Sheila T. Murphy

Ethnicity and attitudes towards life sustaining technology

The ethical and legal implications of decisions to withhold and withdraw life support have been widely debated. Making end-of-life decisions is never easy, and when the cultural background of doctor and patient differ, communication about these issues may become even more difficult. In this study, we examined the attitudes of people aged 65 and older from different ethnic groups toward foregoing life support. To this end, we conducted a survey of 200 respondents from each of four ethnic groups: European-American, African-American, Korean-American and Mexican-American (800 total), followed by in-depth ethnographic interviews with 80 respondents. European-Americans were the least likely to both accept and want life-support (p < 0.001). Mexican-Americans were generally more positive about the use of life-support and were more likely to personally want such treatments (p < 0.001). Ethnographic interviews revealed that this was due to their belief that life-support would not be suggested if a case was truly hopeless. Compared to European-Americans, Korean-Americans were very positive regarding life-support (RR = 6.7, p < 0.0001); however, they did not want such technology personally (RR = 1.2, p = 0.45). Ethnographic interviews revealed that the decision of life support would be made by their family. Compared to European-Americans, African-Americans felt that it was generally acceptable to withhold or withdraw life-support (RR = 1.6, p = 0.06), but were the most likely to want to be kept alive on life-support (RR = 2.1, p = 0.002). Ethnographic interviews documented a deep distrust towards the health care system and a fear that health care was based on ones ability to pay. We concluded that (a) ethnicity is strongly related to attitudes toward and personal wishes for the use of life support in the event of coma or terminal illness, and (b) this relationship was complex and in some cases, contradictory.

Feeling and Facial Efference: Implications of the Vascular Theory of Emotion

Is facial muscular movement capable of alterning emotional state? Facial feedback theories answer this question in the affirmative but do not specify the intervening process. Cognitive appraisal theories do not address this question at all. The vascular theory of emotional efference (VTEE) holds that facial muscular movement, by its action on the cavernous sinus, may restrict venous flow and thereby influence cooling of the arterial blood supply to the brain

Subliminal Mere Exposure: Specific, General, and Diffuse Effects

The present research examined the possibility that repeated exposure may simultaneously produce specific and diffuse effects. In Study 1, participants were presented with 5-ms exposures of 25 stimuli each shown once (single-exposure condition) or with five repetitions of 5 stimuli (repeated-exposure condition). Participants in the repeated-exposure condition subsequently rated their own mood more positively than those in the single-exposure condition. Study 2 examined whether affect generated by subliminal repeated exposures transfers to unrelated stimuli. After a subliminal exposure phase, affective reactions to previously exposed stimuli, to new but similar stimuli, and to stimuli from a different category were obtained. Previously exposed stimuli were rated most positively and novel different stimuli least positively. All stimuli were rated more positively in the repeated-exposure condition than in the single-exposure condition. These findings suggest that affect generated by subliminal repeated exposure is sufficiently diffuse to influence ratings of unrelated stimuli and mood.

Additivity of Nonconscious Affect: Combined Effects of Priming and Exposure

Affect deriving from 2 independent sources--repeated exposure and affective priming--was induced, and the combined effects were examined. In each of 4 studies, participants were first shown 72 Chinese ideographs in which the frequency of exposure was varied (0, 1, or 3). In the second phase participants rated ideographs that were primed either positively, negatively, or not at all. The 4 studies were identical except that the exposure duration--suboptimal (4 ms) or optimal (1 s)--of both the initial exposure phase and the subsequent priming phase was orthogonally varied. Additivity of affect was obtained only when affective priming was suboptimal, suggesting that nonconscious affect is diffuse. Affect whose source was apparent was more constrained. Interestingly, increases in liking generated through repeated exposures did not differ as a function of exposure duration.

Narrative versus Nonnarrative: The Role of Identification, Transportation, and Emotion in Reducing Health Disparities

This research empirically tests whether using a fictional narrative produces a greater impact on health-related knowledge, attitudes, and behavioral intention than presenting the identical information in a more traditional, nonfiction, non-narrative format. European American, Mexican American, and African American women (N = 758) were surveyed before and after viewing either a narrative or non-narrative cervical cancer-related film. The narrative was more effective in increasing cervical cancer-related knowledge and attitudes. Moreover, in response to the narrative featuring Latinas, Mexican Americans were most transported, identified most with the characters, and experienced the strongest emotions. Regressions revealed that transportation, identification with specific characters, and emotion each contributed to shifts in knowledge, attitudes, and behavioral intentions. Thus, narrative formats may provide a valuable tool in reducing health disparities.

Ethnicity and advance care directives.

dvance care directives for health care have been promoted as a way to improve end-of-life decision A making. These documents allow a patient to state, in advance of incapacity, the types of medical treatments they would like to receive (a living will), to name a surrogate to make those decisions (a durable power of attorney for health care), or to do both. Although studies have shown that both physicians and patients generally have positive attitudes about the use of these documents,’ relatively few individuals have actually completed one? What underlies this discrepancy between amtudes and behavior with regard to advance care directives? One obvious explanation is tack of acccss. Emanuel et al. estimated that approximately 90 percent of the population desire an advance care directive;’ and they pointed to access as the major barrier. Yet interventions that increase accessibility have typically failed to yield more than a 20 percent completion rate.’ Thus, it appears that access is not the sole determinant of advance care directive completion. r\ second and related factor oftcn cited to account for the relatively low completion rate is knowledge. It has been argued that if individuals simply had sufficient information &out advance directives, they would complete one. The bulk of existing research, however, does not support this proposition. Far instance, in a random study of 302 patients, Jacobson et al. found that although 90 percent of them knew about living wills, only 20 percent had actually completed one? Moreover, in a study by Sachs, Stocking, and Mils: fifty-two patients were specifically given both information on advance care directives and copies of forms for living wills and durable powers of attorney for health

Bioethics in a Different Tongue: The Case of Truth-Telling

After a survey of 800 seniors from four different ethnic groups showed that Korean-American and Mexican-American subjects were much less likely than their European-American and African-American counterparts to believe that a patient should be told the truth about the diagnosis and prognosis of a terminal illness, we undertook an ethnographic study to look more deeply at attitudes and experiences of these respondents. European-American and African-American respondents were more likely to view truth-telling as empowering, enabling the patient to make choices, while the Korean-American and Mexican-American respondents were more likely to see the truth-telling as cruel, and even harmful, to the patients. Further differences were noted in how the truth should be told and even in definitions of what constitutes “truth” and “telling”. Clinical and bioethics professionals should be aware of how their cultural and economic backgrounds influence the way they perceive ethical dilemmas and remember to make room for the diverse views of the populations they serve.

Inference Under the Influence: The Impact of Alcohol and Inhibition Conflict on Women's Sexual Decision Making

Integrating Zajoncs affective primacy framework with Steele and Southwicks Inhibitory Conflict Model, we hypothesized that alcohol would have its strongest impact when ones initial affective reaction was in direct conflict with more cognitively based inhibitory cues. In an alcohol by expectancy balanced placebo design, women viewed potential partners from a fictitious video dating service who varied in attractiveness and sexual risk. Only under high inhibitory conflict (i. e., an attractive, sexually risky partner) did alcohol enhance perceived relationship potential. Interestingly, women who consumed alcohol were not less likely to notice risk cues than their sober counter-parts. Alcohol expectancy resulted in both lower estimates of risk and elevated estimates of relationship potential for the high inhibitory conflict target. Thus, in situations involving high but not low inhibitory conflict, alcohol and alcohol expectancy may suppress the impact of inhibitory cues, enabling women to more readily pursue their initial affective reactions.

Evaluating a Minor Storyline on ER About Teen Obesity, Hypertension, and 5 A Day

This study evaluates the effects of an ER (NBC) storyline about teen obesity, hypertension, and 5 A Day on knowledge, attitudes, and behavior. The storyline depicted an African American teen who presented at the emergency room with burns from a workplace injury. Upon diagnosis, the teen was discovered to have hypertension and counseled to eat more fruits and vegetables and get more exercise. The evaluation was conducted using three separate datasets, one of which provided data on a sample of primetime viewers before and after the storyline aired. Results showed that the storyline affected self-reported behavior change and had modest impacts on knowledge, attitudes, and practices. Interestingly, these effects were stronger for men than for women, possibly due to mens lower knowledge levels at baseline. Issues including identification with characters and the value of even modest effects on large audiences and the implications of our findings for future evaluations of entertainment education (EE) and other health communication programs are discussed.

Consideration of Future Consequences and Unprotected Anal Intercourse Among Men Who Have Sex with Men

Abstract This study of men who have sex with men (MSM) examined whether tendencies to consider the future consequences of ones actions were associated with sexual behaviors that place oneself at risk for HIV infection. A total of 339 HIV-negative MSM responded to the Consideration of Future Consequences Scale (CFC; Strathman et al, 1994) and to questions about their anal intercourse practices in the past year. In bivariate analyses, men with a stronger future orientation were less likely to engage in anal intercourse unprotected by a condom (p < .05). Multivariate analyses revealed that CFC accounted for significant variance in three of four measures of unprotected anal sex after statistically controlling for demographic covariates (education, income, ethnicity, age). CFC was a better predictor of sexual behavior and accounted for more unique variance than any of the demographic factors. Additional research is needed to confirm that CFC is an antecedent of behavior and to examine the feasibility and efficacy of focusing on CFC in HIV prevention interventions.