UNT Theses and Dissertations - 2 Matching Results

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Morality and Mortality: the Role of Values in the Adoption of Laws Governing the Involuntary Removal of Life Sustaining Medical Treatment in Us States

Description: Disputes between patients and providers regarding life-sustaining medical treatment (LSMT) are universal across all U.S. states, yet policies regarding these disputes differ significantly. This dissertation determines that all 50 states have advance directive laws that protect a patient’s right to refuse LSMT even when a healthcare provider objects, yet only some states have policies that protect the patient’s right to choose to continue LSMT when a healthcare provider objects (a dispute known as medical futility). Some states have pro-patient laws that protect the patient’s right to make the final decision, while other states have enacted pro-provider medical futility policies that explicitly grant the provider authority to remove LSMT against the patient’s wishes. Finally, in one state, the law delegates the final decision to a third-party: institutional healthcare ethics committees. This dissertation studies the innovation and adoption of these 17 state medical futility policies, examining the theory that values determine both whether the state adopts a medical futility policy as well as what type of medical futility policy a state will adopt- as the policy actors that represent these values: policy entrepreneurs and interest groups. A comparative case study of successful third-party policy adoption in Texas contrasted against a failed effort in Idaho could not affirm the necessity of policy entrepreneurs for policy adoption but did affirm the necessity of interest group consensus and the role of values. Furthermore, quantitative analysis failed to offer statistically-significant evidence of value indicators, but did suggest that government ideology and political party affiliation may potentially become indicators of the type of medical futility policy that states choose to adopt.
Date: August 2012
Creator: Harvey, Jacqueline Christine
Partner: UNT Libraries

Strategic Path to Fiscal Sustainability: Revenue Diversification and the Use of Debt By U.S. Municipal Governments

Description: This work explores the relationship between municipal government debt and revenue diversification using a prism of institutional and fiscal interactions, concentrating on revenue fungibility effects over time and on the role of state-imposed constraints. A diversified revenue structure tends to stabilize revenue levels by balancing income-elastic and inelastic revenue sources. The impact of such diversity has been the subject of much research on expenditure and service levels among state and local governments. Considerably less research has been conducted on its potential relationship with debt, although capital financing is a necessary and often-utilized mechanism for funding capital and operational spending for local governments. Since it is well known that debt payments are fixed in the short run, they require sufficient revenue adequacy through economic highs and lows. It is thus argued that local governments with more diversified revenue structures are better able to utilize debt financing since revenue diversity mitigates the risk of borrowing by providing for greater fiscal predictability in the long run. This hypothesis is tested on two samples - a large sample of cities in Massachusetts from 2000 through 2009, as well as a cross-state sample, encompassing the cities from the majority of U.S. states. The findings of both studies provide preliminary evidence on the influence of revenue diversification on the levels of municipal indebtedness. While the Massachusetts study reveals that revenue diversification is, indeed, a statistically significant determinant of debt per capita, which also has an indirect effect on property tax burdens, the cross-state study suggests that revenue diversification has a mitigating impact on certain state-imposed fiscal rules, further adding to its weight as a strategic financial management tool. Both studies also reiterate the importance of such fiscal capacity factors as fund balances, intergovernmental revenue, and the size of government, while also revealing some new interaction patterns ...
Date: August 2012
Creator: Maleckaite, Vaida
Partner: UNT Libraries