Who is Responsible for Dignity?

I am reading Shōgun right now, and I am impressed by many things. The one that gets me more than any other is the incredible dignity of the Japanese people in feudal Japan, a dignity that, in many ways, still permeates Japanese culture today.

Clearly, in feudal Japan, much of that dignity and deference was enforced by fear within a severe caste system. I do not want to romanticize that. But the idea caught my mind and got me thinking:

Who is responsible for dignity?

In medicine, where vulnerability is a constant, dignity is of the utmost importance. And yet, it seems to be one of the first things to go when life and death enter the equation.

This is not a question I have an answer to. It may be one I chew on for the rest of my life.

But dignity is important to feeling human. Which raises another question:

If dignity is not prioritized in medicine, has medicine, at that point, become inhumane?