'It's not all just about the dying'. Kaumatua Maori attitudes towards physician aid-in dying: A narrative enquiry.

AIM: To explore kaumatua attitudes towards physician aid-in dying, to gain a clear understanding of how such attitudes may influence and shape their expectations of medical care at the end of life and to assist health professionals in Aotearoa/New Zealand to address the healthcare needs of older Maori near the end of life. DESIGN: A kaupapa Maori consistent approach was undertaken. A systematic narrative technique was employed for the qualitative data analysis. Data were triangulated through independent data coding by three researchers (two of whom identified as Maori researchers), to ensure a robust and consistent method of analysis as well as adhering to a kaupapa Maori research approach. SETTING/PARTICIPANTS: Recruitment of participants was through kaumatua of Te Kupenga Hauora Maori (Maori leadership within the Faculty of Medical and Health Sciences), University of Auckland and local Auckland marae. Focus group or individual interviews (as per their preference) were undertaken with 20 Kaumatua from the Auckland region. RESULTS: Five closely interrelated themes were identified from kaumatua narratives regarding physician aid-in dying. These were (1) attitudes and understandings of physician aid-in dying, (2) influence of power, (3) significance of kawa, (4) whanau relationships and the (5) significance of wairua. CONCLUSION: The study demonstrated that for these kaumatua, medical practices that hasten death such as physician aid-in dying are 'not all just about the dying'. Tikanga and kawa are important processes and concepts to understand during death and dying, and whanau are central to such processes being respected by those involved in the dying process. These factors are so closely intertwined that they cannot be considered in separation of each other.

A critical exploration of a collaborative Kaupapa Maori consistent research project on physician-assisted dying.

AIM: This paper critically explores the research approach undertaken by Maori and tauiwi researchers working alongside kaumatua within the context of physician-assisted dying. We critically explore the collaborative process we undertook in framing the research context and discuss the rewards and challenges that emerged. METHOD: The research this critical discussion draws on undertook a qualitative Kaupapa Maori consistent research approach and drew on the principles of an Interface Research approach. The paper focuses on the collaborative approach taken between the 10 researchers involved in the study. RESULTS: Challenges identified within the collaborative Kaupapa Maori consistent research process included: determining appropriate authority and representation of researchers and participants; maintaining clear communication; time and logistical management. The key strengths that emerged from this research design were: establishing a culturally safe and robust research process; an ability to build and maintain relationships between researchers and participants; and the opportunity to develop academic research skills between researchers and participants. CONCLUSION: Collaborative Kaupapa Maori consistent research approaches to research can enable accountability, control and representation throughout the entire research process. Given the rich research results achieved and personal rewards gained from this study design, we would advocate for the application of such approaches within health research contexts.