End-of-life decision making in the intensive care unit.

Physicians are increasingly involved in how their critically ill patients die [72]. The more this happens, the more physicians will have to understand not only how their own backgrounds and biases influence their medical management, but also the cultural and religious backgrounds of the patient and surrogate [72, 73]. The medical profession must realise that, despite tremendous advances in medical knowledge and technology, not everyone can be saved all the time, even in the area of intensive care. Physicians must understand that "doing everything" that is best for the patient may not mean starting epinephrine or performing CPR, but rather may imply moving from a process of curing to caring with palliative care [10]. This process should be initiated by discussions with the patient or surrogate, and should include knowledge of the patients' wishes as demonstrated by advance directives and durable power of attorney. The patient's code status and the intention of forgoing life-sustaining treatment should be discussed with other members of staff together with the patient and/or family in a compassionate and humane manner. The wishes of the patient and family should be taken into consideration and the physician must try to make an impartial decision by doing what is medically and ethically correct and best for this specific patient. Hopefully, in this way, a more ethical and compassionate approach to end-of-life decisions in the ICU will be obtained.

International perspectives on ethics in critical care.

Differences in culture, resources, demand, level of development, and cultural and religious differences may alter ethical approaches around the world. The principles of medical ethics are beneficence, nonmaleficence, autonomy, disclosure of information, and social justice. Difficult decisions as to whom to admit and whom to exclude are faced by physicians internationally. Differences between countries are seen in the withdrawal and withholding of treatments and in the obtaining of informed consent in emergency circumstances.

Euthanasia.

This article provides a brief review of the history of euthanasia. The problems involved in withholding or withdrawing treatment, physician-assisted suicide, and arguments for or against euthanasia are discussed. Changes in both societal and physician attitudes and practices are presented.

Assessment of earthquake vulnerability of critical industrial facilities in the Central and Eastern United States

Critical industrial facilities can be defined as those facilities that could, if damaged release substances harmful to the public or to the environment. From a engineering point of view, critical industries facilities require more stringent critica than general use facilities such as office buildings, but shoult not require critica as stringent as that required for nuclear power plants (AU)

Earthquake vulnerability assessment of A 40-inch cruce oil pipeline in the Central United States

A 40-inch diameter crude oil pepiline runs from St James, Louisiana. to a terminal near Patoka, Illinois over a distance of 635 miles. This pipelines delivers more that 1.000.000 barrels of crude oil per day, primarilyfrom gulf of Mexico wells and overseas sources, to refineries in the Midwest, The pipeline passes in close proximity to the New madrid Seismic Zone, which is located principally in northeast Arkansas and southeast Missouri. A general assessment of the vulnerability of the 40-inch pipeline to seismic hazards such as liquefaction (lateralspreading and flow slides), landslides (i.e., slope instability), and ground shaking effects (above-ground facilities)was recently conducted. The effects of two levels of earthquakes were evaluated, one with a recurrence interval of 100 years and the other having an intensity equal to the 1811-12 New Madrid earthquake sequence (AU)