News Analysis: A Polarizing Figure in End-of-Life Debates

 

In reports of Dr. Jack Kevorkian’s death on Friday at the age of 83, the general rule of obituaries held: Do not speak ill of the dead.

Dr. Kevorkian was generally described as a difficult man who helped advance the cause of assisted suicide for those with terminal illness.

Within the movement known generally as death with dignity, however, the evaluation of his contribution might seem surprisingly qualified, and the praise decidedly muted.

“He raised the profile of the issue, but he put the wrong face on it,” said Eli D. Stutsman, a lawyer in Portland, Ore., who helped draft his state’s trailblazing Death With Dignity Act, which allows terminal patients to end their own lives with the help of a doctor.

The 1997 Oregon law was built with compromise and careful consideration of policy, Mr. Stutsman said. It includes requirements that the patient be at the end stage of terminal disease and not have psychiatric disorders like depression, and that the patient take the drugs used in the procedure without help, to ensure that the act is voluntary from start to finish.

It is a very different system from that of Dr. Kevorkian, who seemed to make up his methods as he went along. He did not appear to screen patients to determine whether they were actually close to death, and he seemed to make no efforts to get counseling for those who might have wanted to live longer.

He devised “suicide machines” that could deliver drugs or carbon monoxide gas and could be set off by the patients. He carted the equipment to patients in his battered Volkswagen van and left many of the resulting 130 or more bodies at emergency rooms or even in hotel rooms.

Death, certainly — but death with dignity, no.

“Under the Oregon Death with Dignity Act, we would have put him in jail,” Mr. Stutsman said. “We ended up using him as an example of how not to do it.”

Since the act was passed, 525 people have ended their lives under its auspices, according to the state’s 2010 annual report. In 2010, 96 prescriptions were written for the barbiturates used, and 65 people ended their lives.

Mr. Stutsman went on to be a founding board member of the Death With Dignity National Center, which promotes similar legislative efforts around the country. They face serious opposition by groups that reject physician-assisted suicide for reasons that include religious belief and concern that such laws would open the door to forced euthanasia.

Mr. Stutsman said successful campaigns in Oregon and Washington State showed the value of a strategy of compromise and coalition building.

“He was advocating from the margins of the political debate,” Mr. Stutsman said of Dr. Kevorkian. “I was working from the middle of the political continuum — it’s very hard to change public policy from the margins of the debate.”

The movement won a major victory in 2006 when the United States Supreme Court ruled that the federal government could not prosecute Oregon doctors who participated in the assisted-suicide law.

Peg Sandeen, the executive director of the Death With Dignity National Center, said the ruling helped convince states that their own efforts would be respected — and was, she said, a major factor in the 2008 passage of the Washington State bill.

The Montana Supreme Court held in 2009 that no state law restricts the right of its citizens to end their lives with the help of physicians, though the court did not go so far as to say that physician-assisted suicide is a right under the State Constitution.

Efforts so far in California, Hawaii, Maine and Vermont have not been successful, though a new bill is before the Vermont Legislature. Barbara Coombs Lee, the president of Compassion and Choices, a group that promotes what it refers to as “end-of-life choice” in legislatures and the courts and was a co-plaintiff in the Montana case, said Dr. Kevorkian “was quite scornful of any effort to change the law.”

She called his death “the end of an era.”

Noting that he was a polarizing figure — “people either thought he was a saint and martyred or the devil incarnate” — she explained, “To us, he was neither, but certainly pivotal to our movement.”

Even at the extremes, she said, he “raised everyone’s consciousness about the problem of end-of-life suffering” and spurred others to look for ways for those with terminal illness to end their lives on their own terms.

An “ignominious” death at the hands of Dr. Kevorkian “was a dramatic display of just how desperate people were who are seeking a peaceful end of their terminal disease,” she said.

The policy-oriented groups worked to distinguish themselves from the Kevorkian spectacle. One Washington briefing in 1999 was titled “Jack Kevorkian and Physician-Assisted Dying: Not One and the Same.”

Still, disagreement has its uses, said Scott Blaine Swenson, who was the executive director of the Death With Dignity National Center from 2001 to 2005. “He was the perfect foil” for the centrist movement that was promoting policy change, Mr. Swenson said. “You need somebody to play against,” he said.

Dr. Kevorkian — erratic, loud and playing by his own rules — helped the movement establish rules that voters could live with, Mr. Swenson said.

“The truth, I think, is that had a Kevorkian not existed, that folks in Oregon and other proponents of assisted dying would have needed to invent him,” he said.

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News Analysis: Brinkmanship in Sudan as a Deadline Nears

His troops and tanks violently annexed Abyei, a flashpoint town on the contested border dividing northern and southern Sudan. Then he sent thousands of soldiers into two other volatile areas, Blue Nile and Southern Kordofan, while continuing a crippling blockade of the south, strangling it of food and fuel.

At the same time, renegade southern militias, widely believed to be armed by Mr. Bashir’s intelligence services, have stepped up their attacks, hitting army bases, snatching weapons and stretching southern troops thin as they scramble to meet all these threats, often hijacking United Nations vehicles to get to the battlefield.

But diplomats and analysts believe that, rather than trying to start a major conflict, Mr. Bashir may instead be playing out a carefully devised strategy meant to ensure just one thing: that when southern Sudan declares independence next month, his northern government controls as much oil as possible, or at least is richly compensated.

“Khartoum’s capture of Abyei and aggressive posturing on the eve of independence are, among other things, attempts to strengthen their negotiating hand and squeeze the South for as much as possible on oil, economic and border arrangements,” said Zach Vertin, an analyst for the International Crisis Group, which researches conflicts worldwide. In this high-stakes game, the tens of thousands of people who fled their homes during the takeover of Abyei and are now camped out under trees or plastic tarps along the border have become bargaining chips. Both north and south claim Abyei, and analysts say that Mr. Bashir would be willing to give Abyei to the south — and let the people go home — if he gets a good deal on other separation issues, namely the oil.

But life for the bargaining chips, meanwhile, has been miserable. For Mary Achol, it has meant eating leaves.

On a recent morning in the border town of Agok, Ms. Achol slumped in the meager shade of a thorn tree, her belly rumbling from the nearly toxic mix of wild plants she ingested, a baby sweating profusely in her arms. During the chaotic exodus out of Abyei, Ms. Achol lost two other children.

“Maybe they died of thirst, maybe they were eaten by lions,” she said. “I don’t have a lot of hope.”

Of course, there are many sticky issues on the table as Sudan prepares to split into two. But like many other divorces, Sudan’s seems to be about money, and both the northern and southern economies are desperately dependent on oil. While this means that oil is an obvious source of tension, it could also be the glue that holds the two Sudans together. The north has the pipelines and refineries, the south about 75 percent of the reserves, implying some degree of symbiosis.

Since last summer, the sides have been haggling over how to split the southern oil — or the money from it. Those close to the talks say they have hit an impasse, though they expect some deal to be struck before July 9 because no one wants to contemplate the possibility of a shutdown. Much of Sudan’s oil is so thick that the pipelines could get clogged, causing hundreds of millions of dollars in damage, if the flow of oil is suddenly stopped, as the south has threatened to do if no agreement is reached.

This means now is the decisive moment for the oil talks, and diplomats say it is no coincidence that the north has suddenly increased the military pressure. “This is simply about getting the best economic deal possible,” said a Western diplomat in Sudan. “The north needs that oil.”

Publicly, northern officials deny any connection, citing a specific reason for each of their recent military maneuvers — for example, in Abyei, southern forces attacked a northern convoy right before the occupation. But privately, one leading member of Mr. Bashir’s National Congress Party acknowledged that this may be about leverage, at least the Abyei piece.

“If you say that both sides are trying to get a better negotiating position until the resolution of Abyei, then that is acceptable,” said the official, who asked not to be identified.

From Mr. Bashir’s standpoint, he needs to drive a hard bargain. There have been recent food riots in the north; many northerners are already grumbling about the south being allowed to split off; and Darfur is still a headache for him, with the rebels fighting on and the International Criminal Court accusing Mr. Bashir of genocide for the massacres there.

If he hopes to keep his job — which may be the only way of staying out of jail — Mr. Bashir needs to keep the northern economy afloat, which he cannot do without southern oil.

Sudan made its first major oil discoveries in the late 1970s. But soon the north-south civil war resumed, and vicious fighting between northern Arabs and southerners (who are mostly Christian and animist) rendered it impossible to develop a petroleum industry. The northern government eventually co-opted ethnic militias in the south to secure the oil fields and began exporting oil in 1999. Many of these same ethnic militias have recently re-emerged, just as the oil talks hit their final stretch.

“If you need proof these militias are connected to the north, just look how they maneuver,” said Garang Diing Akuong, the southern energy minister. Whenever the militias infiltrate from the north, he said, they bypass the oil installations, where there are obvious southern bases to hit, and go farther south. “These militias have been given instructions not to mess with the oil,” the minister said.

The north has denied any connection to the ethnic militias, whose forces are heavily armed and thought to number in the tens of thousands.

The south has flirted with the idea of building its own pipeline to Kenya’s coast, near the historic island of Lamu. But that would take at least three years, and with 93 percent of the southern government’s revenue derived from oil sales, the south probably cannot hang on that long. Analysts have said that the southern government, already racked by ethnic tensions and militia problems, would implode if soldiers stopped getting their paychecks.

Southern officials chafe at the idea of “sharing” their oil with Mr. Bashir’s government, preferring instead to pay a transit fee, which, according to oil analysts, is typically anywhere from a dollar per barrel to 25 percent. It seems the two sides are stuck on reaching a figure. Sudan currently produces around 500,000 barrels per day.

The south has also made it clear that it doesn’t want to risk its long-awaited independence by going to war, which means that the only way to lift the blockades and get people home may be to give Mr. Bashir what he wants.

“It all adds up to one marvelous strategy,” said the Western diplomat, who spoke on the condition of anonymity, citing diplomatic protocol. He added, “I don’t think a war’s going to break out. These are calculated risks, though sometimes calculations don’t work.”

Josh Kron contributed reporting from Juba, Sudan, and Isma’il Kushkush from Khartoum, Sudan.

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News Analysis: Bin Laden’s Death and the New Unknown in Afghanistan

For the Taliban, the jury is still out: they say their insurgency was never solely dependent on Bin Laden, and they could survive his demise, but the American raid that killed him has raised the possibility that even the movement’s top leaders may not be safe in Pakistan.

Many leaders in Europe, though, see Bin Laden’s death as another reason to pull out of a war they have promised to quit anyway in the next three years. And in Washington, administration officials say they believe that Bin Laden’s death offers them a unique opportunity to unnerve the Taliban leadership and engage them in a political negotiation they have so far resisted.

“If you are Mullah Omar,” one of President Obama’s top advisers said of Mullah Muhammad Omar, the Afghan Taliban’s spiritual leader, who operates from Pakistan, “you’ve got to wonder whether the next set of helicopters is coming for you.”

The mystery now is whether the removal of Bin Laden as the central, mesmerizing figure in the battle between fundamentalists and the West is truly a tipping point, as the White House is betting, or whether it will prove more consequential to the debate in the United States about the pace of troop withdrawals from Afghanistan, set to begin this summer.

That may depend on a series of events that have yet to unfold: whether Al Qaeda strikes back for the killing of its leader, whether the American military force in Afghanistan remains at its current strength and whether Afghanistan’s own military proves more capable than it has been so far in taking the lead in contested areas of the country.

All last week, Mr. Obama and his aides emphasized that their goal was to defeat Al Qaeda — the Taliban, officials have argued since 2009, simply need to be “degraded” as a force, so that Afghans can fight them and the United States can leave. The president made the distinction clear on Friday during his visit to Fort Campbell, Ky., where he met the Navy Seal team that killed Bin Laden.

“We’re making progress in our major goal, our central goal, in Pakistan and Afghanistan, and that is disrupting and dismantling — and we are going to ultimately defeat Al Qaeda,” he said. “We have cut off their head, and we will ultimately defeat them.”

The Taliban’s refusal to hand over Bin Laden led to the American invasion in 2001, of course. And separating Al Qaeda from the Taliban has always been an American requirement for any negotiation.

But there is an alternative possibility heard in Kabul: the Taliban may take heart from the death of Bin Laden if they sense that his demise — and Al Qaeda’s infighting — is likely to accelerate an American withdrawal from the region.

The mood in the Taliban’s main leadership organization in Pakistan, the Quetta shura, is calm, according to people who have spoken to some of the members there. Taliban members were passing around a message from Ayman al-Zawahri, Al Qaeda’s No. 2 and Bin Laden’s possible successor, saying that “killing Osama bin Laden is just like taking a single grape from a bunch of grapes.”

A Taliban commander in Kunar Province, Zar Mohammed Ghairat, projected a similarly resolute air. “He was a leader and a man, but there are hundreds of other Osama bin Ladens left behind,” he said.

Though the Taliban and Al Qaeda have been entwined, their aims are believed to have differed. The Taliban’s primary goal has been to control Afghanistan, whereas Al Qaeda has wanted to establish a global terrorist network.

The question for the United States, then, is how many resources — and how many American casualties — should be devoted to dealing with what is essentially a local insurgency, now that Bin Laden is gone?

Most important to the future of that insurgency may be the choices made by Pakistan’s military and its top intelligence agency, the Directorate for Inter-Services Intelligence, or ISI, which have been the Taliban’s prime sponsors.

Pakistani officials were angered and humiliated by the American raid that killed Bin Laden, and Pakistan is likely to remain a difficult partner, reluctant to eliminate the financing and sanctuaries it has provided to the Taliban.

Pakistan’s support, the survival of Mullah Omar and the reluctance so far of Taliban fighters to join the Afghan government make it unlikely that the movement’s energy will be sapped overnight. Similarly, the Taliban’s leaders have not been free to sit down with President Hamid Karzai and work out a deal without running afoul of their Pakistani hosts.

“It is very early,” said Rangin Spanta, the national security adviser to Mr. Karzai. “On the one hand, losing a charismatic leader is good, but we have to think forward and bring a corrective to our strategy in addressing the sanctuaries and choosing our allies.”

Moreover, Al Qaeda’s importance to an insurgency that is far from uniform across Afghanistan, particularly in terms of financing, has waned, Western and Afghan intelligence analysts said.

Alissa J. Rubin reported from Kabul, and David E. Sanger from Washington. Reporting was contributed by Carlotta Gall from Islamabad, Pakistan; Ruhullah Khapalwak and Sharifullah Sahak from Kabul; Taimoor Shah from Kandahar, Afghanistan; and an employee of The New York Times from southern Afghanistan.

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News Analysis: U.S. Relations With Pakistan Falter in Rift Over Drone Strikes

The rupture over Pakistan’s demands that the Americans end drone strikes — which the Obama administration rejected — and scale back their intelligence presence within Pakistan exposed the tentative nature of the alliance forged after the Sept. 11, 2001, attacks. And it is increasingly apparent that the two countries have differing, even irreconcilable, aims in Afghanistan.

With the Afghan endgame looming, suspicion is overwhelming faint cooperation between the United States and Pakistan, as each side seeks to secure its interests, increase its leverage to obtain them, and even cut out the other if need be, American and Pakistani officials say.

No one in Pakistan or in Washington now speaks of returning to the strategic alliance made by President George W. Bush and Gen. Pervez Musharraf immediately after the Sept. 11 attacks, when the primary goal was to operate joint intelligence efforts to capture operatives of Al Qaeda. Military officials from both sides say that arrangement was never bound to be a longstanding affair.

“There was never a level of trust,” said a former American military official who served in a senior position in Pakistan. “I’m convinced now they don’t want our help.”

The American official did not want to be identified while discussing the delicate nature of a relationship that, whatever its failings, both nations are reluctant to jettison completely.

But politicians on both sides are disappointed with the results of billions of dollars in American military and civilian assistance since 2001, and the Obama administration acknowledged to Congress in a report this month that the results of the spending fell short of expectations.

In any case, the money has done little to pave over the accumulating strategic differences between the two nations.

Broadly, the Americans seek a strong and relatively centralized Afghan government commanding a large army that can control its territory. Almost all those ends are objectionable to Pakistan, which while it calls for a stable Afghanistan, prefers a more loosely governed neighbor where it can influence events, if need be, through Taliban proxies.

The particular differences revolve around which Taliban factions should be included in any settlement; the role of India, an ally of the United States but the enemy of Pakistan; and the size of the new Afghan Army, which the Americans want big and the Pakistanis want small.

The situation is further complicated, American and Pakistani officials said, by discord within the Obama administration over how the United States should withdraw troops from Afghanistan, and what role, if any, Pakistan should play in the exit.

The overall commander in Afghanistan, Gen. David H. Petraeus, is determined to batter the Taliban as much as possible, a policy that the Pakistanis disagree with, both sides say. Pakistan prefers that the State Department tilt toward reconciliation between the Afghan government and the Taliban.

Even within the Pentagon, the chairman of the Joint Chiefs of Staff, Adm. Mike Mullen, who has met with the Pakistani military chief, Gen. Afshaq Parvez Kayani, on more than two dozen occasions, has more tolerance for the Pakistani point of view than does General Petraeus, a senior American official said. With his position in Washington, Admiral Mullen could still prevail on persevering with Pakistan.

These American nuances are well known at the Pakistani Army headquarters in Rawalpindi, where General Petraeus is referred to as Mr. Petraeus — a calculated omission of his military title as a way to mock his perceived political ambitions, according to a recent visitor to the headquarters.

For months, Pakistan’s diplomats and military officials have complained that they were being kept in the dark by the Obama administration’s maneuvering, no matter how preliminary, for a negotiated solution in Afghanistan.

“There is no transparency; they are not telling us who they are talking to,” a Pakistani government official said. Another official, in Pakistan’s security apparatus, said: “We don’t know what the Americans’ endgame is in Afghanistan.”

As their nervousness about American intentions have increased in recent months, the Pakistanis have sought to improve their leverage — threatening C.I.A. operations in Pakistan, cracking down on Taliban leaders to coerce their cooperation, and trying to befriend President Hamid Karzai of Afghanistan, who has also felt on the outs with Washington.

In the latest iteration of this new Pakistani-Afghan relationship, General Kayani and the head of Pakistan’s intelligence agency, Lt. Gen. Ahmed Shuja Pasha, accompanied Prime Minister Yousaf Raza Gilani on a visit to Kabul on Saturday, the most public of a number of visits to Afghanistan by General Kayani in the past year.

American diplomats in Islamabad and Kabul declined to comment on the Pakistani visit to Afghanistan, and appeared to know little about the intention of the Afghanistan-Pakistan Joint Commission unveiled with considerable fanfare by the two sides in Kabul as a vehicle to end the war.

Pir Zubair Shah contributed reporting from Washington, and Ismail Khan from Peshawar, Pakistan.