ANDREW SULLIVAN
From September 2001 To June 2009
Like so many of the choices facing Barack Obama, the Iran conundrum is not of his making but one he has no choice but to confront. I see few ways, alas, in which the US and its allies can prevent Iran getting a nuclear weapon capacity in the near future. Maybe there was a chance earlier this decade, but it seems pretty hopeless to me now. A military attack would be a catastrophe; it would re-ignite Jihadism on a scale not yet seen with repercussions so unpredictable and results so insecure no prudent statesman would contemplate it. It would breathe new life into the Khamenei regime, al Qaeda and every anti-Semitic nutjob on the planet. For it to truly work in extinguishing Iran's dispersed and deeply buried network of sites, some kind of extremely brutal bomb or even tactical nukes would be required. A nuclear first strike by Israel against a Muslim country means a long and possibly swift slide toward global war.
Yes, if we can sharpen sanctions so that key members of the coup regime are personally crippled, fine. But I don't believe that broader sanctions will prevent Iran's nuclear program, and I don't believe the Russians or the Chinese will sign on to anything remotely useful in the first place. Does this leave an intolerable threat to the survival of Israel and the security of neighboring Sunni Arab states? It would be dangerously naive to under-estimate the threat, but equally foolish to over-state it.
Israel, remember, has the potential for massive nuclear response to any attempted strike from Iran.
The obvious aim, it seems to me, of the Revolutionary Guards is not to nuke al-Aqsa, but to use a nuclear capacity to immunize their terrorism in the region, to balance Israel's nuclear monopoly, to scare the crap out of the Saudis and Egyptians, and to shore up their control at home. I see this as an inevitable coming-of-age of Iran as a regional power, and although there is an obvious and acute danger that nuclearization could entrench some of the worst elements of the regime (and they don't get much worse than Ahmadinejad), the brutal truth is: we do not have the tools to stop it. One day, a nuclear Iran, if led by men and women legitimately elected by the people of Iran, could be our friend, not enemy - and a much more reliable and stable friend than the Sunni Arab autocracies we are currently shoring up. I believe, in short, that in my lifetime we will see a democratic Iran, led by the generation that took to the streets this year. And I believe vigilant containment is the only realistic way at this point to get there.
What we have to understand - and what I have come belatedly and painfully to grasp - is that our collective narcissism can be an obstacle to successful statesmanship. In blunter terms: This is not about us. In so far as we have made Iran about us, we have added mountains to the landscape of human misery and pain. This is a struggle for the Iranian people, a long, brutal, bitter struggle. We should do all we can to support them, without the neocon grandstanding that actually helps the regime rather than hurts it. But we have to understand our limits.
This is a deep struggle in the Muslim soul - a struggle to come to terms with its own sectarian past, the bloodiness of some of its scriptures, and the real and present threat of modernity as it crashes down on their medieval order with the power of technology they cannot control.
This process will take time, and Americans' well-meant determination to fix this state of affairs is, however understandable, naive. The arc of history is far slower than our 24-hour news cycle or our ADD blog-posting. The resurgence of religious fundamentalism at this moment of technological marvel and global integration is an utterly predictable phenomenon, and it will not end soon. And when it does end, it will do so by collapsing under its own lies and delusions and denial, just as communism did. We can do a little to nudge this along, but we cannot be the decisive force - or we will merely reignite the civiliizational conflict. Maybe a hot war is inevitable. But if it is, it is essential to our civilization and its core values that we do not initiate it. If Iraq did not convince us of that, nothing will.
I write this at the end of a decade that changed my politics. They changed because reality shifted. Globalization, technology and fundamentalism have reordered our post-Cold War world. The advantage lies with the asymmetrical, the nimble, the long tail, the lone actor. There is nothing the modern state can really do to stop this, and if it tries to assume the powers to have a chance, it will cease to resemble anything like the democracy or republic the Founders envisaged. We can panic and construct a Leviathan so powerful and invasive it will in the end destroy our freedoms, or we can hang in, do all we can to defuse ideological and theological tension, construct more effective means of defense and security, and outlast the Islamist wave even through what will be its many outrages and offenses.
This would be appeasement if strong military action were an effective alternative and could defeat the enemy. But if we have learned anything these past few years, it is that the mightiest military in the world cannot stop a lone fanatic eager to kill himself in order to kill countless others in a religious mission. Even if we were to transform Afghanistan, a Yemen would soon emerge. Even now after spending trillions on Iraq, we cannot stop al Qaeda returning when we leave to exploit sectarian divides.
What we need is sobriety, stoicism, vigilance and a determined defense of our values and the rule of law. We cannot save our civilization by junking it, by pre-emptive wars and torture and near-dictatorial executive power. And we cannot save it by politicizing every attack, thereby magnifying the power of one tiny terrorist with burnt balls to create havoc and division in the free world.
I cannot say I end this decade with any optimism. The age of asymmetry is full of foreboding. But this much George Bush got right: this really is a new kind of war. He got the what. What he didn't get right - what I initially didn't get right - was the how. This how requires self-restraint as much as raw power, dedication to our values as much as emotional gratification, grindingly difficult intelligence work whose successes are rarely known but whose failures are in every headline. I believe that the election of Obama and the Green Revolution in Iran were signs that the next generation understands the magnitude of this crisis and are seeking a new way to overcome it. I believe that in my heart and soul. Which is why I found those events as inspiring as they are now imperiled.
The resistance is currently overwhelming, vicious, angry and alert. But when I feel its lethal force, I remember too the great wave of enthusiasm that brought Obama to the presidency and the explosion of democracy that brought millions to the streets of Iran.
In the words of Niebuhr:
"There are no simple congruities in life or history. The cult of happiness erroneously assumes them. It is possible to soften the incongruities of life endlessly by the scientific conquest of nature's caprices, and the social and political triumph over historic injustice. But all such strategies cannot finally overcome the fragmentary character of human existence. The final wisdom of life requires, not the annulment of incongruity but the achievement of serenity within and above it...
Nothing that is worth doing can be achieved in our lifetime; there we must be saved by hope.
Nothing which is true or beautiful or good makes complete sense in any immediate context of history; there we must be saved by faith.
Nothing we do, however virtuous, can be accomplished alone; therefore we are saved by love.
No virtuous act is quite as virtuous from the standpoint of our friend or foe as it is from our own standpoint. Therefore we must be saved by the final form of love which is forgiveness."
Know hope.
Daily Dish By Andrew Sullivan

NY TIMES
As the Nation’s Pulse Races, Obama Can’t Seem to Find His
By MAUREEN DOWD
WASHINGTON
I was walking through a deserted downtown on Christmas Eve with a friend, past the lonely, gray Treasury Building, past the snowy White House with no president inside.
“I hope the terrorists don’t think this is a good time to attack,” I said, looking protectively at the White House, which always looks smaller and more vulnerable and beautiful than you expect, no matter how often you see it up close.
I thought our guard might be down because of the holiday; now I realize our guard is down every day.
One thrilling thing about moving from W. to Barack Obama was that Obama seemed like an avatar of modernity.
W., Dick Cheney and Rummy kept ceaselessly dragging us back into the past. America seemed to have lost her ingenuity, her quickness, her man-on-the-moon bravura, her Bugs Bunny panache.
Were we clever and inventive enough to protect ourselves from the new breed of Flintstones-hardy yet Facebook-savvy terrorists?
W.’s favorite word was “resolute,” but despite gazillions spent and Cheney’s bluster, our efforts to shield ourselves seemed flaccid.
President Obama’s favorite word is “unprecedented,” as Carol Lee of Politico pointed out. Yet he often seems mired in the past as well, letting his hallmark legislation get loaded up with old-school bribes and pork; surrounding himself with Clintonites; continuing the Bushies’ penchant for secrecy and expansive executive privilege; doubling down in Afghanistan while acting as though he’s getting out; and failing to capitalize on snazzy new technology while agencies thumb through printouts and continue their old turf battles.
Even before a Nigerian with Al Qaeda links tried to blow up a Northwest Airlines jet headed to Detroit, travelers could see we had made no progress toward a technologically wondrous Philip K. Dick universe.
We seemed to still be behind the curve and reactive, patting down grannies and 5-year-olds, confiscating snow globes and lip glosses.
Instead of modernity, we have airports where security is so retro that taking away pillows and blankies and bathroom breaks counts as a great leap forward.
If we can’t catch a Nigerian with a powerful explosive powder in his oddly feminine-looking underpants and a syringe full of acid, a man whose own father had alerted the U.S. Embassy in Nigeria, a traveler whose ticket was paid for in cash and who didn’t check bags, whose visa renewal had been denied by the British, who had studied Arabic in Al Qaeda sanctuary Yemen, whose name was on a counterterrorism watch list, who can we catch?
We are headed toward the moment when screeners will watch watch-listers sashay through while we have to come to the airport in hospital gowns, flapping open in the back.
In a rare bipartisan success, House members tried to prevent the Transportation Security Administration from implementing full-body imaging as a screening tool at airports.
Just because Republicans helped lead the ban on better technology and opposed airport security spending doesn’t mean they’ll stop Cheneying the Democrats for subverting national security.
Congressman Pete Hoekstra of Michigan was weaselly enough to whack the president and “weak-kneed liberals” in his gubernatorial fund-raising letter.
Before he left for vacation, Obama tried to shed his Spock mien and juice up the empathy quotient on jobs. But in his usual inspiring/listless cycle, he once more appeared chilly in his response to the chilling episode on Flight 253, issuing bulletins through his press secretary and hitting the links. At least you have to seem concerned.
On Tuesday, Obama stepped up to the microphone to admit what Janet Napolitano (who learned nothing from an earlier Janet named Reno) had first tried to deny: that there had been “a systemic failure” and a “catastrophic breach of security.”
But in a mystifying moment that was not technically or emotionally reassuring, there was no live video and it looked as though the Obama operation was flying by the seat of its pants.
Given that every utterance of the president is usually televised, it was a throwback to radio days — just at the moment we sought reassurance that our security has finally caught up to “Total Recall.”
All that TV viewers heard, broadcast from a Marine base in Kaneohe Bay, was the president’s disembodied voice, talking about “deficiencies.”
Citing the attempt of the Nigerian’s father to warn U.S. authorities six months ago, the president intoned: “It now appears that weeks ago this information was passed to a component of our intelligence community but was not effectively distributed so as to get the suspect’s name on a no-fly list.”
In his detached way, Spock was letting us know that our besieged starship was not speeding into a safer new future, and that we still have to be scared.
Heck of a job, Barry.

Atlanta Journel Constitution
Dialogue with Iran still necessary
By Maziar Bahari
Since I was released from Tehran’s notorious Evin Prison in October, the questions have come again and again: Can we still talk to these people? Should the Obama administration engage in dialogue with Iran? What should the West do in nuclear negotiations?
After being jailed, interrogated and beaten by the Revolutionary Guards for 118 days for reporting honestly on the disputed June 12 presidential elections, I am often expected to oppose any dialogue. But the West still needs Iran and should continue talking to it — no matter what it has done to people like me.
Inside Evin, I was forced to confess that I was part of an insidious Western media conspiracy to overthrow the regime. I was forced to apologize to Iran’s supreme leader, Ayatollah Khamenei. I was released as suddenly as I was arrested, without explanation. But my interrogator told me to send a message to the world: “We are a superpower. America’s power is waning, and we will soon overtake them. Now that Americans have started this war against us, we will not let them rest in peace.” He paused, perhaps realizing that he sounded defensive.
I was a jailed journalist wearing a blindfold, not some sort of spy. (I’m not even American.) He changed the subject to “soft” war, a term Tehran uses to refer to an imaginary war that it says is promoted by the media against the “holy government of the Islamic Republic.” “We will answer their attacks with all our might,” he said.
The Revolutionary Guards are a schizophrenic bunch, plagued by both deep insecurities and a superiority complex. They have ambitions to take over the government and expand their business empire in Iran. At the same time, they are terrified of individuals and groups that question their grip on power. The Guards are the real power base of Khamenei. They are the main supporters of his claim to be Allah’s representative on Earth.
One of the most serious charges against me was insulting Khamenei. In a private e-mail I had wondered whether Khamenei has been blinded by power and had lost touch with his people, and if that was why he was answering people’s peaceful demands with brute force. That was enough for my interrogator to kick and punch me for days and to threaten me with execution.
In Iran’s triangle of power — the Guards, Khamenei and President Mahmoud Ahmadinejad — the Guards are becoming stronger than the president and the supreme leader. Some Guards are devoted to Khamenei for religious reasons, but many of them use his status as a religious leader to legitimize their own actions.
They also use Ahmadinejad, a former Guard, to increase their political power. The Guards have arms and money. They are the biggest industrial contractors in Iran. They have front companies all over the region and in the West and are involved in smuggling goods into and out of Iran. They answer only to Khamenei.
So can the West, especially the United States, have a dialogue with these people? Yes. Because there is no other choice. The West has to negotiate with Iran on the nuclear program and the stability of Iraq and Afghanistan. Not talking to Tehran doesn’t work: The hostile rhetoric and actions of the Bush administration against even the reformist government of Mohammad Khatami helped the hard-liners to consolidate power. Only by engaging, even with a more radical regime, can the West force Tehran to measure the costs and benefits of dealing with the outside world.
I don’t know exactly why I was released, but I can guess. Over four months, my friends and colleagues at Newsweek and elsewhere waged a massive public and private campaign for my release. Around the time that Iran was sitting down in Geneva to discuss the nuclear program, my conditions inside Evin started to improve. One Iranian official told me later that I had “become more of a liability than an asset in jail.” At least some elements of the regime still make such rational calculations.
So what should the United States do? First, a nuclear Iran should not be tolerated. Although I believe that Iran will not start attacking other countries the day after it builds the bomb, having the bomb will embolden the Guards to intensify their repression inside the country and regional expansion.
The American government should use all of its resources, including President Obama’s charm, to persuade allies, especially China and Russia, to work with it to put in place smart sanctions that solely target Iran’s nuclear program and do not affect ordinary Iranians.
At the same time, the West has to separate the nuclear negotiations from talks about Iraq and Afghanistan. Tehran understands that insecurity in those countries is damaging to itself as well as to the United States. Iran would love to make its help conditional on a grand bargain with the West that would guarantee the security and survival of the regime and preserve its nuclear program. But the better course would be to use cooperation on those two countries as a confidence-building measure in negotiations.
The common perception among my American friends used to be: “If Americans support a certain faction in Iran, it would be easier for the regime to persecute them.” That might have been true once. But Iran has entered a new phase.
Opposition activists from all walks of life have been accused of being agents of the West. I was accused of working for the CIA simply because I wrote for an American magazine. The rumor du jour in Iran is that Obama and the Guards are reaching a deal to normalize relations, in exchange for which America will ignore human rights abuses in Iran. Hence, the opposition movement’s slogan, “Obama, either with them or with us.” The United States has acted against the interests of the Iranian people in the past. Repeating that mistake for tactical gains would be the biggest mistake of the Obama administration.
As for the Iranian people, the more immediate victims of the brutal regime, we have to think long-term. Our anger should be sublimated into something more positive. We have been brutalized to think of the world in black and white. Seeing the shades of gray can be our strongest weapon against those who would jail, beat and torture us.
Maziar Bahari, a Canadian filmmaker and reporter for Newsweek, was released from Evin Prison on Oct. 17.

The London Times
Iranian protest is grassroots and unstoppable, say activists
Martin Fletcher: Commentary
Iran’s panicking regime is once again seeking to suppress the Green Movement by decapitating it.
Just as it did after June’s hotly-disputed presidential election, it is arresting high-profile reformists, academics and journalists who support the opposition.
It hesitates to detain Mir Hossein Mousavi lest millions of his supporters take to the streets, but it has locked up his brother-in-law and is widely suspected of killing his nephew. It cannot arrest Shirin Ebadi, the Nobel laureate, as she is abroad, but it has imprisoned her sister.
The tactic will prove as futile now as it did in June. Decapitation will not work because the opposition is a bottom-up movement run not by Mr Mousavi or Mehdi Karroubi, its nominal leaders, but by its grassroots members. It is a massive campaign of civil disobedience.
“Ahmadinejad, Khamenei and the Revolutionary Guards still don’t get it,” said one Iranian academic. “The Green Movement is a decentralised popular front run by local cells and local leaderships across the country. The main opposition figures do not control it. They are spiritual leaders, but do not provide any direction in regard to demonstrations or slogans.”
For the most part the demonstrations are spontaneous outpourings of anger. Decapitating the movement will not stop them, nor stop the defacing of banknotes with anti-government slogans, the daubing of anti-government graffiti on walls, the boycott of goods advertised on the state-controlled media or the shouting of “Allahu akbar” from rooftops at night.
Iranians are doing these things not because they are told to, but because they choose to. For a reviled regime that rules by diktat, that has to bus in supporters to fill its rallies, that must be a difficult concept to grasp.
Protests are now common not just in Tehran, but in conservative cities such as Mashad and Qom. The regime’s use of violence during the holy month of Muharram, its lack of respect for Grand Ayatollah Hussein Ali Montazeri after his recent death, and other sacriligious acts have eroded its support among the pious poor.
One activist said: “Do Khamenei, Ahmadinejad and the elite of the Revolutionary Guards really think that I, or anyone else, after being beaten by the police, witnessing the murder of Iranians on the streets, hearing stories of rape and murder in the prisons, and knowing of electoral cheating, will ever remain passive and quiet? None of us will ever accept the rule of Ahmadinejad and Khamenei after what they have done.”

President Obama's statement on Iran Violence

The United States joins with the international community in strongly condemning the violent and unjust suppression of innocent Iranian citizens, which has apparently resulted in detentions, injuries, and even death.
For months, the Iranian people have sought nothing more than to exercise their universal rights. Each time they have done so, they have been met with the iron fist of brutality, even on solemn occasions and holy days. And each time that has happened, the world has watched with deep admiration for the courage and the conviction of the Iranian people who are part of Iran’s great and enduring civilization.
What’s taking place within Iran is not about the United States or any other country. It’s about the Iranian people and their aspirations for justice and a better life for themselves. And the decision of Iran’s leaders to govern through fear and tyranny will not succeed in making those aspirations go away.
As I said in Oslo, it’s telling when governments fear the aspirations of their own people more than the power of any other nation. Along with all free nations, the United States stands with those who seek their universal rights. We call upon the Iranian government to abide by the international obligations that it has to respect the rights of its own people.
We call for the immediate release of all who have been unjustly detained within Iran. We will continue to bear witness to the extraordinary events that are taking place there. And I’m confident that history will be on the side of those who seek justice.

On a Holy Day, Protest and Carnage in Tehran
By TIME Staff
From Imam Hussain Square to Freedom Square, from east to west along Revolution Street. The political and religious symbology of Iran's Islamic regime was turned on its head on Sunday. Hundreds of thousands of opposition supporters brought Shiite tradition to bear against an increasingly brutal government, and the blood of martyrs was once again spilled.
Reports had four dead from gunshot wounds. One of those killed was the 35-year-old nephew of opposition leader Mir-Hossein Mousavi. Witnesses say one woman was run down and killed by a Basij member driving a car.
All this on the mourning day of Ashura, the most important day on the Shiite calendar. It marks the death of Imam Hussain whose martyrdom at the hands of the Caliph Yazid is the religious foundation of the Islamic Republic's generalized stand against what it calls the "global arrogance."
"This month is a month of blood. Yazid will fall!" came the cry from the steady stream of thousands of opposition supporters filing down Revolution Street — Yazid, the unjust caliph now equated with Supreme Leader Ayatollah Ali Khamenei.
Such shows of direct opposition would have been unthinkable a year ago. As would the necessity of government-sponsored counterprotests in support of Khamenei. Filing out of Tehran University's East gate, 2,000 government supporters, men strictly separated from women, shouted a well-rehearsed slogan in favor of ideological totalitarianism: "Our leader only Seyyed Ali, our party only the party of Ali."
After Saturday night's savage crackdown in Jamaran, again today, the worst was not long in coming. By the middle of the day Ashura 2009 had produced its own martyrs.
As the growing crowds approached the Hafez overpass, a shout arose to take the bridge. Hundreds streamed into the road. But the same moment saw the first wave of police attacks. More than a dozen police bikes drew up to the crowd. The lead rider pulled out a tear gas pistol and shot into the crowd at close range.
Pandemonium ensued. During earlier protests, chants of "death to the dictator" would have been heard — calls that automatically follow scenes of open police brutality. But today something had snapped. "Death to Khamenei" was the call of escaping protesters.
Crowds scattered. Police singled out individuals and showed little mercy with their batons and whips.
An officer was severely beating one man, repeatedly over the shoulders and head, as he crouched in the dirt by the sidewalk. A woman in a chador tried to pull him away but she became the officer's next target. Somehow, though, the policeman found himself alone and enraged protesters assailed him with rocks. One man hurled a half-brick at his helmet from a distance of less than a yard.
In the back alleys a tall, well-built man who had been beaten severely walked, head held high, alongside his wife. Blood streamed from a growing bulge on his forehead. He smiled. Perhaps he had given as good as he had received.
Many had now been forced away from the main route and were heading west via other routes. The next major gathering was at the junction of Valiasr Street and Taleghani Street, where young men were urging thousands of still tentative protesters to join the main crowd of tens of thousands.
At the center of the throng, a whirlpool of arms flailed in the air and crashed down on chests — a sign that not only the government but the green movement too could use Shiite traditions to stir passions.
Twice police charges were forced back by the sheer weight of numbers and the readiness like never before of protesters to confront security forces and throw rocks. "This is a civil movement," said one youth juggling a jagged piece of rock in his hand.
At one of the many Ashura refreshments stalls placed incongruously in the heart of the battle, one man described a clash he had just witnessed. He said the crowd had had taken down one policeman and lifted his helmet in the air like a trophy. Others at the refreshment stall listened as they ate lentil soup and drank tea with dates. No more than 100 yards away police clashed once again with protesters, while the black-shirted, chador-wearing Shiite faithful gathered around the stall cried, "death to the dictator!"
Farther west but still to the north of Revolution Street, Farmers' Boulevard was heavy with traffic and alive with the constant, monotonous din of honking horns. The junction of Workers' Street was the scene of possibly the largest gathering of the day.
Thousands were already marching towards Revolution Square directly to the south. In the middle of the road, protesters were encouraging a crowd just as large to join the main crowd farther down. On the traffic island, six men considered cutting the wires to the traffic lights to induce further chaos. "Does anyone have any pliers?" one man asked of the stationary motorists.
Rhythmic, deep booms came from the north like the sound of thunderous footsteps. Again the protesters were reclaiming religious practices. This time they had improvised the battle drums associated with the Ashura festival with metal trash cans, which they wheeled down the street and pounded with heavy planks of wood and and lumps of concrete.
Tens of thousands of Iranians brandishing green ribbons and bandanas followed the war drums down towards the square. On the corner, a billboard bearing the image of Ayatollah Khomeini looked benevolently on.
That crowd never made it. Ripples of fear prompted a stampede after a concerted police charge. Tear gas and batons held the day once more. But word later came through that many had in fact reached Revolution Square and some even to Tehran's iconic Freedom Monument.
On Sunday, Iran's opposition made the symbolic journey from a square named after their most revered hero towards a monument dedicated to freedom, along a street called Revolution. The last remaining protesters used V-signs to hail their taxis home.

The Sunday London Times
Inch by inch, Obama is moving mountains
It’s worth remembering that America is a vast and cumbersome machine, designed to resist deep change
Andrew Sullivan
Between Barack Obama and Tiger Woods, it wasn’t such a good December for idolised, lean, brown golfers. Tiger, however, can hide. Barack, alas, cannot. The venom against Obama has been right up there with that directed against, well, Bush, Clinton, Nixon, Johnson ... America is, after all, a tough political arena.
The right treated the Senate passage of health insurance reform — a bill that essentially subsidises private health insurance for the working poor — as if it were the new dawn of bolshevism. Actually, that would be too mild. “Two-thirds of the country don’t want this. And one-third of these jihadists, these healthcare jihadists, do,” opined the Republican commentator Mary Matalin.
The left, however, was no kinder. Many leading liberal lights called for the bill to be killed because it gave too much to insurance and drug companies and failed to provide a publicly funded alternative to private insurance. The columnist Arianna Huffington lamented: “If the miserable Senate healthcare bill becomes the law of the land, it’s only going to encourage the preservation of a hideously broken system.”
My favourite splutter came from the Washington Post columnist Robert Samuelson, who declared the entire bill an encomium to Obama’s self-centredness. “It is about him: about the legacy he covets as the president who achieved ‘universal’ health insurance,” Samuelson inveighed. Then — hilariously — he added: “To be sure, the [proposals] would provide insurance to 30m or more Americans by 2019.” What did the Romans ever do for us?
The bill is not perfect and will need work in the next few years — on cutting some entitlements and controlling costs in other ways. But the law remains largely what Obama promised in the campaign.
As with most attempts to judge Obama, a little perspective helps. So let’s review, shall we? This is the biggest single piece of social legislation in 40 years. The Congressional Budget Office predicts it will indeed insure 30m people.
And this is only the end of year one. In the stimulus package in the spring, Obama invested an unprecedented amount of federal money in infrastructure, with an unsung focus on noncarbon energy sources. He engineered a vast and nerve-racking banking rescue that is now under-budget by $200 billion because so many banks survived.
He organised the restructuring of the US car industry. He appointed Sonia Sotomayor, a Latina Supreme Court justice, solidifying his non-white political base. If market confidence is one reason we appear to have avoided a second Great Depression, then the president deserves a modicum of credit for conjuring it. Growth is edging back into the picture.
No recent president has had such a substantive start since Ronald Reagan. But what Reagan did was to shift the underlying debate in America from what government should do to what it should not. His was a domestic policy of negation and inactivism, and a foreign policy of rearmament and sharp edges.
Obama has, in a mirror image of 1981, reoriented America back to a political culture that asks what government will now do: to prevent a banking collapse, to avoid a depression, to insure the working poor, to ameliorate climate change, to tackle long-term debt. The point about health insurance reform, after all, is that it represents a big expansion of government intervention in the lives of the citizenry — and that’s a game-changer from three decades of conservative governance.
Abroad, the shift has been even more marked. From his Cairo speech to his resetting of relations with Russia, an era of polarisation has ceded to one of intense engagement. We have had the supplanting of the G8 by the G20, a dramatic upgrade of public opinion towards America across the globe, an overhaul of the war in Afghanistan, an end to torture as an instrument of US government and the slow unwinding of Guantanamo.
On Iran, Obama held out what he called an open hand, managed to dislodge Russia a few inches from its usual anti-sanctions approach, busted President Mahmoud Ahmadinejad at the United Nations on the Qom nuclear site, and held tight as the coup regime was assailed from within. If Tehran’s international position has veered between rank belligerence and confused drift, it is because the regime itself is far weaker than it was a year ago, and may not last another year.
The disillusioned are those who weren’t listening in the campaign or not watching closely in the first year. The right has failed to register his steeliness and persistence and the left has preferred to ignore his temperamental and institutional conservatism. Both sides still misread him — hence the spluttering gloom. And there is indeed something dispiriting about the relentless prose of government compared with the poetry of the campaign. But Obama is a curious blend of both: a relentless pragmatist and a soaring rhetorician.
In time, if the economy recovers, if black, young and Hispanic voters see the benefits of their new healthcare security, if troops begin to come home from Iraq in large numbers next summer, if jobs begin to return by the autumn, then the logic of his election will endure.
His care to keep the tone civil, to insist on impure change rather than ideological stasis has already turned the Republicans into foam-flecked nostalgics for a simpler, whiter, easier period and has flummoxed those left-liberals who wanted revenge as much as reform. Both are part of an embittered past that Obama wants to leave behind. His clarity on this, and his refusal to take the bait of divisiveness and partisanship is striking. That takes an enormous amount of self-confidence and self-restraint.
He has failed in one respect: the political culture is still deeply partisan, opportunistic and divided. But this, I believe, is not so much a function of his liberal pragmatism as it is a remnant of an American right in drastic need of new intellectual life and rhetorical restraint. In this respect, Obama has made the right crazier, which may be a necessary prelude to it becoming saner.
It’s worth remembering that America is a vast and cumbersome machine, designed to resist deep change. That this one man has moved the country a few key, structural degrees in one year, and that the direction is as clear and as strategic as that first embraced by Reagan and Margaret Thatcher (in the opposite direction) is under-appreciated. But the shift is real and more dramatic than current events might indicate. I wouldn’t bet on its evanescence quite yet.
andrewsullivan.com

From The London Times
‘Ceausescu looked in my eyes, and he knew that he was going to die’
A former soldier is haunted by the memory of the Christmas Day firing squad that killed Nicolae Ceausescu and his wife Elena
Dorin-Marian Cirlan was a member of the three-man firing squad that killed Nicolae Ceausescu
Christmas Day memories are made of this: a turkey dinner, exchanging gifts, watching television, family togetherness, peace on Earth and goodwill to all men. Dorin-Marian Cirlan’s abiding memory is of the Christmas Day he shot a dictator.
“I know what I would rather have been doing,” said Mr Cirlan, who was a member of the three-man squad that killed Nicolae Ceausescu and his wife, Elena, on December 25, 1989. “As a Christian it is a horrible thing to have to take someone’s life — and that on Christmas Day, that holy holiday.”
Mr Cirlan was in the elite 64th Boteni parachute regiment when Romania crumpled in the 1989 revolution. Unlike the upheavals in Poland, East Germany, Hungary and Czechoslovakia, blood was spilt — some of it on Mr Cirlan’s paratrooper boots.
“You have to picture how it was then,” Mr Cirlan said. “Rumours were swirling — there was panic everywhere on the radio, on television, even on the army radio frequencies. It was like the coming of the Apocalypse.”
The paratroopers had gone over to the side of the revolutionaries; some of their units were fighting agents of the Securitate secret police around the Bucharest television tower. But Mr Cirlan — 27 at the time and a non-commissioned officer — was at regimental headquarters in Boteni, about 30 miles (50km) outside the capital.
“Many army leaders were beginning to break down under the intense pressure.” Someone, it was never clear who, had placed Soviet-made electronic devices around their barracks, creating a loud drone, the sound of explosions. It was psychological warfare at its crudest. Was it a revolution, a Russian-backed coup d’état? Even now there is not much clarity about who was pulling the strings.
Into this maelstrom, early on Christmas Day, came two helicopters. “Our commander needed eight volunteers. We didn’t know where we were going, which is against the military code — every soldier should be told his mission.”
Mr Cirlan has put on weight — his stomach pushes against the waistband of his grey suit — but he still has a military bearing; a sergeant’s ashen moustache. He is a lawyer now, vetting contracts for foreign property dealers. As we sat chatting for three hours in a draughty Bucharest café near Ceausescu’s former Palace of the People, my eye was drawn constantly to his right hand, to the trigger finger.
“We flew at high speed, very low, zig-zagging in our Puma helicopters to avoid radar.” They touched down in Bucharest near the military cemetery and were joined by officers from the military justice department. Mr Cirlan recognised only one man, General Victor Stanculescu.
“He was just like an English gentleman — very elegant.” General Stanculescu had been the favourite of Elena Ceausescu, had briefly taken over command of the army and had now changed sides. “We had a lot of time for him. He knew how to talk to soldiers, had looked after us, arranged coffee and cigarettes for the troops.”
This week the general, undergoing treatment in a prison hospital, has argued in interviews with the Romanian press that the Soviet KGB had helped to plan the toppling of Ceausescu for almost a year, that the United States was aware of a plot and that Russian GRU (military intelligence) were among those firing in Bucharest and Timisoara to increase the sense of menace and accelerate a popular uprising. Twenty years ago though, to Mr Cirlan and his comrades, General Stanculescu seemed to be the only officer who knew what he was doing.
To reassure the garrison in Tirgoviste, where the Ceausescus were being held, one of the officers had unfurled a long yellow scarf that had briefly got caught in the rotors — a code that they were on the side of the revolutionaries. General Stanculescu barked out: “Paratroopers to me!” The Ceausescus, he said, were about to be “judged by the people”. If the verdicts were to be death, he needed soldiers ready to carry out the sentence.
“Who is ready?” All eight men stepped forward. “Those ready to shoot, raise your hands!” All eight raised their hand. Impatient, the general barked: “You, you and you!” The three men were Captain Iomel Boeru, Sergant-Major Georghin Octavian and Mr Cirlan.
The captain was ordered to sit in the makeshift courtroom and shoot the Ceausescus if anyone tried to break in and rescue them. Mr Cirlan and Mr Octavian were supposed to stand guard outside the room.
“I could hear everything through the door,” Mr Cirlan said, “and I knew then that there was something wrong with the trial. Elena was complaining, refusing to recognise the court. The so-called defence lawyers were acting like prosecutors. But I was a soldier obeying orders. It was only later that I realised what a mockery it all was.”
The verdict was read out after a few hours. The Ceausescus were sentenced to death. They had ten days to appeal, but the sentence was to be carried out immediately. A nod to Kafka.
There was a confused silence. Death — now? The dictator and his wife were tied up but not blindfolded. As Mr Cirlan helped to frogmarch the dictator along the corridor, he heard a shout: “Get on with it! The US Sixth Fleet has just sent a helicopter force to rescue them! Move! Move! Do it!”
“Take them to the wall,” General Stanculescu said. “First him, then her.”
But the Ceausescus did not know what was happening until they were led past the helicopters to an outbuilding. “He looked in my eyes and realised that he was going to die now, not at some time in the future, and he started to cry,” Mr Cirlan said. “It was very important to me, that moment. I still have nightmares about it. That look.”
The dictator was lined up with his wife — she had insisted on their dying together — and yelled: “Death to the traitors!” He puffed out his chest and started to sing the Socialist Internationale: “Arise, wretched of the Earth! Arise prisoners of hunger!”
He never reached the fourth line: “This is the eruption of the end / of the past, let us wipe the slate clean.”
“We were told to fire 30 rounds each into them. From the hip. As paratroopers. Not as a firing squad, where some of the shooters have real bullets, some blanks, so that no one has to live with the feeling of being an executioner. We fired live,” Mr Cirlan said, his thick trigger finger unconsciously mimicking his actions of 20 years ago.
“After shooting seven rounds into Ceausescu, the gun jammed. I changed magazines and shot a full 30 rounds into Elena. She flew backwards with the force of it all. We started at about a metre range and then walked steadily backwards, still firing, so that we wouldn’t be caught by a ricochet.”
Elena’s blood splattered on his uniform. The back of her skull had fallen away. “She didn’t die easily. She was in spasms,” Mr Cirlan shook his head at the memory. “I had never even killed a chicken before.”
Behind the three-man squad, two other soldiers had joined in the shooting. One had lost his brother in the Timisoara rising a few days earler and wanted revenge.
“I was angry too when I shot Ceausescu. Until the Timisoara revolt in mid-December, I had been a true- believing communist. What else? Even in kindergarten we hadn’t sung songs about nature and sunsets but about the genius of Ceausescu and how he was our national father. But then the army was used to shoot civilians and it made me, many of us, question everything. I was furious with Ceausescu for betraying socialism.”
After the executions — “it wasn’t a trial, it was a political assassination in the middle of a revolution” — Mr Cirlan was edged out of his army career. He studied law.
Captain Boeru later rose to the rank of colonel and retired. Mr Octavian became a taxi driver. “We don’t meet up any more,” Mr Cirlan said, “because we always end up talking about the same thing.
“Now I try to live according to the teachings of the Bible. But I can’t be happy on Christmas Day, not ever. Across the world, Christians are celebrating. But not me. Not me.”
An edited transcript of the Ceausescus' trial
Chief prosecutor
Esteemed chairman of the court, today we have to pass a verdict on the defendants Nicolae Ceausescu and Elena Ceausescu, who have committed the following offences: crimes against the people. They carried out acts that are incompatible with human dignity and social thinking; they acted in a despotic and criminal way; they destroyed the people whose leaders they claimed to be. Because of the crimes they committed against the people, I plead, on behalf of the victims of these two tyrants, for the death sentence. [He then reads from a bill of indictment, listing genocide, destruction of state buildings and undermining the economy].
Prosecutor
Did you hear the charges? Have you understood?
Ceausescu
I do not answer, I will only answer questions before the Grand National Assembly. I do not recognise this court. The charges are incorrect, and I will not answer a single question here.
Prosecutor
Note: he does not recognise the points mentioned in the bill of indictment.
Ceausescu
I will not answer any question. Not a single shot was fired in Palace Square. Not a single shot. No one was shot.
Prosecutor
By now, there have been 34 casualties.
Elena Ceausescu
Look, and that they are calling genocide.
Prosecutor
In all district capitals there is shooting going on. The people were slaves. The entire intelligentsia ran away.
Elena Ceausescu
The intelligentsia of the country will hear what you are accusing us of.
Prosecutor
Nicolae Ceausescu should tell us why he does not answer our questions. What prevents him from doing so?
Ceausescu I will answer any question, but only at the Grand National Assembly, before the representatives of the working class. Tell the people that I will answer all their questions. All the world should know what is going on here.
Prosecutor What are you really?
Ceausescu
I repeat: I am the President of Romania and the Commander in Chief of the Romanian Army. I am the president of the people. I will not speak with you provocateurs any more, and I will not speak with the organisers of the putsch and with the mercenaries. I have nothing to do with them.
Prosecutor
Please, make a note: Ceausescu does not recognise the new legal structures of power of the country. He still considers himself to be the country’s President and the Commander in Chief of the Army. Why did you ruin the country? Why did you export everything? Why did you starve the people?
Ceausescu
I will not answer this question. It is a lie that I made the people starve. A lie, a lie in my face. This shows how little patriotism there is, how many treasonable offences were committed.
Prosecutor
We have always spoken of equality. We are all equal. Everybody should be paid according to his performance. Now we finally saw your villa on television, the golden plates from which you ate, the foodstuffs that you had imported, the luxurious celebrations.
Elena Ceausescu
Incredible. We live in a normal apartment, just like every other citizen. We have ensured an apartment for every citizen through corresponding laws.
Prosecutor
Mr Chairman, we find the two accused guilty. I call for the death sentence.
Counsel for the defence
Even though he — like her — committed insane acts, we want to defend them. We want a legal trial. [Addressing the defendants:] You have acted in a very irresponsible manner; you led the country to the verge of ruin and you will be convicted on the basis of the bill of indictment. You are guilty of these offences even if you do not want to admit it. Despite this, I ask the court to make a decision that we will be able to justify later as well. We must not allow the slightest impression of illegality to emerge. Elena and Nicolae Ceausescu should be punished in a really legal trial.
Prosecutor
I have been one of those who, as a lawyer, would have liked to oppose the death sentence, because it is inhuman. But we are not talking about people.
After the television broadcast is cut off, the speaker announces that the verdict is the death sentence.
Source: Foreign Broadcast Information Service

MEEP MEEP! Andrew Sullivan's review of President Obama's first year

My own view is that 2009 has been an extraordinarily successful year for Obama. Since this is currently a minority view and will prompt a chorus of "In The Tank!", allow me to explain.
The substantive record is clear enough. Torture is ended, if Gitmo remains enormously difficult to close and rendition extremely hard to police. The unitary executive, claiming vast, dictatorial powers over American citizens, has been unwound. The legal inquiries that may well convict former Bush officials for war crimes are underway, and the trial of KSM will reveal the lawless sadism of the Cheney regime that did so much to sabotage our war on Jihadism. Military force against al Qaeda in Pakistan has been ratcheted up considerably, even at a civilian cost that remains morally troubling. The US has given notice that it intends to leave Afghanistan with a bang - a big surge, a shift in tactics, and a heavy batch of new troops. Iraq remains dodgy in the extreme, but at least March elections have been finally nailed down.
Domestically, the new president has rescued the banks in a bail-out that has come in at $200 billion under budget; the economy has shifted from a tailspin to stablilization and some prospect of job growth next year; the Dow is at 10,500 a level no one would have predicted this time last year. A stimulus package has helped undergird infrastructure and probably did more to advance non-carbon energy than anything that might have emerged from Copenhagen. Universal health insurance (with promised deficit reduction!) is imminent - a goal sought by Democrats (and Nixon) for decades, impossible under the centrist Clinton, but won finally by a black liberal president. More progress has been made in unraveling the war on drugs this past year than in living memory. The transformation of California into a state where pot is now more available than in Amsterdam is as remarkable as the fact that such new sanity has spread across the country and is at historic highs, so to speak, in the opinion polls. On civil rights, civil marriage came to the nation's capital city, which has a 60 percent black population. If that doesn't help reverse some of the gloom from Prop 8 and Maine, what would? And, yes, the unspeakable ban on HIV-positive foreigners was finally lifted, bringing the US back to the center of the global effort to fight AIDS as it should be.
Relations with Russia have improved immensely and may yield real gains in non-proliferation; Netanyahu has moved, however insincerely, toward a two-state solution; Iran's coup regime remains far more vulnerable than a year ago, paralyzed in its diplomacy, terrified of its own people and constantly shaken by the ongoing revolution; Pakistan launched a major offensive against al Qaeda and the Taliban in its border area; global opinion of the US has been transformed; the Cairo speech and the Nobel acceptance speech helped explain exactly what Obama's blend of ruthless realism for conflict-management truly means.
The Beltway cannot handle all this. And that's why they continue to jump on every micro-talking-point and forget vast forests for a few failing saplings.
But when you consider the magnitude of shifting from one conservative era to one in which government simply has to be deployed to tackle deep structural problems, the achievement is as significant as his election year.
I remain, in other words, extremely bullish on the guy. There is a huge amount to come - finding a way to bring down long-term debt, ensuring health insurance reform stays on track and reformed constantly to control costs, turning the corner on non-carbon energy, reforming entitlements, finding a new revenue stream like a VAT, preventing Israel from attacking Iran, preventing Iran's coup regime from going even roguer, withdrawing from an Iraq still teetering on new sectarian conflict, avoiding a second downturn, closing Gitmo for good, ending the gay ban in the military ... well, you get the picture.
Change of this magnitude is extremely hard. That it is also frustrating, inadequate, compromised, flawed, and beset with bribes and trade-offs does not, in my mind, undermine it. Obama told us it would be like this - and it is. And those who backed him last year would do better, to my mind, if they appreciated the difficulty of this task and the diligence and civility that Obama has displayed in executing it.
Yes, we have. And yes, we still are the ones we've been waiting for - if we still care enough to swallow purism and pride and show up for the less emotionally satisfying grind of real, practical, incremental reform.

Arnold Stang, Actor, Dies at 91
By BRUCE WEBER NY TIMES
Arnold Stang, a character actor whose bespectacled, owlish face and nasal urban twang gave him a singular and recognizable persona, whether on radio or television, in the movies or in advertisements, or even in cartoons, died on Sunday in Newton, Mass. He was 91 and lived in Needham, Mass.
The cause was pneumonia, said his son, David.
Mr. Stang considered himself a dramatic actor who could play serious roles. But even he was aware that with his signature heavy glasses and a manner that could be eagerly solicitous, despondently whiny or dare-you-to-hit-me pugnacious, his forte was comedy.
Like Wally Cox, who was a friend, and Don Knotts, Mr. Stang was a natural for roles requiring a milquetoast, a pest or a nerd. At 5 foot 3 and never much more than 100 pounds, he once said of himself, “I look like a frightened chipmunk who’s been out in the rain too long.” And in a story he frequently told, after an auto accident in 1959 that left him needing extensive plastic surgery, he said to the doctor, “For God’s sake, don’t make me look pretty.”
His memorable moments as an actor were oddly varied signposts of popular culture. He was the spokesman for Chunky, the candy bar, in the 1950s, delivering the slogan: “Chunky! What a chunk o’ chocolate!”
In Otto Preminger’s 1955 film about drug addiction, “The Man With the Golden Arm,” he played Frank Sinatra’s pal Sparrow in a performance that is often cited as a precursor of Dustin Hoffman’s turn as Ratso Rizzo in “Midnight Cowboy.”
On “Top Cat,” the animated television series of the early 1960s, he was the voice of T. C., a k a Top Cat himself, the leader of a mischievous cat gang. (The character was based on Phil Silvers’s Sergeant Bilko.)
He was one of two gas station attendants (Marvin Kaplan was the other) who witness the destruction of their station by Jonathan Winters in the 1963 lunatic film comedy “It’s a Mad, Mad, Mad, Mad World.”
Most sources indicate that Mr. Stang was born in Chelsea, Mass., in 1925, but according to his family, though he had relatives in Chelsea, he was born in Manhattan on Sept. 28, 1918. His father was a lawyer until the 1929 stock market crash and earned a living afterward as a salesman.
The Chelsea story was one Mr. Stang perpetuated himself; he told interviewers that he got his first job in radio in 1934 at age 9 after he wrote to “Let’s Pretend,” a New York children’s radio show, and asked for an audition. Told he could audition when he was next in New York, he took the bus from Boston, alone, the following Saturday and was hired.
“We were married 60 years and I never managed to get him to correct that,” his wife, JoAnne Stang, said in an interview Monday.
The truth, Ms. Stang said, was that her husband grew up mostly in Brooklyn and graduated from New Utrecht High School. He wrote the note asking for an audition from Brooklyn, and he was older than 9.
He began his show business career as a teenager — his first radio appearances were on the shows “The Horn and Hardart Children’s Hour” and “Let’s Pretend” — and he went on to perform on dozens of radio programs in the 1930s and ’40s, including soap operas, mysteries and comedies, and was often called on to play more than one role.
He was probably best known at the time for “The Goldbergs,” the long-running family series set in Bronx on which he played the character Seymour Fingerhood, the teenage neighbor to the title family, and later as a sidekick to stars like Eddie Cantor, Jack Benny and especially Milton Berle.
Mr. Stang was a regular on “The Henry Morgan Show,” a showcase for Morgan’s astringent satire, often playing a complaining, goofball New Yorker named Gerard who traded banter and one-liners with the host. After Berle moved his radio show to television, Mr. Stang appeared from 1953 to 1955, bringing along his character, Francis, a pain-in-the-neck stagehand who bugged the star relentlessly.
In addition to his wife, whom he married in 1949 (Wally Cox, a skilled goldsmith, made their wedding rings, she said), and his son, who lives in Cambridge, Mass., Mr. Stang is survived by a daughter, Deborah Stang, of Brighton, Mass., and two granddaughters.
Mr. Stang landed on Broadway three times, the last being a revival of “The Front Page” in 1969. He was a regular on the 1960s comedy “Broadside,” a short-lived, distaff version of “McHale’s Navy,” and was a guest star on numerous series, including “Bonanza,” “Batman” and “The Cosby show.”
He was also the voice of many cartoon characters, including Nurtle the Turtle in the 1965 film “Pinocchio in Outer Space.” Other film credits include Otto Preminger’s 1968 gangster comedy “Skidoo,” with Jackie Gleason; “Hercules in New York” (1970), a comedy with Arnold Schwarzenegger; and “Dennis the Menace” (1993), with Walter Matthau.
“He loved the cartoons, and he liked doing commercials, too,” Ms. Stang said of her husband. “But most of all, he loved radio. It offered him such a span of roles.”

NY TIMES
When Does Death Start?
By DARSHAK SANGHAVI
Robin Beaulieu was telling me about her daughter’s bike accident. It was an event that would force Beaulieu not only to confront the death of her child but also to embrace a new way of dying. We were sitting last spring in the kitchen of her small apartment in Manchester, N.H. Beaulieu took a drag on a Marlboro, poured a cup of coffee and told me that her daughter, Amanda Panzini, had been a rambunctious, bighearted teenager. She loved animals, even “flea-ridden, mangy dogs,” Beaulieu said, and was a fiercely loyal friend. When confronted by the possibility of donating her brain-injured daughter’s organs after the accident, Beaulieu never doubted that Amanda would have wanted them to go to someone who needed them. But Amanda first had to be declared dead, and in her case, the only way that could happen was if her parents chose a precisely choreographed death — one conducted by medical personnel in a hospital procedure meant to allow Amanda to die while preserving her organs. From this, the doctors and Beaulieu hoped, would come new life.
The last time Beaulieu talked to her daughter was on the morning of June 21, 2008, a Saturday. Amanda attended an eighth-grade dance the night before; she told her mother that she had her first kiss there. After Beaulieu left for work at a nearby minimart, Amanda decided to ride her bike a few blocks to her friend Kate’s house. She didn’t take her helmet. At the crossing of Taylor and Young Streets, a Ford F-150 pickup truck slammed into Amanda and threw her into the street. When the paramedics arrived, Amanda wasn’t breathing. They inserted a tube into her windpipe and rushed her to Elliot Hospital nearby. Beaulieu received an emergency call at the minimart; the paramedics had identified Amanda by the name engraved on her iPod.
The rest of the afternoon passed in a harrowing blur. Beaulieu remembers a concerned doctor trying to prepare her to see Amanda. She remembers seeing her child’s swollen face in the emergency room and then being loaded with her onto a trauma helicopter for transport to Children’s Hospital in Boston. Though the lighted monitors showed stable vital signs, Beaulieu sensed, as she hovered in the sky, that her child had died. Doctors in Boston performed emergency neurosurgery to decompress her skull, but it was not successful. Amanda was then admitted to an intensive-care unit and put on life support. Monica Kleinman, the clinical director of the unit, examined Amanda the next morning. The girl’s cerebral cortex — the part of the brain where desires, fears and hopes are created — was irreversibly damaged. In her 20 years of practice (I worked with her as a pediatrics resident years ago), Kleinman has treated dozens of similar injuries. Few of these patients ever left the hospital; those who did were in vegetative or otherwise neurologically devastated states.
Beaulieu, Kleinman recalls, digested the news and “immediately got it.” Amanda was never coming back. Beaulieu decided to take her off the ventilator and asked to donate her daughter’s organs. But there was an obstacle. When Kleinman examined Amanda, she noticed that some primitive and reflexive neurons of the brainstem were still working. Amanda gagged a bit when the back of her throat was tickled, and one of her pupils budged slightly when a flashlight was shined on it. The significance of this information was immediately apparent to Kleinman: Amanda was not brain-dead.
Organ transplantation must abide by the so-called dead-donor rule: a person has to be declared dead before any vital organs can be removed. Yet organs have to be alive if there is any hope of successful transfer to a recipient. Medical professionals have handled this paradoxical situation — finding a dead body with live organs — by fashioning a category of people with beating hearts who are said to be brain-dead, usually after a traumatic head injury, and who are considered just as dead as if they had rigor mortis.
To diagnose brain death, doctors typically go through a checklist of about a dozen items, including assessing reflexes like blinking, coughing and breathing, which are all controlled by the brainstem. The criteria are extremely strict, and only a tiny fraction of severely brain-injured people meet them. Kleinman realized that Amanda, despite her severe brain damage, was not one of them. There was, Kleinman told Beaulieu, another option — one that was still controversial and had never been pursued successfully at Children’s Hospital. The procedure was called donation after cardiac death, or D.C.D., and it would exploit the other way the law defines death: as the “irreversible cessation” of the heartbeat.
D.C.D. requires doctors to confront the shadowy question of exactly when somebody dies after the heart stops. To authorize D.C.D., doctors must follow a strict procedure. Amanda would be taken, technically alive, to an operating room, where her breathing tube would be removed. If her breathing ceased naturally and her heart stopped quickly (within an hour), she would be moved to an adjacent operating room and Kleinman would count off precisely five minutes, during which time Amanda would be prepped for surgery with antiseptics and surgical drapes, while Kleinman carefully watched for signs of a returning heartbeat. If there were none, Amanda would be declared legally dead; the stoppage would then be considered “irreversible.” Before her organs were seriously damaged by the lack of oxygen (every minute counts), the surgeons would rapidly open Amanda’s torso and remove them for transplant.
There was a chance none of this would work. If the comatose girl didn’t stop breathing in the operating room, she would be returned to the intensive-care unit, though not put back on life support. Once taken off the ventilator Amanda would most likely die, but it might take hours or days, during which time her organs would deteriorate and would be unfit for transplantation.
Four days after Amanda’s accident, Beaulieu and Amanda’s father, Dan Panzini, sat in a darkened operating room and said their goodbyes as Amanda was disconnected from her ventilator. To Beaulieu’s relief, she didn’t breathe on her own, and her heart gradually slowed. “Amanda’s heart has stopped,” Kleinman soon said. Amanda’s heart never started again, and the surgeons took her liver, kidneys and pancreas.
In procuring organs from patients like Amanda, doctors have created a new class of potential organ donors who are not dead but dying. By arbitrarily drawing a line between death and life — five minutes after the heart stops — they have raised difficult ethical questions. Are they merely acknowledging death or hastening it in their zeal to save others’ lives?
With modern technology like respirators and tube feedings with synthetic formulas, Beaulieu might have kept her unconscious, brain-damaged child alive indefinitely. But as she sipped coffee in her apartment from a mug reading “#1 Mom,” Beaulieu told me that if Amanda had lived, she could “never bike, rollerblade or go out with friends, and she’d never want that.” If people with no hope for meaningful recovery can be kept alive artificially, shouldn’t they also be permitted to die artificially?
Since the inception of organ transplantation a half-century ago, defining death has taken on both medical and ethical urgency. Before Joseph Murray performed the world’s first successful kidney transplant in 1954 and showed that organs could be put to productive use outside their original host, doctors waited until the deceased was blue and stiff to declare death. Identifying a precise moment of death was a diversion for eccentric researchers like Duncan MacDougall, who, in the early 1900s, placed dying patients on a scale in order to determine when death occurred: the moment they lost three-quarters of an ounce, the presumed weight of the soul.
The paradox of needing a dead donor with a live body was first addressed in 1968. Henry Beecher, a Harvard anesthesiologist and medical ethicist, convened a 13-member committee to write a definition of “irreversible coma,” or brain death, for The Journal of the American Medical Association. Not everyone accepted the four-page report’s conclusions. After Norman Shumway, a Stanford University surgeon, performed the first American heart transplant from a brain-dead donor, he was threatened with prosecution by the Santa Clara County coroner. As a result of the widespread disagreement over the meaning of “brain death,” President Jimmy Carter asked a blue-ribbon commission to examine the issue. The commission culminated in the Uniform Determination of Death Act in 1981, which defined death as “irreversible cessation of all functions of the entire brain, including the brainstem.” The procedure to diagnose brain death, however, was never codified into law, and as a result, it varies from hospital to hospital. In 1987, the nation’s pediatrics authorities tried to standardize the diagnosis, listing 14 different criteria to confirm brain death, like the absence of reflexes, and requiring, under certain conditions, additional X-rays and tests for brain-wave activity. Last year, in the journal Pediatrics, researchers from Loma Linda University reported that of 277 brain-dead children in California who were referred to the regional organ bank over many years, only a single child received the full set of diagnostic tests.
In 2008, a young Oklahoman named Zack Dunlap was declared brain-dead after an all-terrain-vehicle accident and was considered for organ donation. Then, suddenly, he recovered. He later appeared on NBC’s “Today” show. The precise medical details of the case are not public, but it is possible that a diagnostic error was made because a checklist was not followed. Dr. Wiley Hall, the director of neurocritical care at the University of Massachusetts Medical School, where I am the chief of pediatric cardiology, told me about a similar case last year in Massachusetts; it turned out that a brain scan had been performed improperly.
Such sloppiness is potentially tragic, but it is also exceedingly rare. Whether or not a checklist is followed, by the time a neurologist is consulted to assess a critically ill patient for brain death, the odds of recovery are already minuscule. Doctors see that these patients have begun dying, and the uncertainty is not about whether it will happen but when. The families of dying patients often realize this, too, and ask to donate their relative’s organs. Dr. Robert Truog, a professor of medical ethics at Harvard Medical School, says he believes this is a situation where “all the ethical vectors are lined up,” since the patient’s family, the doctors and the recipient’s family all want to proceed with organ donation. The holdup is that the patient is not legally dead.
The current shortage of organs gives urgency to any new avenue for donation. The United Network for Organ Sharing, a nonprofit, coordinates the nation’s system of organ transplantation. Its Web site maintains a continuously updated count of people waiting for transplants. As of early this month, 105,172 men, women and children were in line. On an average day, the organization estimates, 18 people on the list die because they don’t receive an organ in time. Despite widespread campaigns to encourage donation, availability has changed only modestly over the past decade — last year there were fewer than 8,000 deceased donors — while waiting lists have doubled in size.
The small number isn’t because of refusal — to give one example, 85 percent of eligible brain-dead patients’ families in central Massachusetts chose to donate last year — but because of the rarity of brain death. According to Kevin O’Connor, a senior vice president at the New England Organ Bank, improved public-safety laws — automobile safety belts, bicycle helmets — along with fewer violent crimes, have meant there simply aren’t many people showing up in hospitals with severe head injuries and otherwise healthy bodies. At the University of Massachusetts, 238 people were on a transplant waiting list last year, yet our medical center, a leading source of donated organs in the state, recorded only 19 deceased donors.
A lack of organs because of better safety and lives saved is, unquestionably, a good thing. But it means that transplant doctors and patients are forced to think beyond brain-dead donors. The 1981 Uniform Determination of Death Act also defines death as the “irreversible cessation of circulatory and respiratory functions,” which left an opening for another source of donors. In 1997, the federal government asked the Institute of Medicine, an independent advisory body, to gather experts to determine how a dying donor might be treated. The experts ended up endorsing the procedure for donation after cardiac death, in which death occurs through a process of withdrawing life support and allowing the heart to develop “irreversible cessation.”
There were two crucial conditions. First, families could not be pressured to stop life support; they had to come to the decision on their own, in consultation with their relative’s doctor. No member of the organ-procurement team could participate in the family’s decision or declare death. Second, “irreversible cessation” of cardiac function meant that at least five minutes had to pass without a heartbeat. That interval was arbitrary — the panel of experts made no reference to supporting research — and they admitted that “this recommendation is only an expert judgment.”
The Institute of Medicine created a new class of potential organ donors: living patients with little hope of recovery who could be declared dead soon after life-support removal. Within a decade, the number of such donors increased tenfold; they now account for 8 percent of organ transplants nationwide, up to 20 percent in certain areas. Still, many hospitals were slow to adopt the practice.
The case of Children’s Hospital in Boston is instructive. In 2005, Children’s convened a 17-member task force of doctors, lawyers and health care professionals to explore the ethics of allowing D.C.D. After two years of regular meetings, the group was unable to reach a consensus. “The more we talked about it, the more polarized we became,” recalls Dr. Peter Laussen, a committee co-chairman. Supporters of D.C.D. argued that the practice was legal and compatible with families’ wishes. Those opposed worried that caregivers would see critically ill patients merely as organ donors, and their end-of-life care could be compromised.
At a certain point in the committee’s debate, members were asked to mark where they stood on D.C.D. on a continuum, with one end signifying “totally disagree” and the other “totally agree.” The participants almost uniformly chose one extreme or the other. There was no middle ground. And then a few days before Christmas in 2007, an 8-year-old girl named Jaiden Tlapa ended up in the Children’s Hospital intensive-care unit.
The snow was coming down quickly in Milford, N.H., and school had been canceled. Holleigh Tlapa baked cookies for her three children, and then they decided to play outside. There was a path to the yard, and Holleigh got out the snowblower to clear it.
I visited Tlapa last April. As she started telling me what happened that day, her voice cracked. She got a box of tissues and continued talking. She had started the snowblower and the powder began flying. Then — she doesn’t know exactly what happened — Jaiden somehow lost her footing and fell into the path of the blower. Instantly, Jaiden was pulled into the powerful machine, and the strings from her hood tangled tightly around her neck. Tlapa couldn’t free her daughter no matter how she struggled and pulled. Frantic, she called 911. It seemed like an eternity before the paramedics arrived. It took them several minutes to cut Jaiden free. Placed on a respirator, the comatose child was later taken by ambulance to Children’s Hospital in Boston.
For a moment on Christmas Eve, Jaiden opened her eyes, but her parents recall that they were “vacant.” She never opened them again. The weeks rolled by. Repeated brain scans showed severe brain shrinkage. Despite her devastating cortical injury, however, Jaiden had a few primitive brainstem reflexes that kept her from being classified as brain-dead. “She looked normal, so you would assume consciousness, but that was misleading,” Tlapa told me.
Over time Holleigh Tlapa and her husband, Paul, realized Jaiden wouldn’t get better, and they asked about organ donation. Because she wasn’t brain-dead, D.C.D. was the only option. Although the task force at Children’s disagreed about D.C.D., the hospital drafted a protocol. The Tlapas were told about the disagreement, but they chose to proceed. On Jan. 13, 2008, a dying but not dead organ donor was brought to the operating room and prepped for withdrawal of support for the first time in the hospital’s history. Holleigh and Paul lay in their daughter’s bed and played Jaiden’s favorite Miley Cyrus song as the breathing tube was removed. They held their daughter and waited.
There’s something remarkable about such families. I’ve known hundreds of parents whose children are stricken by terrible diseases. For many, the gravity of the situation is so overwhelming that they withdraw into themselves, letting no emotion escape, and then suddenly explode into a supernova of blame and anger. But there are others on whom this terrible pressure exerts a metamorphic power that turns some of their sadness into a compassion that is strong and diamond-brilliant.
Though her gasps were irregular, Jaiden didn’t stop breathing entirely. After an hour her heart hadn’t stopped, and, in this situation, the hospital protocol called for the patient to be returned to the intensive-care unit. The chance to donate her organs was over. Jaiden continued to take shallow breaths into the next morning, and then her heart finally stopped. She was legally dead. “It was so hurtful that she died so soon after,” Tlapa said, disappointed that Jaiden’s organs died with her. Still, she finds solace in knowing that Jaiden at least helped change some attitudes among skeptics and paved the way for the first successful D.C.D. procedure at Children’s Hospital — the one involving Amanda Panzini. (Holleigh also founded a charity to help families facing similar decisions.)
Paul has some difficulty understanding why, if Jaiden was going to die anyway, she could not have been put under general anesthesia, undergone surgery to donate her organs, and then been declared dead. Removing the breathing tube to attempt D.C.D. had the same effect, only it took much longer and Jaiden breathed irregularly for many hours, which seemed to Paul more distressing. “If it was all up to me,” he explained, “I would have said, ‘Take her organs.’ ”
As Gary Greenberg wrote in The New Yorker, donating organs in such a manner, deliberately and with anesthesia, could simply be “a particular way to finish our dying, at the hands of a surgeon, after some uncertain border has been crossed.” But Francis Delmonico, a professor of surgery at Harvard Medical School and a national leader in organ transplantation, fervently defends the need to establish death before removing organs. “I understand a family’s anguish and inability to have consolation when a child doesn’t die after removal of life support,” he explains, “but I don’t see this as a patients’-rights issue. It’s a matter of public trust in the system.”
Donation after cardiac death already arouses suspicion. Just as transplant surgeons like Norman Shumway were once harassed for procuring organs from brain-dead donors, a California-based surgeon, Hootan Roozrokh, was tried for dependent-adult abuse, a felony, after participating in an attempted D.C.D. A nurse who objected to the proceedings later registered a complaint about how painkillers were administered to the patient. Prosecutors charged him with trying to hasten the patient’s death. Though none of this held up in court — Roozrokh was acquitted last year — the trial left many transplant surgeons shaken. Just think of the outcry, Delmonico cautions, if families and doctors also decided it was acceptable to euthanize patients to procure their organs. “You would destroy organ donation in this country,” he said.
Delmonico certainly has a point about the importance of maintaining the public’s trust, but it’s hard to witness an actual D.C.D. procedure without conceding that the process of declaring death in any setting is inherently arbitrary. I saw this myself when I was permitted to observe a D.C.D. procedure at the University of Massachusetts hospital. The patient was a middle-aged woman with no close family ties who had been committed years before to a psychiatric hospital. Found unconscious after choking on French toast, she received CPR and came to the UMass intensive-care unit. She remained comatose with severe brain injury for days but was not brain-dead. Following hospital regulations, the doctors reported an “impending death” to the New England Organ Bank, which agreed she would be a suitable donor. (These reports are mandatory, on the theory that they ensure no donation opportunities are missed.) Faced with the grave prognosis from the woman’s doctors, her state-appointed guardian consented to donation after cardiac death.
The woman was wheeled to the step-down unit next to the operating rooms, prepped for surgery and covered with sterile sheets. With a medical student, a representative from the organ bank and me looking on, a nurse practitioner from the intensive-care unit supervised the removal of the breathing tube at 9:16 p.m. The patient didn’t breathe. We gazed intently at the portable monitor at the foot of her bed, which showed her heart’s electrical rhythm, oxygen level and blood pressure. By 9:18, her oxygen level fell from 95 percent to 60 percent. By 9:21, the oxygen level fell further to 22 percent, but her heart rate stayed normal at 74 beats per minute. At 9:25, her blood pressure dipped a little, her oxygen level was zero — which meant her blood was becoming acidic and possibly harming her organs — but her heart rate was still 62 beats per minute.
Watching someone die, observing her heart struggle and ultimately fail over the course of a half-hour, brought home how death occurs in its own way, at its own idiosyncratic pace. There is no escaping the tragedy of the moment. I thought about Jaiden and Amanda, and their stories together with this woman’s seemed an endless loop of sorrow.
At 9:32, the woman’s heart still beat 60 times per minute, though she was blue and unresponsive. At 9:38 her heart rate was 20, and then she flat-lined. Immediately, a stopwatch was started to count the five minutes before death could be declared.
The woman was wheeled to the operating room, where the surgeons were assembled. Three minutes passed without any heartbeat, and then four, then four and a half. There was silence. It was the nurse practitioner’s sole responsibility to declare death without any interference from the transplant surgeon. Suddenly, there was a single blip on the heart monitor. The blip was almost certainly an artifact of some outside electrical interference and not a true heartbeat, but it was hard to tell for sure. Five minutes had passed, and every delay meant the organs were more starved for oxygen.
The nurse practitioner hesitated as she considered whether to call the death or restart the five-minute count, and then she made her decision. She looked at her watch and called out, “Time of death was 21:44.” A flurry of activity began as the surgeons called for their instruments and the operating room sprang to life. There was no anesthesiologist at the head of the bed, so I stood there as the team prepared to make the incision. Suddenly, Dr. Adel Bozorgzadeh, the attending transplant surgeon, raised his hands. “Let us take a moment of silence and consider the gift that is being given on this day,” he said. A few seconds passed. Then he brought the knife down.
Like Amanda Panzini, the teenager hit by the truck, the patient I observed bequeathed several abdominal organs, but not her heart. Although the liver and kidneys are relatively hardy and can withstand the five minutes of oxygen starvation before removal, the wait seriously damages the more delicate heart and renders it unusable. Heart transplants thus call only for brain-dead donors, whose hearts are still beating until just moments before they’re removed.
This, it was thought, was the only way to get a viable heart. But a pediatric cardiologist named Mark Boucek at Denver Children’s Hospital was growing tired of watching young children with incurable heart defects die. In 2004, financed by a federal grant, Boucek wrote a far more aggressive D.C.D. protocol that would save the heart, which was adopted after going through the hospital’s review process. His version had two key innovations. First, large intravenous lines would be placed in the donor’s groin before death, to enable the donor’s entire blood volume to be replaced with a refrigerated salt preservative when it was time to remove the heart. Second, and most controversially, Boucek, who has since died from pancreatic cancer, rejected the five-minute rule imposed by the Institute of Medicine and initially picked three minutes instead; after all, no law had codified a particular time period. But David Campbell, the pediatric cardiac surgeon at Denver who procured the first heart using the protocol, realized that even three minutes was too long. “When we opened the chest and pericardium, the heart was distended and blue,” he told me. Upon transfer to the recipient, the heart failed to work well initially and required the child to remain on a dangerous heart-lung bypass machine for several days. “That’s why I asked that we move the time down lower,” Campbell said. In reviewing the medical literature, Boucek found the longest recorded time that a heart had ever stopped and then spontaneously restarted without medical intervention was 65 seconds. If the law required “irreversible” cessation of heart function, Boucek concluded, there was no reason to wait much longer than that.
Waiting just over a minute after cardiac arrest to declare death was unprecedented. Last year, when the Denver specialists published their provocative case reports in The New England Journal of Medicine, many observers assailed their work and called it a back-door method of performing euthanasia. Robert Veatch, a professor of medical ethics at Georgetown University, calls the Denver doctors “lone wolves,” and he categorically rejects heart transplantation using D.C.D. because he maintains that a donor heart cannot have “irreversible” cessation. After all, it works fine after it’s transplanted. Veatch is especially concerned about a potential public outrcry against organ donation. “I spent all morning today dealing with conservative right-to-life scholars all worked up about stem cells,” he told me recently, adding that he could only imagine their reaction to taking hearts from “helpless little babies.”
The first baby whose heart was donated under the much-shortened wait period was a newborn girl named Addison Grooms in 2007. Her parents, David and Jill Grooms, have no tolerance for Veatch’s viewpoint. Addison’s brain was severely damaged in a complication from delivery. “There was no chance at all that our daughter was going to survive,” says David, whose brother died of a malformed heart as a baby. “I can follow the ethicist’s argument, but it seems totally ludicrous.” Had the couple found out another child died because they weren’t allowed to donate Addison’s heart, it would be “like another slap in our faces.” Further, both parents would have permitted simply taking out Addison’s heart under complete general anesthesia — without the intermediate process of the choreographed death — which would have been a painless way to end their child’s life, had it been legal.
Three months after Addison’s death, a neuroscientist named Lori Driscoll gave birth to a son, Liam, with a catastrophic injury similar to Addison’s, and he was also transferred to Denver Children’s. Testing showed that almost every part of Liam’s brain was destroyed, though some primitive reflexes remained. Lori and her husband consented to Boucek’s novel protocol. They accompanied Liam to the operating room, where the breathing tube was removed. They held his hand for 10 minutes until his heart stopped.
Moving past a binary concept of life and death is, for most of us, an uncomfortable process. It’s worth considering how various cultures think about the beginning of life. Tibetan monks believe a new life begins around the time of a mating couple’s orgasm; many Catholics posit that it starts at the union of an egg and sperm; Roe v. Wade effectively established a legal threshold of life at 24 weeks of fetal gestation; some consider meaningful life to begin at birth; the Navajo think a baby is fully human when it laughs for the first time. If the emergence of life occurs on a continuum, perhaps the same is true of life’s recession.
Still, preserving the notion that the transition from life to death can be clearly defined may be a fundamentally necessary fiction. Though no religious organizations or right-to-life groups have yet mounted any opposition to D.C.D., including the Denver protocol, it is important to change practices in deliberate steps that give decision makers clear rules of action and establish gradual consensus.
Lori Driscoll, for one, is grateful for the changes Boucek made to the D.C.D. protocol. After her baby Liam died, she was told that a 3-month-old girl received his heart. That infant was prepped for surgery for her new heart in the room adjacent to the one where Liam died. The surgery went well. Months later, Driscoll learned that recipient was a girl with the uncommon first name Annika. She did some sleuthing and found Annika’s mother’s MySpace page. The women exchanged photos, arranging to meet last year. Driscoll fantasized about running up to Annika, holding her close and placing her ear over the toddler’s chest to again hear her son’s steady heartbeat and feel his presence. But something unexpected happened when she met the girl. “It was the most amazing thing to see her thriving,” she said, and her initial emotional rush “had nothing to do with Liam.” For a moment, the weight of the past was forgotten as Driscoll marveled at the healthy little person before her.
Darshak Sanghavi, the chief of pediatric cardiology at the University of Massachusetts Medical School, is Slate’s health care columnist and the author of “A Map of the Child: A Pediatrician’s Tour of the Body.”