254 M. Coombs and M. Woods
Case 3: Clinical Practice Commentary
In the final part of this chapter, we move beyond events in hospital and
explore wider cultural influences that impact decision-making about
organ donation. In this section, we offer a brief (non-comprehensive)
perspective on Māori views about death, organ donation, and trans-
plantation. In Clifford’s story, we will explore how culturally held views
about health, the body, and death influences attitudes towards organ
donation.
Decisions made at end of life, and social customs and practices about
what is appropriate at this time, are informed by culturally held val-
ues and beliefs. Such philosophies influence health care in many ways,
including the manner in which technology is used at end of life, the
moment at which death is recognised, and the body is perceived after
death. With 15.5% of the estimated 4.6 million people in New Zealand
identifying as Māori (Statistics New Zealand 2015 ) and with rates of
organ donation proportionately lower for the Māori population com-
pared with non-Māori populations (Grace et al. 2014 ; Shaw and Webb
2015 ), it is important to understand what factors may impact end-of-
life care and decision-making about organ donation among Māori.
In traditional Māori culture, care given to those who are dying and
deceased is informed by an understanding of what is sacred (tapu).
Whether death is of a circulatory or non-circulatory nature, the same
rites and practices are afforded. The person who has died, and whose
spirit has begun the journey to the resting place of their ancestors, is
considered tapu. Death and dying may be associated with prayer (kara-
kia) and song commemorative of life’s important events (waiata). To
respect the sacred at this time, food or drink is not usually permitted
into a room where the deceased lies, and a bowl of water may be placed
outside the room for the whānau to sprinkle themselves with prior to
entering and upon exiting the room. Such acts keep the worlds of liv-
ing and the dead symbolically separate. The deceased’s body (tūpāpaku)
is handled respectfully and, if the death has occurred in hospital, the
deceased’s body will be removed to the mortuary, leaving the ward area
feet first. It will be taken along a predetermined route, using designated
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