This study investigated the perceptions of emergency managers regarding the degree of emergency management professionalism in Mexico and how it can be improved. The disaster of the Mexico City earthquake of 1985 was used as the starting point for this case study, as the prospects for more-frequent and more-intense disasters lend credence to the need for improved professionalism and, thus, effectiveness among emergency managers in the future. An expansive framework of emergency management professionalism mechanisms (or characteristics) and an additional compilation of new public management components (or values) were devised from the extant literatures found within the respective emergency management and public administration fields. The theory advanced by this study is that by integrating new public management components with emergency management mechanisms, professionalism in Mexico will improve and, thus, emergency managers will become more effective. ualitative field research was the methodology employed and it included interviews with 35 emergency managers in Mexico in corroboration with documentary evidence, to ascertain emergency managers' perceptions of professionalism in Mexico. The findings of this study determined that emergency managers in Mexico are implementing many of the mechanisms of professionalism but fewer new public management components. This study posits that by integrating new public management …

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 …