Edward L. Bernays and Nursing’s Code of Ethics: An Unexplored History

The Code of Ethics occupies a special place in nursing profession. A code of ethical conduct, as Marsha Fowler notes, is of vital importance because it stands as a central and necessary mark of a profession. It functions as a general guide for professions members and as a social contract with public that it serves.1 The Canadian Nurses Association explains that code is a statement of ethical values of nurses and of nurses' commitments to persons with health-care needs and persons receiving care.2 Harold Sox calls codes of ethics the tangible expressions of professionalism and arguably way a profession defines itself to public.3Establishing a code was a priority for American Nurses Associa- tion (ANA) at its founding in 1896.4 Although ANA considered a Proposed Code in 1926 and a Tentative Code in 1940, it was not until 1950 that it ultimately adopted Code for Professional Nurses.5 Three years later, International Council of Nurses adopted its code of ethics (most recently revised in 2012).6 Since that time, numerous national and regional nursing organizations and regulatory bodies have adopted similar codes. We submit that a significant but unexplored factor in ANA's adoption of Code for Professional Nurses in 1950 was role played by Edward L. Bernays, a widely known public relations expert who served as an ANA consultant from August 1947 to April 1949. As part of his efforts to achieve wider recognition for nursing as a profession, he pressed for adoption of a code of ethics from beginning of his brief tenure with ANA until his termination.Edward L. Bernays: U.S. Publicist No. 1Bernays's profound contributions to field of public relations have been well documented by Stuart Ewen and Larry Tye among others.7 put it simply, in words of Ewen, Bernays' career-more than that of any other individual-roughed out what have become strategies and practices of public relations in United States and, increasingly, on a global scale.s Bernays was often called the father of modern public relations9 and U.S. Publicist No. 1, a title attributed to him by Time magazine. Bernays, a nephew of Sigmund Freud, focused his efforts on shaping public opinion in support of his clients. He defined his basic approach as follows: first, intensify favorable attitudes of a public we already have; second, convert a public we do not have to our point of view, and to get them to undertake actions on our behalf; and third, negate or blanket a public against us.10 He called this approach, which was based on propaganda techniques developed during First and Second World Wars, the engineering of consent.11 He prided himself on his ability to manipulate public opinion. His efforts went beyond merely seeking publicity for his clients. I never visited newspapers, he told a reporter in his later years, I circumstances.12He created circumstances for a wide variety of clients, ranging from presidents and entertainers to major corporations and civic organizations. His campaign for American Tobacco Company, which made smoking in public acceptable for women in 1920s, tied smoking to women's social status and independence; it included a march of women holding lit cigarettes, described as Torches of Liberty.13 To promote soap use among schoolchildren (on behalf of his client, Procter and Gamble, who hired him to boost sales of its Ivory Soap brand), he developed a National Soap Sculpture Contest with a noteworthy panel of judges.14 He helped increase flagging sales of hairnets by devising a campaign to link their use to workplace safety.15Bernays worked on behalf of Committee on Cost of Medical Care, a high-profile, foundation-supported initiative whose 1932 report included recommendations to reorganize health care services to make them more widely accessible. These recommendations included encouraging group medical prac- tices and voluntary or tax-supported medical insurance. …

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