BMS 115 · Common Core (Tronc commun)Section 4.1 · Dignity, dying and death
Section 10 of 15
Respect for life, dignity and euthanasia
Explain what respect for life and dignity requires of a nurse at the end of life, describe death as a process of the body, and distinguish euthanasia from ordinary comfort care.
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Why this matters
Every nurse will one day sit beside a person who is dying, and the family will watch closely what is done at that bedside. Two decisions are taken there that look alike and are not the same: relieving a suffering person, which is treatment, and ending a person’s life, which the law calls a crime. This section gives you the vocabulary to tell them apart — why life and dignity are protected even when cure is impossible, what death is as a bodily process, and how the word euthanasia used in the lecture notes relates to the comfort care you will actually give.
What you need to know first
You need the vocabulary of dignity introduced in section 2.2 and the distinction between giving death and letting the illness take its course, which runs through the code of ethics. No legal training is required: the section explains the few rules you need and states honestly what the lecture notes leave open.
Words to know (5)
Dignity
The inherent worth of every human being, which does not depend on health, usefulness, age or social status, and which makes every person worthy of equal moral consideration. A dying patient who can no longer speak is still greeted by name and covered respectfully.
Dying process
The period, usually of hours or days, during which the organs progressively stop working before death; it is a series of events rather than a single moment. A patient sleeps more, eats less and breathes irregularly in the last two days of life.
Euthanasia
The practice of ending the life of a patient in order to limit that patient’s suffering; the word comes from the Greek eu, good, and thanatos, death. A lethal injection requested by a patient with advanced cancer is active euthanasia.
Comfort care
Treatment given to relieve symptoms and distress — pain, breathlessness, nausea, fear — without the aim of curing the disease or of shortening life. Giving an analgesic at the dose the pain requires is comfort care.
Futile treatment
A treatment that cannot reasonably be expected either to restore health or to relieve suffering, and which therefore does not have to be started or continued. Ventilating a patient whose lungs have been destroyed by cancer is futile treatment.
One idea at a timeIdea 1 / 4
In one sentence Respect for the dignity of persons is the most fundamental ethical principle in health care, and it still binds when the patient cannot be cured.
Respect for dignity remains when cure is no longer possible
Respect for the dignity of persons is the most fundamental and universally found ethical principle, and it gives the philosophical foundation for many other principles. It recognises the inherent worth of every human being, whatever differences exist in social status, ethnic origin, gender or capacities, and that worth demands equal moral consideration. The patient therefore has rights to dignity, respect and privacy: rights which say that you matter, that you have your own thoughts and feelings, and that you must be treated as a human being. Being treated with dignity also supports recovery. At the end of life this principle remains when technique has nothing left to offer.
For example
A patient with advanced cancer can no longer swallow or speak. The nurse still explains each care measure aloud before performing it, addresses him by name, and keeps the door closed while washing him. Nothing curative is left, but dignity is still being delivered.
Pause and check yourself
A dying patient is confused and does not recognise the nurse. Does respect for dignity still apply to him?
Show the answer
Yes, and it applies regardless of what he can recognise. Dignity rests on the inherent worth of the person, not on capacities, awareness or behaviour. The nurse who waits for the patient to be lucid before treating him with respect has reversed the foundation of the principle.
Read detailed explanations
What Cameroonian law actually says — and what the notes leave open
Cameroon has no statute authorising euthanasia or assisted suicide, and the supplied notes never settle the question: they define the word and stop there. The legal position has to be assembled from four layers. The first is constitutional. The preamble to the Constitution (Law No. 96/06 of 18 January 1996) provides that everyone has the right to life and to physical and mental integrity and must be treated humanely in all circumstances, and that no one may be subjected to torture or to cruel, inhuman or degrading treatment. The second layer is criminal. The Penal Code, re-enacted by Law No. 2016/007 of 12 July 2016, punishes the deliberate causing of death: murder, article 275, by life imprisonment; assassination, article 276 — killing that is premeditated or carried out by poisoning — by death; involuntary killing, article 278, by six to twenty years. Consent does not convert a killing into a treatment. The third layer is international. Article 45 of the Constitution gives duly ratified treaties authority over domestic legislation, and article 4 of the African Charter on Human and Peoples’ Rights states that the human being is inviolable and that every human being is entitled to respect for his life and the integrity of his person. The fourth layer is professional and regulatory, and it is the one that governs the reader personally. Decree No. 89/354 of 3 March 1989 promulgates the code of ethics of the professions of nurse, midwife and medical technician, and it requires the professional to obtain the patient’s informed consent before giving care or communicating a fatal prognosis to the family; it adds that a serious prognosis may be legitimately concealed from the patient, while a fatal prognosis may be revealed to him only with the greatest circumspection. That wording predates the modern right of the patient to information and is now read alongside it: concealment is exceptional, must be justified in the patient’s interest, and may never be used to keep a patient who wants to know in the dark. What the code does not do is authorise a lethal act. Read together, these texts mean that an injection given in order to cause death is homicide in Cameroon whatever the patient or the family requested, and that the nurse who prepares or administers it risks criminal responsibility and the loss of the licence to practise. What is not criminal is different: withholding or withdrawing a treatment that has become futile or disproportionate, and giving analgesia titrated to the patient’s symptoms, are acts whose object is the relief of suffering and not death. The notes call the second situation “passive euthanasia”; that label is contested, because stopping a treatment that no longer helps is more accurately described as letting the disease take its course. The honest conclusion for a first-year student is that the law protects life, the professional standard requires comfort, and no Cameroonian instrument — no statute on advance directives, which are the written statements in which a person sets out the care they would or would not want if they later lose the capacity to decide — presently transfers to the patient the power to decide that life should end.
Where the line is drawn: intention, double effect and the written record
The professional line between comfort care and ending life is drawn by intention, and the tradition has a name for the reasoning that holds it in place. The doctrine of double effect, formulated by Thomas Aquinas in the thirteenth century and still used in clinical ethics, holds that an act with one good and one foreseen bad effect may be permitted when four conditions are met: the act itself is good or indifferent, the intention is the good effect only, the bad effect is not the means by which the good is obtained, and there is a proportionate reason to accept it. Giving morphine to a patient in severe pain meets those conditions when the dose is titrated to the pain, because relief is obtained through the analgesic action and not through respiratory depression; giving the same drug in order to stop the breathing does not, because there the bad effect is the means. Contemporary practice states the same rule more simply: the World Health Organization’s 2002 definition describes palliative care as an approach that improves quality of life by preventing and relieving suffering, and adds that it intends neither to hasten nor to postpone death. That phrase is the cleanest professional test available to a student. Three further terms matter because they are argued about in public. Physician-assisted suicide means that the lethal product is prescribed or supplied by a professional for the patient to take; it is tolerated in Switzerland because article 115 of the Criminal Code punishes only assistance given for selfish motives, while a direct lethal act by a third party (euthanasia) remains prohibited there; the Netherlands and Belgium, under statutes of 2002, permit a physician to end life at the patient’s request. It remains unlawful in Cameroon. Terminal sedation means the use of sedatives such as midazolam to control unbearable symptoms in the last hours; it is palliative when the intention and the dose are proportionate, and it becomes killing when sedation is deepened primarily in order to end life. The usual beginner’s mistake is to call any strong analgesia at the end of life euthanasia, and then either to under-treat pain out of fear or to believe that the law permits a lethal dose once the patient asks for it; both readings are wrong. The written record is what protects the patient and the nurse: the prescription, the indication, the dose, the observed effect and the words the patient used are entered at the time, so that any later question can be answered from the file rather than from memory.
Explore the diagram
Look at the whole drawing first. Then select one numbered part and connect it to the idea you just read.
Respect for life, dignity and the line the law draws
Respect for life and dignity is the foundation. Death is a process the nurse must be able to read and explain. Below it, the same bedside act divides into comfort care, whose aim is relief, and the act whose aim is death. Select any part to read what it means and how the nurse handles it.
New to diagrams? Read this first
Look at the whole drawing once without clicking anything. Ask yourself only: what kind of picture is this (a comparison, a route, a sequence, a table)?
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01 / 5Respect for life and dignity
If the drawing is wider than this panel, scroll it sideways. Labels stay readable; the numbered explanations below show the same ideas.
Respect for life and dignity
This band is the foundation of the whole plate, and it does not depend on the patient’s health, age or capacities. The notes state that respect for the dignity of persons is the most fundamental and universally found ethical principle, and that it recognises the inherent worth of every human being, so that all are worthy of equal moral consideration. In the last days of life, when cure is no longer the aim, this principle is what still organises the care: the person is addressed by name, covered, informed and protected from suffering, whatever the prognosis.
Teaching schematic, not a legal opinion or a clinical protocol. The law and the professional standard are summarised as they stand for Cameroon in the course sources; the two columns describe the aim of an act, since the visible gesture — a syringe, a drip — can be either.
Key points to remember
✓Respect for the dignity of persons is the most fundamental ethical principle; it rests on inherent worth, not on capacities, and it still governs care when cure is impossible.
✓Death is the end of life and a definable moment, but it is also a process: the vital organs stop one after another, and knowing the changes helps the nurse prepare the patient and the family.
✓Euthanasia is the act of ending a patient’s life to limit suffering; it is active when a product is given and called passive in the notes when curative treatment stops and only comfort care remains.
✓Comfort care and killing are separated by intention: titrated analgesia and the withdrawal of futile treatment aim at relief, while a lethal act aims at death and is a crime in Cameroon.
Go deeper
Worked example
A request to end it all at three in the morning. Mr E is 58 years old and has advanced stomach cancer with liver metastases. He has been told that no further curative treatment is possible. He is drowsy from opioids, has lost a great deal of weight, and has a dry mouth and a distended bladder. At 03:00 he takes the student nurse’s hand and says: “I cannot go on. Give me something to finish it. My brother did it in Europe.” His wife is asleep in the corridor. The student is alone on the ward.
Answer the person, not the request. Stay, sit down at eye level and ask what has become unbearable tonight: the pain, the breathlessness, the fear of choking, the inability to sleep, the thought of being a burden, or a debt. A request to die is almost always a report about suffering, and it is treated by finding out what is suffering.
Treat what is treatable before discussing what is not. Check the analgesia against the pain, and look for the reversible causes of distress: constipation, a full bladder, a dry mouth, untreated anxiety, an infection. Several of the reasons Mr E wants to die tonight can be relieved within the hour, and relief changes the request.
State the limit honestly, without moralising. Tell him that you will treat his pain and his fear, that you cannot give him a product to end his life, and that this refusal is not abandonment but the rule under which the profession works. Say it once, calmly, and then return to the suffering.
Call for help and write it down. Inform the nurse in charge and the doctor on call, ask for a review of the prescription and a palliative-care referral, and record in the notes the exact words he used, what you checked, what was given and at what time. An intention that is not written down cannot be defended later.
Care for the family as well. When his wife wakes, explain what has been treated and why, ask what she has heard from him at home, and let her see that his pain is being taken seriously. The family’s fear is part of the total suffering that palliative care addresses.
Mr E is not given anything to end his life. He receives an adjusted analgesic, a bladder catheter, mouth care and an explanation, and by morning his pain score is lower and he is no longer asking to die. The request was real and was taken seriously; what was treated was the suffering behind it. The student’s record of the words, the checks and the actions is what allows the team to show, later, that the intention was always relief and never death.
Common misconception
The commonest beginner mistake is to confuse everything that shortens a life with euthanasia. Students often believe that “passive euthanasia” is simply the ordinary nursing care of the dying, that a strong dose of morphine given for pain is killing, and therefore that the ethical choice is to keep the patient uncomfortable so as to stay safe. That is wrong on both counts. Comfort care is treatment: the dose is titrated to the symptom, the intention is relief, and neither the act nor the aim is death. The opposite mistake is equally common and more serious: a student who has understood that the patient is suffering and has been asked to help may conclude that the law allows a lethal act once the patient consents. It does not. Consent authorises treatment; it never authorises killing, and the nurse who prepares the lethal product is personally exposed, whatever a relative or a colleague has requested. A third error is to treat dignity as a slogan that requires agreement with the family about everything. Dignity requires respectful care of this person, which sometimes means refusing what the family asks and explaining why.
Check your reasoning
Think of a death you have witnessed, in your family or in a hospital, and of one thing that was done to the dying person. Was the aim of that act to relieve suffering, to keep the body alive, or to bring the end closer? Could you tell the aim from the act itself, or only from what the people around the bed said and wrote?
Reveal an answer
Most people find that the act looked the same in every case — a syringe, a drip, a hand on the forehead — and that the aim was visible only in the explanation and the record. This is why the section insists that intention be stated and written down. The nurse who can say “this is for his pain, at this dose, and here is the effect I observed” has done the ethical work; the one who cannot is asking to be judged on appearances. If your memory includes an act whose aim you still cannot name, that is also a useful lesson: unanswered questions at a death are usually questions that were never asked at the time.
Where this comes from
BMS 115 Health Care Ethics lecture notes (Mme Bakume Jessey) · Chapter on death: “What is death?”, “What happens to your physical body when you die?” and “Death itself is a process” (notes lines 402–407); “Respect for dignity” (lines 103–108); “Euthanasia” (line 89). The notes’ errors on the breathing pattern and on the Kübler-Ross book title sit in the dying-process material taught in section 4.3, which carries those corrections in its own sources.
Constitution of the Republic of Cameroon, Law No. 96/06 of 18 January 1996 · preamble — the right to life and to physical and mental integrity, humane treatment in all circumstances, and the prohibition of cruel, inhuman or degrading treatment; article 45 — duly ratified treaties prevail over domestic legislation.
African Charter on Human and Peoples’ Rights (1981) · article 4 — the human being is inviolable; every human being is entitled to respect for his life and the integrity of his person.
Decree No. 89/354 of 3 March 1989 — code of ethics of the professions of nurse, midwife and medical technician (Cameroon) · Quoted in the supplied notes, lines 234–250: duties towards the patient, including informed consent before care or before communicating a fatal prognosis to the family, and the rules on concealing a serious prognosis and revealing a fatal one. Used as the professional and regulatory layer of the legal survey.
Swiss Criminal Code, article 115 (incitement and assistance to suicide) · article 115 punishes incitement to or assistance in suicide only where the motive is selfish, so unselfish assistance is not an offence; a direct lethal act by a third party (euthanasia) remains prohibited in Switzerland.
Netherlands Termination of Life on Request and Assisted Suicide (Review Procedures) Act 2002; Belgium Act on Euthanasia of 28 May 2002 · these statutes permit a physician, under statutory conditions, to end the life of a patient at the patient’s request. They are the source of the comparative statements in the detailed explanation.
Thomas Aquinas, Summa Theologiae II-II, q. 64, a. 7 (doctrine of double effect) · the four conditions of the double-effect reasoning used to distinguish analgesia titrated to pain from an act intended to end life, together with the WHO 2002 clause that palliative care intends neither to hasten nor to postpone death.
Plenna, End-of-life planning: Cameroon · euthanasia and assisted dying are not recognised in Cameroon, there is no advance-directive statute, and end-of-life decisions remain family-led and informal.
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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.