ANS Ethics Collection – Entry 1

From 1979 through 1991, an unplanned series of articles focusing on nursing ethics appeared spontaneously and unsolicited in the journal Advances in Nursing Science (ANS). Each of the articles in this unplanned series has received its own acknowledgement in subsequent nursing literature, but the principles and the debate that appears over time was only recognized in 2017, when I authored a chapter for the Handbook for Caring Science  titled “Evolution of Nursings’ Ethics of Caring.”  (Chinn, 2018).   This is the first in a series of blogs that will feature the evolution of this collection.

Taken together, the articles in this collection provide a wonderful exemplar of the fundamental approaches to the development of ethical knowing in nursing, which are the critical processes of clarifying and exploring, and he affirmation processes of dialogue and justification. These processes are not intended to produce a conclusion or a final “word” – rather they are vital to reaching a fulsome understanding of the nature of nursing ethics (Chinn, Canty & Mkandawire-Valhmu, 2026)

The purpose of this first blog is to introduce the literature that inspired the ANS articles. Subsequent blogs will present an analysis of each of the articles that appeared in ANS over the 12 years, from 1979 through 1991.  I was the Editor of ANS throughout this period of time, and while I was delighted as each of these articles reached publication, and the “building” of an important ethics debate was evident, it was only in retrospect that the significance of these articles as a collection became evident. My analysis of this collection is grounded in the definition of nursing by Newman, Sime and Corcoran-Perry – “caring in the human health experience” (Newman et al., 1991). 

The articles in this collection affirm the fact that nursing’s moral action derives from encounter between the nurse and the patient, and is grounded in the context that shapes the encounter, described as follows:

• The experience of relationship – knowing the other(s) and being known by the other(s) – knowing the life story that is interrupted
  • The experience of the social and political context, knowing the social structure that is interrupted 
• The desire to diminish the possibility of dehumanization in the encounter.
  • The desire to prevent dehumanizing conditions, and to create humanizing environments – locally and beyond.
• The desire to flourish even in the context of human suffering
  • The desire for conditions that reduce human suffering, promote flourishing, and protect the environment and community 
• The experience of the struggle to find meaning, mutuality and understanding
  • The experience of the struggle to create policies that benefit all in the shared human condition. (Chinn, 2018)

The ANS articles that this blog series will examine were inspired in part by Barbara Carper’s little-known article titled “The Ethics of Caring“, published in 1979 in ANS (Carper, 1979).  She argued that specialization and technology in healthcare are inherently depersonalizing, and that the caring relationship with all providers is the antithesis to this dehumanization. However, she emphasized that there is not sufficient assurance that the relationship will be a humane, caring relationship for all providers.  Nursing’s unique and well-established ethic of caring in relationship provides this assurance for nursing.

In April of the same year (1979) Leah Curtin, Editor of Supervisor Nurse”  published an editorial titled “The Prostitution of CPR”  (Curtin, 1979b) addressing the effect of technology on nursing care. The immense response to this editorial prompted Curtin to write a follow-up editorial titled “CPR Policies in Perspective” in which she stated:

“Today’s hospitals are seeking ways to humanize the care they offer; to moderate the conflicting demands of medical technology and human emotional need; and to reduce stress by adjusting policies. Such is the conclusion I have reached from reading the barrage of letters following the publication of the April editorial, “The Prostitution of CPR.” In addition to the letters, there have been numerous phone calls. The vast majority of respondents requested help – model policies, guidelines, techniques – so that they could adjust their policies to reflect a humane and rational approach to CPR”(Curtin, 1979a, p. 9).

Thus began the unplanned series of ANS articles, starting with Barbara Carper’s 1979 article on the Ethics of Caring, and followed by the Roland Yarling and Beverly McElmurry article titled “Rethinking the nurse’s role in ‘do not resuscitate’ orders: a clinical policy proposal in nursing ethics.” (Yarling & McElmurry, 1983). Carper examined specifically the negative influence of specialization and technology on the value of carng. Yarling and McElmurry took up Curtin’s challenge.  They described the situation in which DNR orders existed as a microcosm of the larger challenges in practice, implicitly exploring the claim made by Carper regarding the influence of technology in providing humane care. Three years later they published a second article titled “The Moral Foundation of Nursing,” in which they posited that nurses are not free to exercise their moral agency because of the restrictions and policies imposed on them by institutional policies.

Sources

Carper, B. (1979). The Ethics of Caring. ANS. Advances in Nursing Science, 1(3), 11–19. https://journals.lww.com/advancesinnursingscience/citation/1979/04000/the_ethics_of_caring.4.aspx

Chinn, P. L. (2018). The evolution of nursing’s ethics of caring. In W. Rosa, S. Horton-Deutsch, & J. Watson (Eds.), A Handbook for Caring Science (pp. 37–52). Springer Publishing Company. https://doi.org/10.1891/9780826133892.0003

Chinn, P. L., Canty, L., & Mkandawire-Valhmu, L. (2026). Knowledge Development in Nursing: Theory and Process (12th Edition). Elsevier.

Curtin, L. L. (1979a). CPR Policies in Perspective. Supervisor Nurse, 10(8), 9. https://pubmed.ncbi.nlm.nih.gov/257809/

Curtin, L. L. (1979b). The prostitution of CPR. Supervisor Nurse, 10(4), 7. https://www.ncbi.nlm.nih.gov/pubmed/254402

Newman, M. A., Sime, A. M., & Corcoran-Perry, S. A. (1991). The focus of the discipline of nursing. ANS. Advances in Nursing Science, 14(1), 1–6. https://doi.org/10.1097/00012272-199109000-00002

Yarling, R. R., & McElmurry, B. J. (1983). Rethinking the nurse’s role in “do not resuscitate” orders: a clinical policy proposal in nursing ethics. ANS. Advances in Nursing Science, 5, 1–12.

List of Articles in the ANS Ethics Collection (Chronological order)

Carper, B. (1979). The Ethics of Caring. ANS. Advances in Nursing Science, 1(3), 11–19. https://journals.lww.com/advancesinnursingscience/citation/1979/04000/the_ethics_of_caring.4.aspx

Yarling, R. R., & McElmurry, B. J. (1983). Rethinking the nurse’s role in “do not resuscitate” orders: a clinical policy proposal in nursing ethics: a clinical policy proposal in nursing ethics. ANS. Advances in Nursing Science, 5(4), 1–12. https://doi.org/10.1097/00012272-198307000-00004

Yarling, R. R., & McElmurry, B. J. (1986). The moral foundation of nursing. ANS. Advances in Nursing Science, 8(2), 63–73. https://doi.org/10.1097/00012272-198601000-00010

Bishop, A., & Scudder, J. (1987). Nursing ethics in an age of controversy. ANS. Advances in Nursing Science, 9, 34–43. https://doi.org/10.1097/00012272-198704000-00011

Cooper, M. C. (1988). Covenantal relationships: grounding for the nursing ethic. ANS. Advances in Nursing Science, 10(4), 48–59. https://doi.org/10.1097/00012272-198807000-00008

Packard, J. S., & Ferrara, M. (1988). In search of the moral foundation of nursing. ANS. Advances in Nursing Science, 10(4), 60–71. https://doi.org/10.1097/00012272-198807000-00009

Twomey, J. (1989). Analysis of the claim to distinct nursing ethics: Normative and nonnormative approaches. ANS. Advances in Nursing Science, 11 (3), 25–32. https://doi.org/10.1097/00012272-198904000-00007

Fry, S. T. (1989). Toward a theory of nursing ethics. ANS. Advances in Nursing Science, 11(4), 9–22. https://doi.org/10.1097/00012272-198907000-00005

Parker, R. S. (1990). Nurses’ stories: the search for a relational ethic of care. ANS. Advances in Nursing Science, 13(1), 31–40. https://doi.org/10.1097/00012272-199009000-00005

Newman, M. A., Sime, A. M., & Corcoran-Perry, S. A. (1991). The focus of the discipline of nursing. ANS. Advances in Nursing Science, 14(1), 1–6. https://doi.org/10.1097/00012272-199109000-00002