating Te Tiriti into the implementation
The health sector’s Tiriti framework is embedded in Whakamaua: Māori Health Action Plan 2020–2025. This framework draws on the findings of the Hauora Report on the Health Services and Outcomes Kaupapa Inquiry (Wai 2575) and adopts an approach based on both the principles and articles of Te Tiriti.
The principles of Te Tiriti, as understood by the Ministry in Whakamaua: Māori Health Action Plan, were considered and incorporated as part of the planning and deliverables during the implementation of the Act. This included:
- focused and ongoing engagement with Māori health and disability organisations and Kaupapa Māori health and disability service providers as part of the establishment of assisted dying
- ensuring the Te Tiriti o Waitangi commitments are incorporated in the service design and reflected in the guidelines, standards of care, care pathway, clinical guidelines, Section 88 notice (funding mechanism); training for the sector, and information about the service.
- formal partnerships and governance that provide ongoing guidance and direction alongside the Ministry of Health.
Māori engagement during the implementation programme
Engagement was undertaken with Māori health and disability organisations and Kaupapa Māori health and disability service providers as part of implementation of the Assisted Dying Service. This included regular meetings with Māori led primary health organisations and Māori health providers with general practitioner practices.
Engagement as part of the implementation of the service aimed to recognise Māori, and support Māori in their aspirations, whatever they are, by recognising mana motuhake – self-determination.
The purpose of the engagement as part of the implementation was to inform the sector about the Act, and the implementation of the Act, and invite the sector to inform the design of the new service, including at key stages.
Engagement included meetings and discussions with Māori led primary health organisations, Māori primary health care providers, and regular updates with the National Māori Health Organisations as part of the implementation of assisted dying.
Māori health organisation feedback is included in the care pathways, the health professional training and guidance, the Standard of Care and Clinical Guideline, and the Section 88 Notice that supports the funding for practitioners delivering the services.
There will be continued work to develop information that will support care planning specific to Māori who may request assisted dying. For example, it is important the person and their whānau can explain preferences as part of the assisted dying service, particularly from a social, cultural, and spiritual perspective.