BMS 115 · Common Core (Tronc commun)Section 3.1 · Vulnerability and human rights
Section 7 of 15
Human-rights texts, the ICN codes and the Cameroon code
Explain how the 1948 Universal Declaration of Human Rights (UDHR), the African Charter adopted in 1981, the codes of the International Council of Nurses (ICN) and Cameroon’s 1989 code of ethics fit together as one ladder of obligations that a nurse can name at the bedside.
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Why this matters
A patient who is frightened, poor or unable to speak is not protected by your good intentions alone. She is protected by texts: an international declaration that names her rights, a regional charter that gives her a forum, a professional code that tells you what your duty is, and a national code that can be enforced against you. Nurses who cannot name these texts lose arguments they should win, and patients lose care they are entitled to. This section gives you the four layers and the vocabulary to use them.
What you need to know first
You need no legal training. You need to be able to read a numbered article and say in one sentence who it protects and what it forbids, and to notice the difference between a text that inspires and a text that a tribunal can apply.
Words to know (5)
Universal Declaration of Human Rights
The thirty-article declaration adopted by the United Nations General Assembly in Paris on 10 December 1948, setting out the basic rights and fundamental freedoms of every human being. Article 1 states that all human beings are born free and equal in dignity and rights.
ICN code of ethics
The ethical code of the International Council of Nurses, first adopted in 1953 and revised in 1973, stating the nurse’s core responsibilities and duties in every setting. The code asks the nurse to respect the values, customs and beliefs of each person cared for.
African Charter on Human and Peoples’ Rights
The regional instrument whose drafting the African heads of state launched at Monrovia in 1979 and which was adopted at Nairobi in 1981, protecting individual rights and the rights of peoples and adding duties towards family and community. The charter protects respect for life and for physical and moral integrity.
Code of ethics of the health professions in Cameroon
The national code given legal force by Decree 89/354 of 3 March 1989, which sets out the duties, the prohibitions and the discipline of nurses, midwives and medical technicians. The code requires informed consent before care and before a fatal prognosis is communicated to his family.
Disciplinary chamber
The formation in which the council of the professional order sits to hear an alleged breach of the code and to impose a sanction. A repeated breach of professional secrecy may bring a nurse before the disciplinary chamber.
One idea at a timeIdea 1 / 6
In one sentence The declarations adopted after 1945 state rights that belong to every person, and the professional codes exist to make those rights real in ordinary care.
Human rights are the ground floor of every code a nurse follows
The Universal Declaration opens by saying that all human beings are born free and equal in dignity and rights. That sentence is not addressed to governments alone. It sets the measure by which a nurse is judged when the person in front of her is frightened, poor, very old or unable to speak for herself. The texts studied in this section — an international declaration, a continental charter, a professional code and a national code — say related things at different distances from the bed. What they share is the claim that the person being cared for has claims on you that do not depend on your goodwill, your mood or the habits of the ward.
For example
A patient who cannot pay the bill is still owed the same explanation, the same hygiene and the same attention as the patient in the private room. No text makes dignity conditional on payment.
Pause and check yourself
A colleague says that rights talk belongs to lawyers and that nurses should simply be kind. What is wrong with that position?
Show the answer
Kindness is a disposition and it varies with the person and the day; a right is a claim the patient can hold you to. Being kind will not tell you what to do when kindness and the patient’s refusal conflict, whereas a named right does.
Read detailed explanations
Ten December 1948: how the Declaration was drafted, counted and then hardened into law
The Declaration was not a spontaneous document. A United Nations committee chaired by Eleanor Roosevelt drafted it in the aftermath of the Second World War, answering what the preamble calls barbarous acts which outraged the conscience of mankind. The General Assembly adopted it as Resolution 217 during its third session, on 10 December 1948, at the Palais de Chaillot in Paris. The vote deserves to be remembered precisely because it shows the text was contested: of the fifty-eight member states then in the United Nations, forty-eight voted in favour, none against, eight abstained and two did not vote. The substance is thirty articles. Article 1 states that all human beings are born free and equal in dignity and rights; Article 2 forbids discrimination by sex, race, language, religion or social standing; Article 3 protects life, liberty and security of person; Article 25 requires a standard of living adequate for health and well-being, including food, clothing, housing and medical care. One number in your lecture notes must be corrected, and it is not a detail. The notes list the right to social security twice as Article 21, once after the genuine Article 21 on participation in public affairs. The right to social security is Article 22. The distinction is clinically useful: Article 22 covers social protection, while Article 25 covers the standard of living and medical care, and a nurse arguing about a patient who cannot afford treatment is usually standing on Article 25 and its reference to necessary social services. The Declaration itself created no court. Its content was elaborated in the two international covenants of 1966, which entered into force in 1976, and then into regional charters, national constitutions and professional codes. Article 29 recalls that rights carry duties towards the community, and Article 30 forbids any state, group or person from using the Declaration to justify destroying the rights it lists.
Monrovia 1979 to Nairobi 1981: an African charter, and why the notes call it American
The regional instrument has a precise address, and the address matters. The African Charter on Human and Peoples’ Rights was not adopted at Monrovia. There, through Decision 155 of the sixteenth ordinary session of the Assembly of Heads of State and Government of the Organisation of African Unity, held in Monrovia, the capital of Liberia, from 17 to 20 July 1979, the assembled states launched the drafting of an African charter. The instrument itself was adopted at Nairobi in 1981 and entered into force on 21 October 1986. Your lecture notes render that decision as a declaration by the United States, and describe the signatories as the United States. That is a mistranslation of états africains, African states. The organisation is the OAU, which became the African Union in 2002; the United States played no part in the instrument. The error is worth correcting aloud because a student who believes the text is American will look for it in the wrong legal family and will not find the regional forum that actually exists. A second correction follows. The notes say that an African Human Rights Commission was established within the United Nations. That is also incorrect: the African Commission on Human and Peoples’ Rights is a body of the African system, set up after the charter entered into force on 21 October 1986 and beginning its work in Banjul, in the Gambia. The distinction is practical, not pedantic. A complaint about a violation of a patient’s rights in Cameroon travels through the African institutions, not through the United Nations treaty bodies, and a professional who misidentifies the forum sends the file where it cannot be heard. The charter’s opening articles protect human dignity, equality before the law, respect for life and for physical and moral integrity, freedom of religion and conscience, the right to information and expression, freedom of association and of movement, the right to work and to remuneration and the right to property, and they treat the family as the natural unit and basis of society. Its later articles add duties towards the family, the community and the state, which is why the charter speaks of peoples as well as of persons.
Two ICN codes and one decree: nursing’s own texts and Cameroon’s Decree 89/354
The International Council of Nurses adopted an ethical code at São Paulo, in Brazil, on 10 July 1953, and a revised code at Mexico in May 1973. The change of wording between the two is itself a lesson in how a profession matures. The 1953 text names three responsibilities — to keep life, to relieve suffering and to promote health — and asks the nurse to care for the sick, to create a physical, social and spiritual environment favourable to health, to teach health, to keep professional secrecy, to respect religious and philosophical convictions, to recognise personal limits and refer to more competent colleagues, and to carry out prescriptions intelligently while refusing to take part in acts that ethics condemns. It also asks for a private life that does honour to the profession, and for continuing education through retraining, conferences, seminars and recent scientific journals as a recurrent obligation. The 1973 code states four core responsibilities — promote health, prevent illness, restore health and alleviate suffering — and organises the duties under headings: the nurse and the individual, the nurse and nursing practice, the nurse and society, the nurse and colleagues, the nurse and the profession. It is written to be built upon with national law, regulations and standards rather than to replace them. Cameroon gave this material legal force in Decree 89/354 of 3 March 1989, signed by the President of the Republic, on the code of ethics of the professions of nurse, midwife and medical technician. The duties towards the patient include providing all necessary care, acting with correction, verifying that treatment is carried out, giving prophylaxis, advising hygiene to the patient and the family, avoiding interference in family affairs, and obtaining informed consent before care and before communicating a fatal prognosis to his family. The code also requires notification of communicable diseases and public-health statistics, transmission of the employment contract to the ministry and to the council of the order within one month of taking office where the professional is approved to practise occupational medicine with a company, moral assistance between confreres (that is, between colleagues), warning a colleague before taking over a patient he was following, and avoiding direct competition. Its prohibitions include claiming to cure serious illnesses, misleading clients about their health, practising under the influence of alcohol, working while impaired, financially exploiting clients and sexual misconduct, together with refusing to work with a particular nurse, ignoring a call for help with a patient and ostracising a colleague without explanation. Breach may be sanctioned by the council of the order sitting as a disciplinary chamber, seized on the initiative of the order of the medical professionals of Cameroon and of the Ministry of Public Health.
Explore the diagram
Look at the whole drawing first. Then select one numbered part and connect it to the idea you just read.
Four layers of obligation, and the chamber that enforces the last one
Each step down the ladder comes closer to the bed: a declaration names the right, a regional charter gives it a forum, a professional code states the standard, and a national code carries the sanction. Select a numbered part to read what it binds and how it is used.
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01 / 5The universal layer
If the drawing is wider than this panel, scroll it sideways. Labels stay readable; the numbered explanations below show the same ideas.
The universal layer
The Universal Declaration of Human Rights, adopted on 10 December 1948, is where a nurse finds the vocabulary of dignity, life, liberty and security of person. It is a common standard of achievement rather than a self-executing statute: it created no tribunal and no penalty. Its use at the bedside is to name what the patient is owed and to point to the binding text, national or regional, that says the same thing with force.
Teaching schematic, not a legal hierarchy. The layers support one another and are often quoted together; the arrow shows the route from a general right to an enforceable sanction, not a claim that a lower layer cancels a higher one.
Key points to remember
✓Human-rights texts set the floor: the patient has claims that do not depend on your goodwill, and the professional codes exist to make those claims real in ordinary care.
✓The 1948 Declaration is a standard of achievement of thirty articles, not a self-executing law; binding force comes from treaties, regional charters, constitutions and national codes.
✓Rights are read by family and at three levels — personal, social and institutional — which is what turns a principle into a checklist a nurse can act on.
✓The ICN code states the profession’s standard and the national code of 1989 supplies the enforceable rule, the prohibitions and the disciplinary route before the council of the order.
Go deeper
Worked example
“The family asks you to say nothing”: choosing the right text. You are a second-year nurse on a medical ward. A 61-year-old man has just been diagnosed with advanced liver disease. His brother takes you aside and asks you not to tell him anything, saying that the news would destroy him. The doctor has written a serious prognosis in the file. Your colleague comments that the family knows the patient best and that the notes allow a serious prognosis to be concealed.
Separate the request from the right. The brother is asking for secrecy; the patient holds the right to information. These are not two equal preferences to be balanced by whoever is present. The starting point is the patient’s own claim, and the family’s request has to justify itself against it rather than replace it.
Name the texts that speak to the question. The 1948 Declaration gives the rights; the national code of 1989 requires the patient’s informed consent before care and speaks specifically about the communication of a fatal prognosis to the family; the professional code asks the nurse to respect the person’s values and her right to information. Naming them converts a family quarrel into a professional question.
Handle the older wording honestly. The supplied notes state that a serious prognosis can be legitimately concealed and that a fatal prognosis may be revealed only with the greatest circumspection. That is a real tension in the source material, not a settled rule: the same notes demand informed consent. The modern position, held by the World Medical Association and reflected in the patient’s right to information, is that the competent patient is entitled to know, and that family requests do not override that right.
Do not act alone, and record the reasoning. Ask the patient what he already understands, in a quiet place, with a clinician who can answer his questions. If he says he does not want to know, that is his choice and it is recorded. If he wants to know, the family is informed of the decision, not asked for permission. Either way the reason for what was told is written in the file.
The nurse does not resolve the conflict by choosing the kinder participant. She identifies who holds the right, names the texts that protect it, recognises that the source wording is contested, asks the patient what he wants, and documents the reasoning. The result is defensible before the family, before the order and before the disciplinary chamber, which is exactly what a code is for.
Common misconception
The commonest beginner mistake is to assume that the four layers are interchangeable, so that learning one of them is enough. They are not. The 1948 Declaration names rights but creates no penalty. The regional charter gives rights a forum inside the continent. The ICN code states the standard the profession expects and applies across borders, but it is not a criminal statute. The national code, given force by decree, is the layer that can actually bring a nurse before a disciplinary formation. The second mistake, commoner still in examinations, is to treat a code as a list of forbidden acts to memorise. A code is a tool for reasoning: it tells you which question you are facing, whose right is engaged, and what has to be recorded. Memorising the prohibitions without the rights they protect produces a nurse who can recite a rule and cannot defend a decision.
Check your reasoning
Think of a rule you have been taught at school or on a ward that you followed without ever knowing which text it came from. Was it a hygiene rule, a confidentiality rule, a rule about consent? Try now to place it on one of the four layers: universal, regional, professional or national. Which layer would you have to cite if you were challenged?
Reveal an answer
Most rules students can recall turn out to be national or professional: they come from the code of ethics of the health professions or from the ICN code, and they were taught as habit rather than as text. That is why the layer matters. A rule you cannot locate is a rule you cannot defend, extend to a new situation or reform. Notice also that many ward rules are really the local application of a universal right — hand hygiene protects the right to life and physical integrity, confidentiality protects privacy, consent protects autonomy — and that the nurse who can climb from the ward rule to the universal right is the one who can argue when the two appear to conflict.
Where this comes from
BMS 115 Health Care Ethics lecture notes (Mme Bakume Jessey) · Chapter 3 — The different international texts relating to ethics: the Universal Declaration of Human Rights (proclaimed 10 December 1948), the eight aspects and three levels of Pacem in terris, the Monrovia decision of 1979 that launched the drafting of the African Charter, the ICN code of 1953 and the ICN code of 1973.
BMS 115 Health Care Ethics lecture notes (Mme Bakume Jessey) · Chapter 3, Cameroon section — duties of nurses under the code of ethics of 3 March 1989 of the medico-sanitary professions: general duties, duties towards the patient, duties in social medicine, duties of confraternity (between colleagues), duties towards other health professionals, prohibitions, and the disciplinary procedure. Corrected: the notes’ “Declaration of Human Rights by the US, Monrovia 1979” is the OAU/African Union African Charter whose drafting was launched by Decision 155 in 1979 and which was adopted at Nairobi in 1981; the social-security article of the UDHR is Article 22, not Article 21; and the notes’ “A serious prognosis can be legitimately concealed…” is presented as a contested older wording, resolved in favour of the competent patient’s right to information (WMA Declaration on the Rights of the Patient).
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About this course and its sources
Bilingual lessons organised from the supplied BMS 115 Health Care Ethics lecture notes (Mme Bakume Jessey, St Louis University Institute Douala) and the international texts those notes reproduce — the Universal Declaration of Human Rights 1948, Pacem in terris 1963, the African Charter on Human and Peoples’ Rights (drafting launched at Monrovia in 1979 by Decision 155; adopted 1981; in force 21 October 1986), the 1959 Declaration of the Rights of the Child, the ICN codes of 1953 and 1973, and the Cameroon code of ethics of 3 March 1989. The short guided notes and the longer “Read detailed explanations” panels are written as two different jobs: the notes state one idea plainly, and the detailed panels add mechanism, vocabulary and worked judgement that the notes do not contain. Diagrams are original teaching schematics. Ethics, nursing and French-language review are pending.