A sense of acceptance, love and support is integral to the end-of-life journey for sick people. IPEPA Cultural Considerations1
Healthcare professionals and services need to be mindful of a number of practices / rituals in relation to this, including:
- The gathering of family and community is a practice that shows the respect that is associated with the person’s value to the community. Many people will come from long distances to help and support the person and their family during the end-of-life journey
- In many communities, it is not acceptable for a person to die alone. The family may request that someone be allowed to stay with the person at all times, including during clinical / personal care and overnight. It is important for health services to consider ways to accommodate larger family groups and to support the need for someone to be with the person at all times. Providing larger rooms for family to gather, providing rooms with outdoor access, and offering flexibility in visiting regulations, while still respecting the needs of other people and their families are all important strategies.
- In the days before passing, the person may receive spiritual visitors, perhaps Ancestors or other family members who have already passed. These visits usually bring peace to the person and the family who are with them, and should not be confused with delirium
- Torres Strait Islander people may mimic or simulate their totem (animal or bird) during the last days.1
Reaction to loss is highly individual and experienced differently by every person. After a family or community member has passed on, some family and community members may:
- Continue to talk to the person throughout their journey
- Call the spirit home by singing or dancing
- Wail or cry loudly (women)
- Become quiet and not want to talk
- Get angry and blame someone for the loss
- Want to stay near the person’s body
- Commence preparations for the body and spirit’s transition
- Use comfort measures like prayers.
After death, a smoking ceremony may be conducted which involves smoking of the deceased person’s belongings and home to assist with the spirit’s journey to the Ancestors. This is a sacred ritual and may not be discussed openly with healthcare staff. However, it is important that this, and any other cultural practices, are supported, allowing time and space for the family / community. In some Aboriginal communities, it is important after a person’s passing for Elders to identify the causes of death. These are usually of a spiritual nature and will not be discussed openly.2
If a person dies and they are not on their own Country or Island, there is a belief that their spirit can be hindered from returning to Country and becomes ‘stuck’ in the place of death. A smoking ceremony can be performed by the Traditional Custodians of the Country where the person died. It is a ritual that helps a person’s spirit to be released for the journey back to their own Country.1
|In both Aboriginal and Torres Strait Islander communities, the deceased person’s name is not mentioned nor are images / videos of them shown, based on the belief that to do so will call the person’s spirit back and prevent safe passage to the spirit world of the Ancestors. For some families, this is not a concern – as with all cultural considerations, it is important to ask the family what they would prefer. Clarifying this before the person passes is helpful.1
Contacting the next of kin following the death may not be correct practice when caring for either Aboriginal and/or Torres Strait Islander people. Seeking cultural guidance from the Aboriginal and/or Torres Strait Islander health professional involved with the family / community.
It is also important to be mindful of any Aboriginal and/or Torres Strait Islander staff who may be related to the deceased. They should be allowed to be notified of the person’s passing by the appropriate cultural protocols, and supported to attend funerals and other cultural rituals as members of the family / community.2
Sorry Business is the term that many Australian Indigenous peoples use to refer to grief and bereavement. It can also refer to a period of cultural practices and protocols associated with death. Sorry Business acknowledges that the grief experienced from a loss affects the whole person, including their mind, spirit and body, as well as the relationships they have with other people.3
In some areas, both in urban and rural / remote, the whole community will experience grief and mourning after someone has died, and some businesses may close for a period of time out of respect for the loss. Cultural duties for the extended family following a death include supporting the immediate family as well as looking after those who have come to mourn and pay their respects.2
Key Video Resource – Final Footprints: Palliative Care Australia (11:38)
This video provides some guidance on ways to approach interactions with Aboriginal and/or Torres Strait Islander people about dying and death. It supports learning about the cultures and traditions of Australian Indigenous peoples, particularly with regard to the end-of-life journey, and how healthcare professionals can contribute to supporting these.4
Check the thinking points below for some questions to consider with regard to this video.
- View the Final Footprints video and outline the key points that are made about what may be important to Australian Indigenous peoples and their loved ones as they approach end of life.
- Find out about local Aboriginal and/or Torres Strait Islander communities in your area and what resources are available for healthcare professionals to guide culturally-responsive care during the end-of-life journey.
- Reflect on your current or recent practice contexts. What support does the healthcare facility provide to support Aboriginal and/or Torres Strait Islander people and their families during the end-of-life journey?
- PEPA Project Team, Cultural Considerations: Providing end-of-life care for Aboriginal peoples and Torres Strait Islander peoples. 2020, Program of Experience in the Palliative Approach.
- Aboriginal and Torres Strait Islander Cultural Capability Team: Queensland Health, Sad News Sorry Business: Guidelines for caring for Aboriginal and Torres Strait Islander people through death and dying. 2015.
- Australian Indigenous HealthInfoNet. Social and emotional wellbeing portal. 2021; Available from: https://healthinfonet.ecu.edu.au/learn/health-topics/social-and-emotional-wellbeing/.
- Palliative Care Australia. Final Footprints: My Culture, My Kinship, My Country. 2021; Available from: https://palliativecare.org.au/final-footprints-my-culture-my-kinship-my-country/.