Toward Reclaiming Our Ethical Heritage: Nursing Ethics before Bioethics

Abstract

American nursing has an extraordinary body of nursing ethics literature from the 1880s to the mid-1960s. This literature developed prior to the rise of the field of medical ethics (later termed biomedical ethics, then bioethics) in the mid-1960s, and bears little resemblance to its later counterparts. Early nursing ethics was nurse-centric; relationally based; addressed nurses’ ethical comportment in all roles; advanced the social ethics of nursing (especially in response to health disparities); and set forth ethical expectations for the profession as a whole. This first wave of nursing ethics is distinctive and differs significantly from contemporary bioethics, yet it remains grossly under-researched. It offers nurses a wise, comprehensive, generous, and learned ethics that deserves to be reclaimed for today’s nursing practice. This article will offer an author backdrop and an historical review of early nursing ethics literature; consider the nursing profession as a calling; discuss the pivot to bioethics and the Code of Ethics as anomaly.

Rising to “The Highest Morals”—The Rich History of Nursing Ethics

“…), and is not problem, conflict, or medically focused. Rather, nursing's ethics is preventative, centering on averting ethical dilemmas before problems arise by fostering and preserving relationships (Fowler, 2020).…”

“…Although in many ways this move was good for nursing academics, nursing's ethical heritage literature held in hospital libraries did not move into university libraries. Furthermore, ethics education changed from being taught primarily by nurse educators to philosophers and theologians who taught abstract European philosophies unrelated to nursing or nursing practice (Fowler, 2020). Nursing ethics—that is, moral character, moral formation, nursing relationships as essential to nursing practice—was no longer central to nursing education.…”

Ethics Education for Nurses: Foundations for an Integrated Curriculum

“…Ethical principles are, of course, useful for parsing out nuances of a complex situation, but it is the profession's goals and perspectives that provide the anchor for decision making in nursing practice (Grace, 2018b). Fowler (2017Fowler ( , 2020) also critiqued the nursing profession's unexamined adoption of the dominant paradigm of bioethics. She noted the history of nursing ethics prior to 1960 provided a rich and more nuanced interpretation that was relationally based, addressed ethical comportment, and was anchored in social justice.…”

“…She noted the history of nursing ethics prior to 1960 provided a rich and more nuanced interpretation that was relationally based, addressed ethical comportment, and was anchored in social justice. Fowler (2017Fowler ( , 2020 observed that ethics education was essential in early programs of nursing and consisted of both preparation and moral formation. Benner (1991) maintained communities of practice and narratives of everyday practice that dominate the ethics found in nurses' stories are those of care and responsibility.…”

Applying a Foucauldian lens to the Canadian code of ethics for registered nurses as a discursive mechanism for nurses professional identity

“…Within a masculine empirical hegemony, medicine and hospitals became the organizing structures for people's health, and nursing emerged as an occupation that could improve populations' health (Fowler, 2020; Jolley, 2020). Nursing was first organized as an occupation by wealthy women in the Victorian era, through the military caring for wounded soldiers on the battlefields as enlisted soldiers, and within the religious orders (Gregory et al, 2015).…”