ANS Ethics Collection – Entry 5
Available for free download
October 20 – November 20

The next article in the ANS Ethics Collection appeared in the 10th volume of the journal – the year 1988. This issue of ANS focused on the theme “Politics of Knowing.” In her article, Mary Carolyn Cooper (1988) acknowledged the important contributions of both Yarling and McElmurry and Bishop and Scudder. However, Cooper noted, these authors had not examined the fundamental nature of moral agency of the nurse within their relationship with those they cared for. In her article, Cooper made the point that the nurse-patient relationship may be influenced by the institutional context, and by other providers on the healthcare team, but that the relationship does not depend on these factors. Cooper proposed that the nurse-patient relationship is a covenantal relationship that is founded on a willingness of the nurse and the patient to become engaged, and it depends on mutuality, reciprocity, and caring.

“It is argued here that covenantal relationships between the nurse and the patient provide a more substantial foundation for the nursing ethic. Arising from the moral principle of fidelity, this model furnishes guidance for the nurse, a link for the nursing ethic with traditional moral theory, and, most important, a grounding in the unique experience of the nurse-patient relationship.” (Cooper, 1988, p. 48)

Cooper developed her justification for a covenantal relationship by examining the works of William May which explored the physician-patient covenantal relationship concept derived from a Judeo-Christian ethic, Robert Veatch’s triple contract perspective for medical ethics, and nurse-philosopher Sally Gadow’s caring relationship concept as described in Chapter 2 of the book edited by Anne Bishop and John Scudder titled Caring, Curing,Coping: Nurse, Physician, Patient Relationships.

Cooper identified three factors that are common in the works of May, Veatch and Gadow, and proposes that these features form a sound basis for a nursing ethic.  These are:

• Mutuality and reciprocity in the relationship.
• The nurse-patient relationship is not based on a contract or a pre-determined code. Rather, it is a relationship free from self-interest and from legal requirements that characterize contracts.
• Fidelity and promise-keeping are central to the relationship; the nurse must “be there” for the patient. 

Drawing on the common elements of these three perspectives, Cooper described the importance of the unique nurse-patient relationship as a beginning point for developing an ethic of nursing – an ethic that is unique because it is grounded in the relationship. Cooper’s emphasis on the nurse-patient relationship highlights, and brings in to our contemporary discourse, the historical record of nursing’s fidelity in the relationship.

The next article in the ANS Ethics Collection was also published the “Politics of Knowing,” July, 1988 issue of ANS. It is titled “In search of the moral foundation of nursing” authored by philosopher John Packard, and ICU staff nurse Mary Ferrara. Their article focused specifically on a philosophic analysis of Yarling and McElmurry’s 1986 article, the assumptions inherent in their argument, and related discussions of the idea of nursing. Packard and Ferrara proposed that the moral foundation of nursing must come from a clearly articulated understanding of the idea of nursing. Watch for the SONEI blog featuring the Packard and Ferrara article in about 3 weeks!

Sources

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

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