The Nightingale Pledge, which is patterned after medicine’s Hippocratic oath, is generally accepted as the first nursing code of ethics. While it contains a pledge that the nurse devote herself to the welfare of those committed to her care, it does not explicitly mention compassion and respect for human dignity. Similarly, the earliest code drafted by the American Nurses Association in 1926 mentions only devotion. A Tentative Code, published in The American Journal of Nursing in 1940 but never adopted, contains the following statements:

In the 1950 Code for Professional Nurses, a substantive revision of A Tentative Code, we find for the first time:

This statement became the first provision of the 1968 Code for Professional Nurses:

In 1976, the Code added the following important content to this provision:

In addition to signaling the uniqueness of each recipient of nursing care (then newly termed “the client”), the 1976 Code also recognized that things other than nationality, race, creed, color, and status can result in unacceptable differences in treatment. This provision remained the same in the 1985 Code. In the 2001 revision, the scope was broadened to include “all professional relationships” so that “respect” is now broadened to include “inherent dignity (a critical modifier), worth, and uniqueness.” A significant addition was the phrase “practices with compassion and respect.” The addition of the virtue compassion was related to the serious scholarship currently being done by nurse ethicists in virtue theory and care ethics. Also noteworthy was the replacement of the term client with “every individual,” so that the Code now states that:

It is important to recognize that the drafters of the Code of Ethics for Nurses have continued to identify respect for persons as a core ethical principal, including respect for autonomy in this principle (Interpretive Statement 1.4, Right to Self-determination). Although The Belmont Report (National Commission for Behavioral Research, 1979) identified respect for persons, beneficence and justice as the three basic ethical principles, Beauchamp and Childress in their Principles of Biomedical Ethics, now in its fifth edition (2001), popularized four principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice.

As bioethics in the United States evolved, autonomy replaced respect for persons in most lists of core principles. While the emphasis on autonomy was understandable in a country struggling to correct the abuses of paternalistic medicine, its narrower focus ignores bigger challenges related to inherent dignity and worth. Strikingly absent from popularized versions of the principles of bioethics is responsiveness to human vulnerability. The Code of Ethics recognizes the many factors that result in injustices in health care and holds nurses to a high standard of compassion and respect for all—especially those most vulnerable. As recent national studies continue to prove, great disparities in health outcomes in the United States continue—making Provision 1 an ideal not yet realized (AHRQ, 2006).

Nurse ethicist Barbara Jacobs recommends respect for, or the restoration of, human dignity, as a common central phenomenon to unite and reflect nursing theory and practice (Jacobs, 2001). Consilience, a way to unify the knowledge that is needed to support this phenomenon, is suggested as one example of a possible approach toward a philosophy of nursing that embraces multiple forms and sources of knowledge in all-encompassing morality that ultimately ennobles the lives of all human beings in covenantal relationships with nurses both in theory and in practice.

Most nurses will tell you that they entered nursing to “help others,” and few at first will admit to being biased or discriminatory in their professional relations. Honest reflection, however, results in most of us realizing that we respond to patients and other professional caregivers differently based on numerous factors, not the least of which are race and ethnicity, age, financial status, position/title, body size, health, and other personal attributes. We probably all think of those with whom we interact professionally as falling into one of three categories: people for whom we’d do anything—even at great personal cost; people whom we give their due; and people we serve grudgingly, if at all. It is to be hoped that few nurses can identify individuals with whom they interact professionally who fall into a fourth category: people they aim to harm by disrespectful behavior or worse.