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July 26,2005 From: Bakker, a professional in Amsterdan  

         Dutch Drug Treatment Policies on Trial AMSTERDAM, The Netherlands, June 24 /PRNewswire/ A former drug addict has filed a lawsuit in the courts against a Dutch addiction treatment provider. For now, the legal case is focussed on the Jellinek clinic in Amsterdam but it seems that it could be expanded to the top levels of Dutch healthcare policymakers. The Jellinek is the only available treatment provider in Amsterdam that is covered by Dutch health insurers. The ex drug user claims that the care he received was inadequate as Dutch policy is to sustain the addiction with methadone, instead of helping the addict to overcome his addiction.

Keith Bakker, the founder of Smith & Jones Addiction Consultants in Amsterdam, has filed the suit. He has first hand experience with the Dutch addictions treatment policies and care. In 1997 Mr Bakker approached the Jellinek asking for detoxification and abstinence based treatment for his heroin, cocaine and alcohol addiction.

The Jellinek doctors informed him their policy was long-term methadone maintenance and he was not offered an alternative treatment option. They did not tell him about the addictive dangers of methadone and the possibility of increased craving as a side effect. In 1997 and 1998 Mr. Bakker repeatedly requested detoxification, but this was denied. In July 1998 Mr Bakker was informed that his case was hopeless and the new free prescribed heroin program was his only option in the Netherlands.

In August 1998 Mr Bakker began successful treatment in a Minnesota Model clinic in the UK. He is drug and alcohol free since then. In the Netherlands there are forty professional institutions and sixteen consultation bureaus (with about 130 regional facilities). The Dutch drug policies are aimed at harm reduction and methadone/heroin maintenance programs and these are applied nationwide. According to Bakker, in the Amsterdam area at that time there were no possibilities for other forms of treatment and he was not offered an alternative.

In the procedure Bakker claims that:

1.The Jellinek was inadequate in the treatment of addicted persons. (Article 448 WGBO (Dutch law)

2.The Jellinek did not give information and guidance about alternative treatment options.

3.The Jellinek used methadone to treat the addiction, knowing that methadone is hazardous and addictive to one's health. The third point is quite important. In recent years there have been international studies that show the ineffectiveness and even dangers of methadone substitution.

If Mr Bakker can convince the Dutch court of this, this case could conceivably turn the Dutch treatment policies upside down. Bakker is now almost seven years drug free, but according to him, in spite of Dutch drug policies. Bakker states "If I had not travelled to the UK for treatment I am sure I would be dead now. I am using my own case to hopefully help raise awareness about the dangers of harm reduction and open-ended methadone maintenance programs. I hope this saves more lives."

September 10, 2002 From: A student from Florida

I have a question regarding confidentiality. A secretary was unable to read the physician's order. Instead of calling the doctor, she asked another doctor, who was not involved with this patient's care, to read for her. the RN informed the secretary that was a breach of confidentiality, the secretary turned to the Director of Nursing and asked her if she was breaking confidentiality. The Director of Nursing replied that she never heard of it. What is your opinion?

July 26,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

         This class has helped me make the right decision when it comes to an ethical issue or dilemma.  The web site has helped me to find the necessary information in order to write my research paper about disclosure and confidentiality of AIDS.   I am glad I have been in this class in which we discuss some topics that we will encounter in our lives.  Ethics has helped me to respect other people's points of view, people that have different cultures and beliefs in decision making.  There sill be times in which people may not agree with other people on how to decide on what to do in a specific situation. The web site has helped me to write my research paper in an easier and more concise manner. Thanks for the help and guidance and for the patience with me and all your students. I enjoyed being in your class and with all the students.  One thing I really liked about this class is that we were able to discuss things in an open manner and express our way of thinking. This class has helped me to provide care to the patient, t respect the party's autonomy, rights and dignity. Thanks once again for your help.

July 26,2001 From : A Student in Haiti

        I think that the web site is very interesting and helpful for the students.  It keeps the student interested in many topics, especially the different case studies. students can also read each others work and receive feed back which makes it even more exciting.

July 26, 2001 from: a M-DCC Student

        This was a great website; it helped me out a lot with issues concerning nursing ethics. I would try to visit it in the future.  It is however difficult to log on to your site. I would like to see more accessibility as you improve it. 
July 26,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

        I enjoy the nursing ethics website at Miami-Dade Community college because it contains several websites about nursing ethics that help me to see what is going on out there in nursing ethics. I have problems sometimes logging on to the site and would like to the site to be more bright and cheerful.
July 26,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

        This web site needs more articles so we, as students, can have more items to choose from. However I learnt a lot from what was presented. Thank you.
July 26,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

         This class helped me to understand what ethics is all about. It has helped me to become more aware that it is very important to understand other people's point of view when it is time to make a crucial decision.  Dilemmas and ethical issues, no only that I will encounter in my life but in this class helped me to make decisions when it comes to my patients. The web site is an excellent way to obtain information that I needed to write my research paper.  The technology of computers makes my life easier. It gives me the necessary information tat I need in order to find and collect information for this class. I enjoyed being in this class, it has helped to understand that when it comes to an ethical dilemma, nursing students need to take ethics and discuss the different problems that health care workers find in every day life. Taking ethics helps us to reach a better understanding on how we can work together to reach a better decision. This class has been excellent and the instructor is knowledgeable in this topic.  It is good to maintain moral standards of conduct and not to make any decisions that will effect our way of thinking. Thank you for your time.
July 26,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

     Thanks for helping us in our ethics class with this website. I found it very helpful when I was doing my assignment. I also want to thank Dr. Petrozella for introducing us to this web site.
July 26,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

     I really enjoyed your website. It helped me earn extra credit points while completing the case studies that are located on the site. The case studies were very good ethical references to refer to. They gave us an open view t many decisions that health professionals encounter. Thank you for all your help and the time and effort that you put into making this site for people like me. Please put a brighter color for the background so that it may be exciting not dull.
July 26,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

        I would like to support your work creating this ethics website.  I think it is very helpful to students because it gives the opportunity to learn more about ethics and to learn about more cases. I enjoyed the case studies, and I would like to have more. It was easy to get into this web site from home, but sometimes we had a little trouble to access it from campus.

July 26,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

       This site was easy to navigate once you got in. Many times from home I could not get in, although I believe it had more to do with trouble getting on M-DCC web site initially. The only problem I saw was the the same few comments from people stayed n the forum for a long time and new ones did not show up until a week or so later. Remember to that we are new to this and still learning, so quite possibly navigating around this site will become simpler with more use on our part. I really enjoyed the Ethics Class and I felt the computer part of the class and this site really helped. 

July 26,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

       Thanks for helping us in our ethics class. I found this website very helpful when I was doing my assignment. It had many interesting cases that are frequently encountered in nursing.
July 26,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

     We are at the last class of nursing ethics, and I'd like to say that I really enjoyed this class. we discussed many ethical issues which will help me later  on during my career. We, as nurses, will be facing different ethical issues everyday in our work environment. It was a great experience searching the Internet, and this web site was very helpful in our research for the class. It has an easy access and allows us to get as many different sources of information as we need, so we can keep up to date with the world.
July 26,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

      I like the web site and the opportunity it gives us to express our point of view. However, it would be nice to see more articles and case studies on which to comment. Over all it is a good tool and with a bit more fine tuning I am sure it will be great.
July 26,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

      This website has been very helpful to me while I have been taking the ethics class. The only thing I would change or add would be more case studies. Perhaps as a future assignment the students could each be assigned to find or create an ethical situation to post on the website as part of the class.
July 25,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

       Buying or selling organs is illegal and is considered unethical, but new tactics to attract living donors raise issues of ethics and altruism reported in an article by Susan Okie of the Washington Post on Saturday, June 9, 2001 (page A01). The article explained that the members of family of a patient awaiting a kidney were offered an option by doctors at Boston's New England Medical to donate a kidney to a stranger...and in exchange, their patient would be bumped almost to the top of the hospital's waiting list for a cadaver organ. It seems that such a trade, known as living donor/cadaver exchange are being adopted by some organ banks and transplant programs around the country. Such practices have forced ethicists and transplant surgeons to revise their assumptions about how much selflessness can be considered normal and to redraw the the boundary between asking for a reasonable sacrifice and offering a quid pro quo.
July 25,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

       I logged on 7/17/01 to read the abstract from Medical Economics Inc. 2000. As one who believes in autonomy I believe that it's ethical to allow patients to exercise their autonomy by refusing medical care if it conflicts with their spiritual needs.  A nurse has an ethical obligation to provide the spiritual needs of a patient in the form of contacting their priest, clergy, or rabbi to assist them in making a decision when faced with an ethical dilemma involving healthcare needs and spiritual needs. Whenever a nurse fulfills a request for a religious leader it not only shows that the nurse is empathetic and lets the patient exercise their autonomy and thereby decreases anxiety.
July 21,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

       I have really enjoyed my first day of class, I have learned about websites and ethical issues.
July 18,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class

        I learned a lot about Nursing Ethics. I also learned a lot from ethical issues that the students are sharing in the class. I didn't know the difference between surrogate and proxy until I attended this class. I believe if we perform under the ethical code of nurses requirements that we have been taught in this class, a lot of law suits will be prevented, and our nursing license will be safe. 
July 18,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class

          My comments are on the ethical dilemma whether or not we should test people for the AIDS virus upon coming to the U.S. I think that if the U.S. wants to test individuals coming here, they should do it for all countries. As opposed to the ANA who think they should not do it at all. What the U.S. is now doing is a double standard. Not only should they test all individuals coming here to warn them, but also test those coming here to go to other countries as well. If it is got to be done, it has to be done both ways, otherwise don't so it at all.
July 17,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class

            I went through the ANA position statement on HIV Infected Nurse, Ethical Obligations and Disclosures. The HIV infected nurse is bound by the same precepts for practice found in the code for nurses. The first duty is to protect the patient. Nurses who know that the have a transmissible blood-borne infection should voluntarily avoid exposure-prone invasive procedures that have been epidemiologically  linked to HIV or blood-borne infection transmission. I agree with the ANA position statement, the techniques of an HIV nurse in performing invasive procedures need to be modified to prevent risk of HIV transmission to the patients. In my opinion, transmission of infection can be avoided through strict adherence to CDC guidelines and OSHA standards. 
July 15,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

      I read an ANA position statement on Ethics and Human Rights which claimed that discrimination and racism continue to be a part of the fabric and have diversely affected minority populations, the health care system in general, and the profession of nursing. The ANA is committed to working toward egalitarianism and the promotion of justice in access and delivery of health care to all people. I agree with the ANA's position statement, an individual's lifestyle, or value system should not be considered in providing care regardless of religious beliefs, gender, or race.
July 13,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class

         Health care has become increasingly complex with challenging ethical and issue questions and dilemmas. Nurses frequently encounter the impact of these realities in practice, yet all too often feel inept or unqualified to deal with the dimensions of the professional practice. According to "Mechanics Through which SNA's Consider Ethics/Human Rights Issues", ANA's position statement that nurses need to learn how to identify the ethical aspects of practice, engage in ethical decision making, and assist in the development of ethically sensitive institutional and public policy and encourage that through development of mechanisms such as educational programs r/t to ethics and human rights to prepare nurses to deal with such programs. I feel this is a good way to help this problem.
July 10,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class

      Just wanted to comment of the article "could the nurse be an endangered species?" April-June 2001 Volume 7 Number 2. This editorial by Judith Stoner Halpern, RN, MS, CEN makes an analogy comparing nursing to an endangered species. Quite a scary thought, but not totally unrealistic! The nursing shortage is a global problem that definitely presents and emergency situation. How far will we let healthcare issues and the safety of patients slide? Will there be enough time to remedy the problems once they are identified, in order to prevent disastrous situations from occurring? I continually hear from friends and past colleagues of stories and complaints of how the problems are compounding at an alarming rate with no end in sight. I hear, on the end of the spectrum, stories from friends on their visits to emergency rooms and hospital stays where waiting time for treatment is becoming dangerous and the same complaint of not enough nurses to give quality care is an ever present problem. Judith Halpern touches upon the diversification of nursing in this editorial. I agree with her that the nursing shortage should be solved from within and not recruit nurses from other countries as that just compounds the shortage in the country where the nurses are recruited from. It seems to make a vicious cycle which in the long run cannot possibly be cost effective. I believe that hospitals need to look at offering better benefits and options to nurses who are already here and willing to work. As soon as a foreign nurse becomes a resident she also will find another job which offers better salary and benefits in time. The problem will increase, not be solved. Brining in nurses from other countries is a temporary solution that has proven not to work in solving the shortage, but actually increases it, especially globally. Hopefully some of the current problems being addressed in the legislature, such as mandatory overtime, will help ease the situation.
July 5,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

     I just read the press release (June 30,2001) that the ANA House of Delegates passed the revised Code of Ethics. Even thought this newer revision will serve the nurse well as a guide, it has become apparent to me after reading more articles of different ethical situations that it is quite possible that his new revision of the code might need a closer look in the near future. After discussing with another student the ethical issue of cloning, as well as rapid advancements in genetics, there will be many issues that need to be addressed. Reviewing the present Code should be an ongoing process and definitely not be stuck in a ten year revisement process.
June 25,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

     I just finished reading "Owing up the errors: Put an end to the blame game". This is an interesting concept and I would really like to know exactly how this was implemented and how long it tool. The results were certainly positive, proving that this program is really working. The question is, "How many other hospitals will be implementing similar programs and when?" I am also wondering whether this idea will work for other organizations as well and will it be as effective?
July 2,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class 

      I went to the International Journal of Trauma Nursing and found this very interesting since I used to work in ER. The only problem is certain articles cannot be read as Full Text if you are not a subscriber, but I really enjoyed reading Trauma News Today on this site. From April - June 2001-Volume 7- Number 2 there were six sections that I read, but I will only comment on three I thought were pertinent to our class. The first was from WHO (World Health Organization) on the crisis in nursing going on currently and midwifery worldwide. This reports stated that midwives and nurses internationally are in a state of crisis, as well we know. The WHO also cites specific examples of the crisis worldwide. The trend is obvious as all countries are showing a drop in the number of students choosing nursing as a profession and there is also a shortage of nurses and midwives in the public sector. I also read from the same Trauma site about venous thrombosis and airline travel. Interesting short on the link between air travel and venous thrombosis naming the high risk persons and what should be done as a preventative measure when traveling. Lastly, I read an ANA report on a survey that was done on 7299 nurses from De. 7,2000 through Jan. 19, 2001. They reported a high percentage of negative commentary from nurses regarding their work conditions. Mentioned were the fact that many nurses were skipping meals and putting patients ahead of their own personal needs. I can identify with this having worked long 14hr. shifts in the ER without eating and not being able to use the restroom when I needed to. This article also talked about voluntary overtime and feeling increased pressure to accomplish work. This I am finding to be a reoccurring thread throughout the reading and research I have been reading.
June 25,2001 From:  Nursing AO Student F/T-Dr. Petrozella's class 

    I read through the 49th Congress in Nashville, Ethics Code for Student Nurses. I was very impressed with the patient's rights, student's rights and the push for better all around student, faculty and in general professional courtesy. I think if covers all of the Ethical Principles.
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