1. 1 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” 5. The workshop participant will be able to identify examples of how Native cultures perceive death and dying. Module Objective #5 “The mystery of all endings is found in the birth of new beginnings. There is no ending to the journey of the four directions. The human capacity to develop is infinite. The medicine wheel turns forever.” Phil Lane, Jr. p. 71

2. 2 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” 5. The workshop participant will be able to identify examples of how Native cultures perceive death and dying. Module Objective #5 NOTE: Although the medicine wheel is not used by all tribes, its concept is familiar to most tribes and is used within this module. Palliative care - to provide comfort and relief without curing

3. Which of the following is TRUE? 1. Most Natives die in their homes. 2. Most Natives have plenty of pain control medication when they die. 3. Preparation for dying ceremonies primarily focus on physical issues. 4. Traditional Indian funerals are illegal in most states. 5. Don’t want to answer

4. Which of the following is TRUE? 1. Neither the Medicine Wheel nor the Circle of Life include “death” 2. All cultures have death ceremonies that are very serious and somber 3. Almost all Native tribal Nations use the same death ceremony 4. Preparing the dead body for burial or disposal is usually regarded as a high honor by most tribes 5. Don’t want to answer

5. Which of the following is NOT TRUE about how many tribal Nations describe death or dying? 1. “Walk on” 2. “Cross the river” 3. “Down Under” 4. “Gone to the spirit world” 5. Don’t want to answer

6. 6 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” The medicine wheel “The medicine wheel teaches us that the four elements, each so distinctive and powerful, are all part of the physical world. All must be respected equally for their gift of life.” Phil Lane Jr., The Sacred Tree, Four Worlds Development Press, Lethbridge, Alberta, Canada, 1984 p. 11

7. 7 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” The medicine wheel variation from Phil Lane Jr., The Sacred Tree, Four Worlds Development Press, Lethbridge, Alberta, Canada, 1984 Birth / childhood Elders / End of life / death Adults Youth Death is part of the Medicine Wheel … and the “Circle of Life”

8. 8 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” Have you ever been to a funeral for a family member? 1. No 2. Yes 3. Don’t want to answer

9. 9 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” helps with the grieving process for family and for the person who is dying (i.e., preparing for death ceremonies) helps community recognize and honor the loss of a valued individual Query: Why do you think death ceremonies are important? thank you January Scott!

10. 10 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” helps the family and grievers know that they are supported by the community. Importance of death ceremonies (continued) thank you January Scott! helps grievers “express” and not “repress” their grief Death is part of the / wheel / “circle” …

11. 11 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” What is the underlying theme? Non-Native cultures frequently perceive death as a very separate part of the life cycle. But all cultures have special ceremonies that accompany the death of a loved one. QUERY: What are some examples of things other cultures, religions, or people do to acknowledge the death of a loved one? Like “funerals”

12. 12 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” Stereotypical examples of how cultures “respond” to the death of a loved one Irish funerals? the wake food, alcohol sharing of good stories about the deceased

13. 13 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” Catholic funerals? solemn mass: colonnade from church to mortuary food at family’s home Stereotypical examples of how cultures “respond” to the death of a loved one

14. 14 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” New Orleans funerals? music / parade in streets group praying / crying Stereotypical examples of how cultures “respond” to the death of a loved one

15. 15 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” Example of 1 SW tribe 3 day mourning period no mention of the person’s name So what are examples of how some Native cultures “respond” to the death of a loved one

16. 16 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” Another SW tribe Special ceremony to prepare the body for mother earth So what are examples of how some Native cultures “respond” to the death of a loved one body is placed in sitting up position in the grave and must be buried within 24 hours

17. 17 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” How do Native communities discuss the “death” process? Death and dying are referred to using different words / phrases by Native communities – a lot of differences! “cross the river” “walk on” “move on” “passing on to the other side” “gone to the spirit world” and of course the one popularized by Hollywood, “gone to the happy hunting grounds” Question: What are some ways you’ve heard Natives use to describe death?

18. 18 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” How do Native communities discuss the “death” process? As diverse as Native cultures are, most refer to dying as part of the "Circle of Life". The medicine wheel

19. 19 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” If the dying person asked you to help prepare his/her body for burial, how would you feel? 1. I am not supposed to touch dead bodies and would have to refuse 2. I would have a hard time doing it, but I would do it 3. I would feel it is an honor to be asked and would do my best to do things in the right way 4. Don’t know /not certain 5. Don’t want to answer

20. 20 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” Traditionally, ceremonies were implemented, sometimes over many months, for the chronically ill or dying patient. –Allows the dying patient make peace with this world and prepare for the next. Native communities and the “death” process

21. 21 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” –Allows the loved ones to raise upsetting issues and consequently to address them with the help of others. –The entire family is affected. –This includes the extended family which can consist of adopted relatives and respected elders and healers within our communities. Native communities and the “death” process

22. 22 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” Most Natives choose to ”go to the spirit world" while in their home setting, surrounded by family and community members. Many of the cultural support systems that help prepare for the passing existed a few decades ago. These may or may not be present in our local communities today. Native communities and the “death” process

23. 23 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” Native communities and the “death” process Preparation for death by the individual and the family differs among tribal Nations Preparation of the body Preparation of the spirit “Passing” ceremonies

24. 24 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” Interactive Activity – Small Group Please from groups of 3-5 individuals each Please share with your group the following information for how your tribe / culture handles a family member’s death and dying process

25. 25 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” Small group activity 1.How does your culture prepare for the death of a loved one? 2. How does your culture believe the body should be prepare for burial / burning, etc.? 3.How does your culture believe the spirit should be prepared for passage to the next life / world? 4.What types of ceremonies does your culture do to help deal with death and dying of a loved one?

26. 26 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” Small group activity Please take 15 minutes to share your answers with one another in your groups. After 15 minutes, we will ask for volunteers who are willing to share something they learned from their group.

27. 27 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” This session provided an overview of different ways cultures perceive death and dying. Summary Our tribal Nations approach the death process very differently from one another. Our death ceremonies help us grieve and confront the passage of a loved one from this place on earth to the spirit world.

28. 28 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” No single ceremony related to death is “right” for everyone. Summary We each have our own private and public ways to deal with death. All of us deal with both the death of loved ones and with our own death.

29. 29 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” Which of the following is TRUE? 1. Most Natives die in their homes. 2. Most Natives have plenty of pain control medication when they die. 3. Preparation for dying ceremonies primarily focus on physical issues. 4. Traditional Indian funerals are illegal in most states. 5. Don’t want to answer

30. 30 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” Which of the following is TRUE? 1. Neither the Medicine Wheel nor the Circle of Life include “death” 2. All cultures have death ceremonies that are very serious and somber 3. Almost all Native tribal Nations use the same death ceremony 4. Preparing the dead body for burial or disposal is usually regarded as a high honor by most tribes 5. Don’t want to answer

31. 31 Native American Cancer Research (303-838-9359) EOL Obj. #5, “Native perceptions of death and dying” Part of NACR’s Cultural Modification to ELNEC Module #4 “Ethical/Legal Issues in End-of-Life Care” Which of the following is NOT TRUE about how many tribal Nations describe death or dying? 1. “Walk on” 2. “Cross the river” 3. “Down Under” 4. “Gone to the spirit world” 5. Don’t want to answer

32. Native American Cancer Research ARS polling question32 Was this information for you: 1.too difficult to understand? 2.understandable (I understood it) 3.too easy – I wanted more challenging information

33. Native American Cancer Research ARS polling question33 Was the Medicine Wheel helpful in the explanation of chronic care in this session? 1.No, it was not helpful or relevant to me 2.Yes, it was a little helpful to me 3.Yes, it was very helpful to me 4.Don’t know / not sure 5.Don’t want to answer

34. Native American Cancer Research ARS polling question34 Were you comfortable with the language used in this session? 1.No, the words were too difficult or unfamiliar for me 2.Yes, most of the words were understandable and comfortable for me 3.Yes, the words were very comfortable for me 4.Don’t know / not sure 5.Don’t want to answer

35. Native American Cancer Research ARS polling question35 How did using the keypads influence your learning experience? 1.interfered with my learning 2.made no difference in my learning 3.improved my learning 4.don’t know / not sure

36. Native American Cancer Research ARS polling question36 Would you want to have a keypad system included in future education presentations? 1.No 2.Yes 3.Don’t know/not certain