Story: Death and dying
Page 1 – Dying and bereavement
The number of deaths in New Zealand climbs each year as the population increases in both size and age. In the year to June 2010, 28,840 people died in New Zealand. Only 5% of those who died were under 40 years old, compared to 9% in 1990. Most of those who die are over 60 years old – the median age at death in 2009 was 77 years for men and 83 years for women. Age at death still differs significantly for Māori and non-Māori – on average Māori die at a younger age.
All cultures and religious beliefs attach social and spiritual importance to death and mourn the dead.
Home and hospital care
In the late 19th and early 20th centuries death usually occurred at home, with family members caring for the dying during the final weeks, days or hours of life. During the 20th century death was more likely to occur in hospital as doctors and nurses became involved in caring for dying people. In the early 21st century 70–80% of deaths occur in hospitals and rest homes.
No place like home
In the 2000s hospitals increasingly support death at home by liaising with general practitioners and district nurses who take over responsibility for the prescription and administration of medication. Peter Hicks, head of Wellington Hospital Intensive Care Unit, said in 2005 that facilitating death at home ‘humanises what we do … you can forget about blood pressure and testing … I think it has helped how we care for patients in the unit’.1
Catholic religious orders were the first to provide care outside the family for the dying, chronically ill and disabled. In the mid-20th century international support developed for modern hospices – places that provided physical, social, spiritual and emotional support for those dying, and their family and friends. By 2010 there were 34 secular and religious hospices in New Zealand, which focus on enhancing the lives of the terminally ill and providing appropriate pain relief.
Hospitals and community health teams have adopted many of the strategies of hospices as they relieve pain and work to improve the comfort of those who are dying.
A ‘good death’
In many religious and cultural traditions, a ‘good death’ involves being conscious, recognising those around and engaging in acts of forgiveness, farewell and reconciliation. However, death may be accidental, untimely, violent and unexpected.
In most religious and cultural traditions certain things are said and done before and after death. Family, friends and neighbours gather to say goodbye and the dying person may offer a final speech. Prayers, chants and special rituals may be performed.
Many Catholics want to receive holy communion or viaticum (food for the journey) and the sacrament of reconciliation (confession) from a priest. Other Christians may also receive holy communion when they are close to death. These rituals recall the death of Christ and focus on the life of the spirit or soul beyond death. Across different religious traditions prayers and chants are offered to farewell the spirit of the dead person immediately after death.
Secular rituals include lighting candles, playing music, singing songs, assembling special objects and having final conversations that connect the person who is dying with those who love them. Non-religious rituals are increasingly important in the 21st century because nearly a third of New Zealanders do not identify with any particular religion but feel that it is still important to do something of significance for the dead and the living.
In the past people wore black, cut their hair or shaved their head when someone close to them died. In Victorian times mourning jewellery was worn which sometimes incorporated hair from the person who had died. Mourners are now less likely to dress differently, although some people still wear black to funerals.
For Māori it is vital for bereaved whānau to participate in a set of rituals over several days. Non-Māori from a range of different cultural and religious backgrounds also spend time with dying relatives and friends, and engage in rituals of farewell. The Holidays Act 2003 provides for up to three days bereavement leave on the death of a close relative (the minimum time for tangihanga or Māori mourning rituals), and there are no limits on the amount of bereavement leave in any year.
Support for those grieving usually comes from family members, friends and religious institutions. Professional grief counselling developed in the later 20th century. People also use the services of community organisations such as Skylight, an organisation set up to support children and young people experiencing grief and trauma. Hospices and funeral directors increasingly offer grief support.