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Storch, “Moral Relationships Between Nurse and Client:
The Influence of Metaphors”
Storch is doing two distinct, but related things in this piece. She is both analyzing and critiquing the common metaphors used to discuss the moral relationship between a nurse and a client as well as use them to determine the best way to think about this relationship. She is considering the metaphors used to discuss this relationship and the nature of metaphors themselves. The latter is important for both the analysis and critique as well as determining a satisfactory metaphor. A metaphor is a figure of speech where we treat one thing as if it were another thing both for comparison and elucidation purposes (e.g., and Juliet is the sun) (179). Metaphors help us grasp things that may be more foreign to us using something that is more familiar, and they are also used to sharpen our thinking about the lesser known object. The problem with metaphors is that, since the objects/relationships being compared are distinct, the metaphor will include too much or too little, often excluding what is important or including something that hinders us from thinking about the object clearly or both.
The most common metaphor of the nurse-client relationship is the nurse as a surrogate mother. The metaphor is powerful in both directions. In the positive sense, it provides us with core ethical commitments of a nurse to his or her client: a relationship based upon trust, integrity, promise-keeping, dedication, and nurturance (181). But there are two problems with this metaphor. Being a mother or parent is something universal: it is something any of us can do and does not require, in and of itself, specific knowledge. But being a nurse does require specialized knowledge to engage in the practice. In other words, the moral features of the relationship are not necessarily what define a nurse by itself but rather necessary features of a nurse to perform their work well. Second, as should be suspected, this metaphor of nurse as surrogate mother influences us to assume that all nurses are female or should be female or is a feminine profession (one way to make the distinction here is between strictly thinking in terms of biological sex, female, and how we think of gender in any given society, here, what is feminine as opposed to masculine). We can see that this view influences another powerful metaphor, although one that is largely detrimental, of nurse as servant. This reduces the nurse to something like a household maid, something that a nurse is not, although certain parts of the profession could be easily confused with the occupation of a servant.
Storch emphasizes that it is important to think of nursing as a profession, meaning, it has specific knowledge and set of skills that take time and training to acquire. But Storch points out that this is limiting as well. The technical skills of a nurse mean little if they are not performed with the right care and reflection about the particular individual under the nurse’s charge, something that cannot necessarily be seen by the casual observer. So, Storch finds one more metaphor: nurse as a covenantal relationship. A covenant is a kind of bond made between two parties to follow a certain policy or laws or set of virtues. (The most famous covenant is between the Jewish people and God in what most of us called the Old Testament.) The idea here is that a covenant is more than just a contract because the former is inherently moral, to break it is inherently immoral (on the other hand, you might break a contract because you believe the other party is not living up to it and not be immoral). In quoting Bernal (183-4), Storch points to the fact that the nursing profession has a reciprocal indebtedness to the public. The public bestows both the profession and its trust to those who practice it in return for the service that nurse provides. These services are captured in two other metaphors: nurse as healer and nurse as a patient advocate. The nurse is one individual who aids the individual throughout the entire healing process, complimenting the doctor and providing appropriate care. Second, the nurse often comes to have a closer relationship to the patient and can act as an advocate as well as interpreter for the patient.
So here is my question: it would seem best to jettison the metaphor of nurse as surrogate mother, yet with that metaphor comes vital ethical norms the nurse is expected to follow. Can we derive these ethical norms from another metaphor? Or, as Storch seems to suggest, since we must use metaphors or they are at least very helpful, can we preserve what is powerful in this metaphor of nurse as surrogate mother yet leave aside what is limiting and clearly sexist?
