Palliative Care Practice in New Zealand

This essay discusses the palliative care framework in New Zealand, focusing on the holistic aspects of 'Whānau' and 'Te Whare Tapa Whā'. It explores the New Zealand Palliative Care Strategy, best practice trends, significant contributions, legal and ethical considerations, and key areas for consideration. The essay emphasizes the importance of culturally competent, holistic, and person-centered approaches in improving patient quality of life and dying.

Running head: PALIATIVE CARE PRACTICE
PALIATIVE CARE PRACTICE
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Introduction
The following essay will discuss aspects of a palliative care framework in New Zealand,
considering the holistic aspects of ‘Whānau’ and ‘Te Whare Tapa Whā’.
Discussion
Palliative care in New Zealand
One of the essential frameworks guiding palliative and end of care is the New Zealand
Palliative Care Strategy. The Ministry of Health and the Health Funding Authority, after taking
insights from the National Health Committee’s project on ‘Care of the Dying’, introduced the
framework in order to mitigate the emerging elderly population of the nation, along with care
burdens experienced by aged care organizations and hospices of New Zealand (Meier et al.,
2016). The New Zealand Palliative Care Strategy is considered for operation when an
individual’s health condition is beyond the scope for cure and further treatment. Such a palliative
care strategy relies on the principle, that irrespective of attaining the terminal stage of health, a
patient has the right to receive holistic care aimed at achievement of social, psychological and
physical wellbeing (Phillips, Ingham & Macleod, 2015).
Best Practice Trends
For the purpose of ensuring positive health outcomes, relief from debilitating symptoms,
improved quality of life in the patient who is terminally ill, palliative and end of life care services
consider adherence to a number of essential practices (Robinson et al., 2016). The practices and
healthcare palliative services which have been considered to yield the best results include:
conductance of care that is person centered and is inclusive of the patient preferences as a direct

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determinant of the palliative decision making process, delivers terminal care which is sensitive to
the unique cultural needs and practices of the Maori population, incorporates sensitive
interpersonal communication between the health staff, the patient and his or her family/whanau,
administers a holistic care plan through participation of a multidisciplinary team for achievement
of psychological, social and spiritual wellbeing, includes family centered approaches which
allows terminally ill patients to be close to their near and dear ones and respects autonomy of the
patient especially in terms of selection of treatment (Landers, Dawson & Doolan-Noble, 2018).
Significant Contribution
One aspect of palliative care strategies such as the New Zealand Palliative Care Strategy,
which contributes significantly towards improvement of the quality of dying and life in end of
life patients and their families is the inclusion of the Maori aspects of ‘Whānau’ and ‘Te Whare
Tapa Whā’ (Gott et al., 2015). ‘Whānau’, translated as ‘extended family’ in the Maori
communities. Indeed, the cultural and spiritual practices of Maoris take into consideration the
importance of belonging to a closely knit community and respecting the emotions of near and
dear ones (Schill & Caxaj, 2019). Similarly, ‘Te Whare Tapa Whā’ is the foundational principle
dictating Maori health practices and is dependent on maintenance of an equilibrium between four
cornerstones of health. Hence, Maori culture defines optimum health as one consisting of
adequate physical growth and development (taha tinana), the ability to practice spiritual fate
(taha wairua), the capacity to be with family (taha whānau) and the capability to be mentally and
emotionally sound (taha hinengaroa) (Gott et al., 2017). New Zealand’s palliative care
frameworks contributes significantly to quality life and dying by respecting the importance of
family and delivering help to patient’s whānau. Additionally, palliative services incorporates the
four aspects of Te Whare Tapa Whā through provision of a multidisciplinary of health

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professionals attending to multifaceted health needs of the palliative patient (Moeke-Maxwell et
al., 2018).
Legal and Ethical Considerations
A number of ethical and legal considerations surround the concept of palliative and
hospice across patients, families and health professionals. Palliative health professionals must
consider ethically conducting patient centered practices by respecting autonomous decisions of
patients regarding palliative treatment. To adhere to the same, health professionals must adhere
to patient needs after their demise, as per the preferences set out by the patient’s enduring power
of attorney, that is, whānau (Park & Astell, 2017). In the legal aspect, New Zealand’s ‘Death
with Dignity Bill’ treats the patient’s decision to avoid treatment and opt for physician assisted
euthanasia as ethical, only however, after provision of counseling, medical confirmation,
psychiatric assessment and reflection by the patient (Oliver, Wilson & Malpas, 2017).
Conflicting opinions are presented by New Zealand Medical Association (NZMA) who consider
PAS to be unethical but however, supports the patient’s right to deny treatment, despite the same
hastening the patient’s death (Egan et al., 2017).
Key Areas for Consideration
A key area of concern is the lack of adequate interactions on approaching death between
the patient’s families and the palliative care professionals. Health professionals delivering
palliative care are hence recommended to engage in empathetic interpersonal communication to
clarify families’ expectations on palliative care (Walker & Waterworth, 2017). Additionally, it is
recommended that palliative care professionals enlighten themselves on culturally competent
care and Maori healthcare practices for successful administration of ‘Whānau’ and ‘Te Whare
Tapa Whā’. It is also recommended that palliative care professionals educate themselves on legal

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and ethical sensitivities associated with palliative care, as well as provide whānau/family
centered counseling referrals or services for assisting bereaved families (Frey et al., 2016).
Conclusion
Hence to conclude, it is advised that palliative care frameworks, policies and
professionals must consider adherence to culturally competent, holistic and person centered
approaches to improve patient quality of life and dying.

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References
Egan, R., MacLeod, R., Jaye, C., Mcgee, R., Baxter, J., Herbison, P., & Wood, S. (2017).
Spiritual beliefs, practices, and needs at the end of life: results from a New Zealand
national hospice study. Palliative & supportive care, 15(2), 223-230.
Frey, R., Robinson, J., Boyd, M., Foster, S., & Gott, C. (2016, July). Barriers and facilitators of
palliative care communication in Aged Residential Care (ARC): A New Zealand
example. In 3rd International Sociological Association Forum of Sociology.
Gott, M., Allen, R., Moeke-Maxwell, T., Gardiner, C., & Robinson, J. (2015). ‘No matter what
the cost’: A qualitative study of the financial costs faced by family and whānau
caregivers within a palliative care context. Palliative medicine, 29(6), 518-528.
Gott, M., Moeke-Maxwell, T., Morgan, T., Black, S., Williams, L., Boyd, M., ... & Waterworth,
S. (2017). Working bi-culturally within a palliative care research context: the
development of the Te Ārai Palliative Care and End of Life Research
Group. Mortality, 22(4), 291-307.
Landers, A., Dawson, D., & Doolan-Noble, F. (2018). Evaluating a model of delivering
specialist palliative care services in rural New Zealand. Journal of primary health
care, 10(2), 125-131.
Meier, D. E., Back, A. L., Berman, A., Block, S. D., Corrigan, J. M., & Morrison, R. S. (2017).
A national strategy for palliative care. Health Affairs, 36(7), 1265-1273.

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Moeke-Maxwell, T., Mason, K., Toohey, F., & Dudley, J. (2018). Pou Aroha: An Indigenous
Perspective of Māori Palliative Care, Aotearoa New Zealand. Textbook of Palliative
Care, 1-17.
Oliver, P., Wilson, M., & Malpas, P. (2017). New Zealand doctors’ and nurses’ views on
legalising assisted dying in New Zealand. NZ Med J, 130(1456), 10-26.
Park, S. J., & Astell, H. (2017). Prevalence of enduring power of attorney and barriers towards it
in community geriatric population in Counties Manukau Health. The New Zealand
Medical Journal (Online), 130(1453), 35.
PHILLIPS, J., Ingham, J. M., & MACLEOD, R. (2015). Development of palliative care in
Australia and New Zealand. Textbook of Palliative Medicine and Supportive Care, 59.
Robinson, J., Gott, M., Gardiner, C., & Ingleton, C. (2016). The ‘problematisation’of palliative
care in hospital: an exploratory review of international palliative care policy in five
countries. BMC palliative care, 15(1), 64.
Schill, K., & Caxaj, S. (2019). Cultural safety strategies for rural Indigenous palliative care: a
scoping review. BMC palliative care, 18(1), 21.
Walker, H., & Waterworth, S. (2017). New Zealand palliative care nurses experiences of
providing spiritual care to patients with life-limiting illness. International journal of
palliative nursing, 23(1), 18-26.