Ui mai ki a au, he aha te mea nui o te ao, maku e ki atu, he tangata, he tangata, he tangata. Kei nga huia kaimanawa o te motu, rarau mai ki Te Hui. Ko Mihingarangi tenei e mihi atu nei ki a koutou katoa. Welcome to The Hui ` Maori current affairs for all New Zealanders. E taro ake nei... Assisted dying ` an issue of tino rangatiratanga or a transgression of tikanga Maori? How might the End of Life Choice Act impact Maori? There are serious ethnic disparities in our health system. This bill will be front and centre within that system, which we know already doesn't work for Maori, for Pasifika and for ethnic minorities. Tikanga is about dignity and mana. And he said that the most important tikanga is mana, and the ultimate indignity, sir, is living without mana. So how will Maori vote in the upcoming referendum? We reveal the results of our special poll. Captions by Able. www.able.co.nz Copyright Able 2020 Karahuihui mai. This September, when New Zealanders vote in the general election, they'll also be asked to vote on whether or not the End of Life Choice Act comes into force. The controversial act will allow the terminally ill to end their lives with medical assistance from a doctor. Currently, voluntary euthanasia, or assisted suicide, is legal in parts of Australia and Europe, Canada, Colombia and several US states. To discuss the possible implications for Maori, I'm joined by Selah Hart, CEO of Hapai te Hauora, senior lecturer and academic Te Hurinui Clarke, Kingi Snelgar, lawyer and advocate, and all the way from Te Tai Rawhiti, the Reverend Chris Huriwai. Tena koutou katoa. ALL: Kia ora. Can I start by giving a show of hands of who will vote yes in this referendum? So, two, and you're gonna vote against? Ka pai. Let's see what the rest of the motu has to say. We asked a sample of 543 Maori how they will vote in the referendum. And we asked our survey group ` 'If the law comes into force, 'are you concerned there will be a disproportionate number of Maori who will choose to end their life 'as a result of the inequality of care in our health system?' So with that, still 61% of those polled are not concerned with the health inequality as a factor. Chris, what are your thoughts? Uh... I have a really nuanced position when it comes to this kaupapa. I think it's an important one, and because of the depth of that importance, I think that all the boxes need to be ticked, all the I's dotted, all the T's crossed before I'd be in a position to be able to vote for something like the End of Life Bill. Do you think that the inequality, though, might be a concern around that? It is one of my chief concerns. So, I think it was last year, the Waitangi Tribunal released their report on primary healthcare organisations and their impact, or lack thereof, among Maori communities. And the frightening fact that came out of that for me was, um, the fact that primary health organisations are both institutionally racist, and many of the individuals within them are individually racist. So for me to then trust the life of my nannies, of my papas, of my whanau to an organisation or a grouping of organisations that suffer from institutional and individual racism is asking too much. I don't trust them. So, with youth, you know, you're considering voting for this in the referendum, but given what we do know about the trust issue, is that something you've considered? Um, you know, OK, Mihi, for me, the... issue is about choice. Um, and I do have some concerns... about, you know, disparities in the health system, but ultimately, it is about choice. We have choice in every other aspect of our life. We should have the choice to end our life as well. This is your area of expertise. (CHUCKLES) Um, I guess, give us some examples of what you've been thinking about in terms of the inequality. I think that, um... When I didn't raise my hand before, it wasn't that I have a yes or no; I'm undecided. And I think I'm undecided because I know that our system in its current format does not address health equity for Maori, first and foremost. And so until we unpack many of the undercurrents or underlying factors that are contributing to our whanau potentially being put in a position to make these decisions, I don't know where I stand, and as an organisation, we have purposefully not held a position in this. You're a lawyer, so you understand inequalities all the way around. I guess, you know, you've indicated that you would vote for this in the referendum. But should we be closing those inequality` the gaps of inequality between Pakeha and Maori before we introduce a new bill? Absolutely, and that's a concern of mine. I agree with Selah that there are massive issues with the healthcare system. And I guess it's quite a personal issue, and it's really sensitive for a lot of Maori. But for me, it's when I've seen whanau members that are terminally ill and the pain and suffering that they go through, and keeping their mana intact ` giving them the ability to be assisted, or fastening that process, is something that I support. But I'm concerned about the wider institutional racism Any... Yeah. Have Maori had... input into this bill? Do you know? Uh, I'm unsure, but one of, sort of, the pou, I suppose, of my opinion, especially coming from Tai Rawhiti, is our papa Amster Reedy. And he did submit... not for this bill specifically, but as part of a submission to a select committee in which he said that, for us in Tai Rawhiti, the idea of euthanasia or assisted suicide is something foreign to our experience as Maori and something foreign to our tikanga. And so I'm guided by those lights, those lights that exist within Tai Rawhiti, within my faith as a Christian. And, yeah, for me, they're pointing towards a nuanced position, I suppose. Yeah. I wanna talk` We're gonna get to tikanga next, cos that's one of the specific questions that we have, so I'm not gonna ask you about that until part two. But I do wanna come just before we wrap up this end ` in terms of the health inequalities, do you have any ideas of how we prevent inequality from therefore forcing people into a decision? I think we need to address the underlying issue of under-investment in health prevention or health protection. We have a society or societies across Aotearoa New Zealand that do not enable health and well-being for our whanau, first and foremost. And so until we, you know, look at the whole environment in which we are surviving now and what didn't sustain our tupuna before us, I think there is much that needs to be done before we can really get into this. Ka pai. Tena koutou. Ka hoki mai Te Hui akuanei. Auraki mai ano. Well, one of the big talking points regarding the End of Life Choice Act is whether or not it's a transgression of tikanga Maori. We asked our respondents what they think, and we'll share those results next, but first, let's take a look at what the Honourable Peeni Henare had to say about tikanga Maori and end-of-life choice. So, we asked our respondents if they believe the End of Life Choice Act is incompatible with tikanga Maori. We also asked if they believed that the terminally ill choosing to die is an act of tino rangatiratanga ` self-determination. Those are really interesting results. I guess, coming to you, Te Hurinui, off the back of Peeni Henare there, should tikanga evolve? I think tikanga does evolve... when it's necessary. Um, yeah. My experience comes from watching my mum suffer. Mm. And, uh, she was a staunch Catholic... as well as a staunch supporter of tikanga Maori. And in her, uh, last... few months, she was, um, challenged, I suppose ` both... in her faith and in her tikanga,... challenged to the extent where she said that, um, if this option was available, she would certainly have taken it. And it was all about maintaining her dignity. So, you know, Dad, who was a karaua at the time, was her caregiver and had to clean her, wash her, bathe her. And certainly, the pain was a factor. But it was more of a fact that... that loss of dignity for her and putting Dad and the rest of the whanau through the pain and anguish of watching her suffer. So I think... I think, when it comes to tikanga, it's part... this is part of a broader... question. It's also a part of, um,... organ donations. It's also a part of where we should be talking about the donation of blood. Sperm donations. So, all we are giving parts of your body away, which, to us, our tikanga, frowns upon. Kia ora. Ka nui te aroha ki to whanau. Um, it's a really interesting point there around hahi perspective. And I wanna come to you, Chris, cos there is a wairua part to this, and what is your whakaaro around that? Yeah, so, I think... when it comes to the faith perspective or the wairua perspective of something like this, I think mate and that process of dying has its own dignity, its own tapu. And that dignity and that tapu should be protected. And I think, uh, like what Te Hurinui's saying, we need to have that wananga around the impacts on our tikanga as Maori, the impact on our tikanga as people of faith, before we start making the decisions as to whether or not we do start using this thing called euthanasia. Mm. One of the other results in there was whether it was an act of tino rangatiratanga. 55% of Maori thought it was. Is this the ultimate act of tino rangatiratanga, in your perspective? It is, but I think it should be coupled with returning tino rangatiratanga to Maori to run our own healthcare system. So, I think it's really complicated, but I agree. It's about returning mana back to those that are suffering. Having lost someone late last year, certainly that question about dignity is there, but also the fact that, at the moment, the bill proposes that it's an individual choice. That's probably not consistent with tikanga Maori ` that we have the person suffering that makes this decision without whanau input ` because I know from my experience whanau are there and caring for those that are suffering. But certainly to help ease the pain for those terminally ill, I support that and think it is consistent with mana. When you consider your position, running Hapai te Hauora,... can you even have a bill like euthanasia when we haven't really got a Maori health system that's working? I think that there is a place for it to exist, and, you know, I'm not going to put an answer to if it is right or wrong or if we're in the right time or not. But what I know is that what we're waiting for is the time ` not if but when we will have our own Maori health authority, first and foremost. And I think that once we get to a place where we start to make our own decisions and are not reliant on a system that continues to fail us, we will then be able to progress into topics and issues such as this. What` What would your message be to lawmakers, then, if this referendum was to go through? What would you be saying to them immediately about, you know, your perspectives in terms of inequality of health? I think that they need to take this... alongside many other things that are impacting our whanau ` take it into consideration that every decision that they make in that house has an implication on our whanau every single day, and that we have put them in the place of being our decision makers because we trust in them, but if they continue not to address or understand the issues and make suitable systemic changes to our system, you know, what does that mean for the outcome for the hauora of our whanau and our communities? Mm. And, I guess, when you listen to Peeni Henare, I wonder ` is he right that the decision isn't for Parliament to make but more about the tino rangatiratanga of your whanau? Yeah, I think so, but I also think it's the wider healthcare system that's an issue. We can't have euthanasia if Maori are treated differently and aren't treated the same. So I think if we're having this discussion, it's important for our people voting to be informed about the bigger issue about Maori being treated differently. And it's not just healthcare. Obviously, where I work, in the justice system, we're treated differently as well. Chris, we have a... someone who's fed in to us who has terminal cancer, and she's a mum, and she's not that old. And she said that she is for end-of-life choice, but she's a Christian, and she's actually really confused about that. And I wondered if you had a message for her. Yeah, so, I would say to people in that position that there is... that... that the choice whether to use euthanasia or assisted suicide is... isn't one that should be... Oh, I'm mumbling my words. The decision to use euthanasia or assisted suicide for people of faith shouldn't be one for which they fear their faith will disagree with them or their faith will condemn them or God will condemn them. I don't believe any of those things to be true in this instance, and I don't believe it to be true in the case of things like suicide. Whereas there are times in the history of the church where we have taught that those things are incompatible with our faith. I don't believe that to be true. My concern around euthanasia is about the vulnerable, basically. I'm not convinced that the vulnerable will be protected. And when it comes to tino rangatiratanga, I'm more than willing to give up my tino rangatiratanga if it means someone's life will be saved. I'm not willing to make someone else's life the cost of my own self-determination. Kia ora. We have some really interesting results on whanau when we come back. And we'll be back with more after the break. Hoki mai ano. So, who gets a say on ending a life? We'll share our respondents' thoughts next. But first ` two of the most impassioned speeches against the End of Life Choice Act were made by Whanganui MPs ` Labour's Adrian Rurawhe and National's Harete Hipango. Kia titiro ake tatou. It will disadvantage Maori further in a system which already disadvantages Maori. Their health inequities are significant. We cannot continue to pass bills... that continue to` to affect Maori... and others... in that way. This is flawed. It is not what it seems to be,... and for Maori, this is a monocultural optics and lens, and the position has been stated that as a Treaty partner, as one of those who bridges the worlds of Maori and Pakeha, this bill is a kill bill. Please prevent it. Well, we asked our survey group how much say, if any, whanau should have about a loved one's decision to die. Legally, what are the challenges around whanau making decisions? Very difficult. You just need approval of two doctors in order for this to happen, and there are privacy things in place. It's interesting, though, that the MPs said... They talked so passionately about it being a monocultural lens, but, you know, how much... She called it a 'kill bill'. I know. How much are they actually investing in Maori healthcare and the monocultural healthcare system that already exists? So, um, we need to think about... They are saying everything really passionately, but are they actually putting that passion into real change? You know, Maori whanau are so involved in mate, but at the moment, it's going to be very difficult for them to have a say, so there needs to be changes to the healthcare system. There also needs to be oversight of these GPs. Who is the watchdog for the two GPs that are making these decisions? Are Maori involved in that? That's a good point ` the watchdog of the doctors that are making the decisions. I guess my question is ` what are` what is whanau's role... in the decision-making of really important health decisions, at present? Yeah, so, all whanau or all patients or... those that are receiving healthcare are enabled the opportunity to have whanau there to support them and to enable them to transition or journey with them through their illness or whatever it might be that they're experiencing. I think, um... I put myself in the shoes of the whanau and think ` you know, if I was put in a position such as this, how would I react, or what would I want? And obviously, we've heard some really personal stories around the table today, and I think it's really important to have compassion when thinking about this whole kaupapa. And, you know, whilst we're going to referendum at the end of this year, in September, I also think about or consider those that don't participate in that process at all, and so where are their voices being heard? You know, I really wonder if this is the right process, and have we missed a couple of steps in this process to get to where we are today? I know that a couple of weeks ago, at the Kingitanga Poukai, it was being heavily debated, this topic specifically, and there was very much a consensus that there was no way that Tainui would be considering this as part of their iwi perspective. So, you know, there are many conversations already happening. Has it been, though, left out of the process? Do you think the bill's flawed because it hasn't consulted widely with Maori? We're talking to a health provider here, a hahi over here. We're just hearing that Waikato Tainui is ruling it out. Do you think that perhaps what they need to do is wind it back and go and consult with Maori? Yeah, I think Maori voice has been lost in the process. It doesn't change my perspective, but I certainly think that the Maori voice... Maori has not been consulted, and there should be a consultation process. The survey, in some ways, is a consultation of sorts and gives you a general idea of what may be happening out there in Maori communities and what Maori communities may be thinking. However, it's not a... the correct process to follow. You know, if we're talking about tikanga, then we need to consult with our whanau. Overall, our survey has put Maori as more supportive of the referendum than non-Maori. Is that a surprise to any of you? No. I think a lot of us have been through the process of seeing whanau pass away, so we're more familiar with the idea of mate, maybe, than non-Maori. I wasn't surprised at the results. Whakaaro? I'm... Similar to Kingi. I'm not surprised, only because we live and exist in a world that acknowledges that mate is a part of life. Mm. Mm. And because of that, we're more ready to talk about it, eh? We're more ready to have the conversation. We're more ready to sit around a table with whanau of differing views and still be whanau once that korero's finished, because we exist in that liminal space, more than, I would say, Pakeha do. One of the results that we didn't bring up was about those who suffered disabilities, and 70% of respondents thought that sufferers of long-term disabilities should also have the right to medically assisted death. What's your whakaaro around that? Does it change? Oh, I think that, again, it goes back to that compassion and case-by-case. If there is someone that has suffered for a long, long time, what other mechanisms has the health system done to support that person, first and foremost? And if this is a consideration, then what does that look like for that person and that whanau? Te Hurinui? Oh, actually, I was away thinking about the previous question So, um, I was thinking that if there is someone in the family who is thinking about... assisted... well, dying with assistance, then the whanau should be consulted earlier. So you hold a wananga well before the six-month... time. And, um... And the whanau come to some sort of understanding as to... what it is that their family member wants, how do we go about supporting them. It's all part of that consultation, that wananga process, whakawhanaungatanga, because, uh, for us,... death ` you know, 'Ko te mate anei te wa; te wa, te mate.' We do talk about life and everything in balance, and we're exposed to death at an early age. So it's not surprising that whanau have, um... have responded the way they have. But I think those conversations need to happen well before they are terminal. And that's a conversation that hasn't happened in this, and you talk about how we, when someone passes away, we all know what to do. The tangi's on, and we all just... it's like clockwork. But this process that we're talking about prior to somebody passing away has not really had any tikanga or customs or anything wrapped around it. Would you agree with that? I'd totally agree with that, and as a person who... officiates funerals, it's what we do. I'm worried that when, all of a sudden, I get a phone call, and someone says, 'This person's died by assisted suicide or euthanasia,' how do I respond from a tikanga place to that tangi? How does the kaikaranga shape and augment her karanga? How does the kaikorero shape and augment their korero to mihi to this person in the reality that they chose themselves for this to happen? So that's a really big concern for me. Again, though, there's that ever-present reality that there is no such thing as Maori tikanga. We're not a homogenous people. We don't all think the same. We have` Even in Tai Rawhiti. Someone in the north of Tai Rawhiti and the south will have conflicting views. Sitting in the same marae ` conflicting views. So, ko te wananga te mahi. What a wonderful place to leave that with lots of things to have a good think about. Tena koutou katoa. Kua hikina Te Hui mo tenei ra. I want to thank you all for joining us today. We leave you today with a special waiata ` ara ko Tangi Hotuhotu na Taisha Tari. Noho ora mai. (SINGS IN MAORI) (EMOTIVE MUSIC) (MUSIC, SINGING CONTINUES) (SINGING CONTINUES, MEN PERFORM HAKA) Captions by Able. Captions were made with the support of NZ On Air. www.able.co.nz Copyright Able 2020 (SINGING CONTINUES) (MUSIC ENDS) ALL: He mea tautoko na Te Mangai Paho. The Hui is made with support from NZ On Air.