President Obama's announcement last month that earlier this year a “U.S. counterterrorism operation” had killed two hostages, including an American citizen, has become a fresh occasion for questioning the rationales for continuing attacks from unmanned aerial vehicles aimed at presumed, suspected, or even confirmed terrorists. This questioning is desirable, although not mainly for hostage-related reasons connected to this incident. Sometimes an incident has a sufficient element of controversy to stoke debate even though what most needs to be debated is not an issue specific to the incident itself. More fundamental issues about the entire drone program need more attention than they are getting.

The plight of hostages held by terrorists has a long and sometimes tragic history, almost all of which has had nothing to do with drones. Hostage-taking has been an attractive terrorist tool for so long partly because of the inherent advantages that the hostage-holders always will have over counterterrorist forces. Those advantages include not only the ability to conceal the location of hostages—evidently a successful concealment in the case of the hostages mentioned in the president's announcement—but also the ability of terrorists to kill the hostages themselves and to do so quickly enough to make any rescue operation extraordinarily difficult. Even states highly skilled at such operations, most notably Israel, have for this reason suffered failed rescue attempts.

It is not obvious what the net effect of operations with armed drones is likely to be on the fate of other current or future hostages. The incident in Pakistan demonstrates one of the direct negative possibilities. Possibly an offsetting consideration is that fearing aerial attack and being kept on the run may make, for some terrorists, the taking of hostages less attractive and the management of their custody more difficult. But a hostage known to be in the same location as a terrorist may have the attraction to the latter of serving as a human shield.

The drone program overall has had both pluses and minuses, as anyone who is either a confirmed supporter or opponent of the program should admit. There is no question that a significant number of certified bad guys have been removed as a direct and immediate consequence of the attacks. But offsetting, and probably more than offsetting, that result are the anger and resentment from collateral casualties and damage and the stimulus to radicalization that the anger and resentment provide. There is a good chance that the aerial strikes have created more new terrorists bent on exacting revenge on the United States than the number of old terrorists the strikes have killed.

This possibility is all the more disturbing in light of what appears to be a significant discrepancy between the official U.S. posture regarding collateral casualties and the picture that comes from nonofficial sources of reporting and expertise. The public is at a disadvantage in trying to judge this subject and to assess who is right and who is wrong, but what has been pointed out by respected specialists such as Micah Zenko is enough to raise serious doubt about official versions both of the efforts made to avoid casualties among innocents and of how many innocents have become victims of the strikes.

The geographic areas in which the drone strikes are most feasible and most common are not necessarily the same places from which future terrorist attacks against the United States are most likely to originate. The core Al-Qaeda group, which has been the primary target and concern in northwest Pakistan, is but a shadow of its former self and not the threat it once was. Defenders of the drone strikes are entitled to claim that this development is in large part due to the strikes. But that leaves the question: why keep doing it now?

The principal explanation, as recognized in the relevant government circles, for the drone program has been that it is the only way to reach terrorists who cannot be reached by other tools or methods. It has been seen as the only counterterrorist game that could be played in some places. That still leaves more fundamental questions about the motivations for playing the game.

Policy-makers do not use a counterterrorist tool just because the tool is nifty—although that may be a contributing factor regarding the drones—but rather because they feel obligated to use every available tool to strike at terrorists as long as there are any terrorists against whom to strike. In the back of their minds is the thought of the next Big One, or maybe even a not so big terrorist attack on U.S. soil, occurring on their watch after not having done everything they could to prevent it, or doing what would later be seen in hindsight as having had the chance to prevent it.

The principal driver of such thoughts is the American public's zero tolerance attitude toward terrorism, in which every terrorist attack is seen as a preventable tragedy that should have been prevented, without fully factoring in the costs and risks of prevention or of attempted prevention. Presidents and the people who work for them will continue to fire missiles from drones and to do some other risky, costly, or even counterproductive things in the cause of counterterrorism because of the prospect of getting politically pilloried for not being seen to make the maximum effort on behalf of that cause.

This piece was originally published by The National Interest.

Editor's Note: This piece originally appeared in Foreign Policy.

The killing of Nasir al-Wuhayshi, reportedly via U.S. drone strike, is not just another notch in the belt of America’s long campaign against al-Qaida and its allies. Wuhayshi was one of al-Qaida’s top remaining leaders, and he is the highest-level death the organization has suffered since Osama bin Laden was killed in 2011. Wuhayshi headed al-Qaida’s most active affiliate, the Yemen-based al-Qaida in the Arabian Peninsula (AQAP), and was the designated successor of al-Qaida leader Ayman al-Zawahiri. His killing adds one more element of uncertainty to the turbulence in Yemen and may set AQAP on a new path. Which path, however, remains an open question.

Wuhayshi helped transform AQAP from a fractious organization on the edge of defeat to one that menaces both Yemen and the United States. A decade ago, Yemen’s jihadi movement seemed near defeat. In the aftermath of 9/11, the Yemeni government rounded up jihadis and imprisoned Wuhayshi, and it was Saudi Arabia, not Yemen, that was the focus of jihadis in the Arabian Peninsula. In 2003, al-Qaida sponsored the original AQAP’s uprising against the Saudi government. Several years later, most of AQAP’s Saudi members were dead or in jail, and its remnants had fled to Yemen. There, they mixed with Yemeni jihadis, including important figures like Wuhayshi, who had escaped from Yemen’s jails in 2006. In 2009, two regional Islamist groups merged and formally anointed themselves AQAP, basing their operations in Yemen and trying to unseat the government. As Osama bin Laden’s former secretary, Wuhayshi became the group’s leader and embraced al-Qaida’s emphasis on attacking Western targets.

The group made fitful progress, at times taking territory but often losing it quickly after alienating locals and proving vulnerable to government counterattacks. But when the government of Yemeni President Ali Abdullah Saleh fell in 2012 during the Arab Spring, AQAP tried to step into the void. Saleh’s successor, Abed Rabbo Mansour Hadi, pursued AQAP vigorously, but his weak government was unable to score any lasting successes.

In addition to its prowess in Yemen, AQAP has long been al-Qaida’s most active affiliate when it comes to taking on the West. The organization was behind the 2009 Christmas Day attempt to down a U.S. airliner over Detroit, a near-miss only foiled by the bomber’s incompetence and the quick thinking of the plane’s passengers. AQAP tried again in 2010, this time attempting to down U.S. cargo planes. The organization also attacked Western targets in Yemen, and puts out Inspire, a stylish English-language online publication that is one of al-Qaida’s more effective attempts to influence Western jihadis.

These AQAP efforts to attack the United States and the West, in general, led to a greater U.S. focus on Yemen and more drone attacks there. In 2011, the United States killed Anwar al-Awlaki, a U.S. citizen and AQAP member who helped lead the terrorist group’s campaign against targets in the United States and Europe. Awlaki has continued to inspire terrorists after his death, with Boston Marathon plotters downloading his sermons before their attack. Awlaki also inspired the Fort Hood shooter in 2009 and the attacks on the Charlie Hebdo office in 2015.

Wuhayshi’s death, however, comes as Yemen is falling apart. Earlier this year, Hadi’s government fell to the Houthi rebels, Yemeni Shiites who oppose both Yemen’s traditional order and the Sunni fanatics of AQAP who see Shiites as apostates. Alarmed by Houthi ties to Iran, Saudi Arabia has led an intervention in Yemen on Hadi’s behalf, bombing the Houthis and trying to reverse their gains. AQAP seems to be flourishing amid the chaos, as its enemies turn on one another.

But with Wuhayshi’s death, AQAP may find it difficult to further exploit the Yemeni civil war. Personal connections, reputation, and charisma play a bigger role in leadership in the jihadi cause than do formal rank, and it is not clear if Qasim al-Raimi, the designated new leader, can retain the support of the AQAP rank and file. There is always a chance, of course, that Raimi proves an even more effective leader than Wuhayshi, and some observers see him as “more dangerous and aggressive.” (Lest we forget: In 1992, the Israelis killed Hezbollah’s Secretary-General Abbas al-Musawi, one of the group’s most competent leaders. Musawi was replaced by Hassan Nasrallah, who has proven one of the most effective terrorist and guerrilla leaders in modern times.)

The bad news is that Raimi and AQAP may seek revenge, both out of genuine anger and to score points within the jihadi community. Al-Qaida’s chief bomb-maker, Ibrahim al-Asiri, may still be out there and has likely passed his sophisticated techniques on to others in Yemen.

The bad news is that Raimi and AQAP may seek revenge, both out of genuine anger and to score points within the jihadi community.

Over time, however, Wuhayshi’s death may push AQAP to focus even more on Yemen and less on the West. His close, personal ties to the al-Qaidacore may have been part of why AQAP was a steadfast ally of Zawahiri in his power struggle with the Islamic State. The opportunities and risks in the civil war are both tempting and frightening for AQAP. On the one hand, by taking up arms against the hated Shiites, AQAP can position itself as the defender of Yemen’s Sunnis, a strategy that has worked well for the Islamic State in Iraq and Syria. AQAP might gain more recruits and local support, while drawing foreign fighters and money from Sunnis eager to find yet another Shiite-Iran axis to oppose. Not surprisingly, AQAP has stepped up its operations against the Houthis in recent months.

AQAP also has an opportunity to govern. And the bad news for the West is that it has learned from its own many mistakes on this front. In the past when AQAP made gains, it tried to impose a strict version of Islamic law that alienated local communities. Now when its fighters seize territory, theywork with local tribal figures and other elites, avoiding the most controversial measures and trying to portray themselves as guardians, not overlords.

Wuhayshi’s death also comes at a time when the broader jihadi movement is split between backers of al-Qaida and supporters of the Islamic State, a struggle in which AQAP has long played an important role. As al-Qaida’s most active anti-Western affiliate, AQAP was important to Zawahiri’s claim that he was leading the struggle against the United States. Its strength in Yemen, moreover, also expanded al-Qaida’s presence and prestige to an important part of the Arab world. Islamic State supporters have already conducted attacks in Yemen, and the death of Wuhayshi offers them a chance to expand their influence there. The core leadership of AQAP is not likely to join the Islamic State, but some of its cells and supporters could break off if Raimi proves a weak leader.

For now, Wuhayshi’s death means the United States has another point in the struggle against the jihadi movement. In the long term, successful disruption is more likely if the United States and its allies can keep the pressure on AQAP, forcing its leaders to go on the run and hindering their ability to communicate — particularly difficult challenges for a group in transition under new leadership. Wuhayshi’s death also comes on the heels of the deaths of several other AQAP members, including its top ideologue and spokesman. Having to hide also makes it difficult for the group to govern, as its exposed leaders run the risk of being killed. But AQAP has lost many leaders before, yet remains a force to be reckoned with. So at best, this should be seen as winning a battle, not the war.

Last June, Brookings senior fellow Elaine Kamarck and I published a paper laying out the rise of short-term thinking in U.S. corporations. We argued that this trend was bad for the economy, and we suggested policies that would at least slow it down and diminish its effects.

Since then, additional research on short-termism has emerged, and an increasing number of corporate leaders are expressing concern about the trajectory of U.S. firms. Last November, for example, the Boston Consulting Group documented a worrisome decline in the corporate activities and investments designed to discover and nurture future growth opportunities. This turn away from exploratory activities may not immediately affect investors, said the BCG report: in the short term, companies can maintain earnings and shareholder returns by “cutting costs, increasing dividends, and pursuing share buybacks.” (As Kamarck and I showed, this is what is happening across our economy.) But in the long run, BCG researchers found, firms that invest in exploration boost revenues and total returns far faster than do those who are content to exploit their existing lines of business and return most of their earnings to shareholders in the form of dividends and buybacks.

A few days ago, Laurence Fink, the chief executive of the world’s largest investment fund and a long-time foe of short-termism, sent a letter to the heads of S & P 500 companies and large European corporations. He noted that in the twelve months ending September 30 2015, buybacks had risen by 27 percent over the previous year, when buybacks already stood at record levels. “Today’s culture of quarterly earning hysteria,” he declared, is “totally contrary to the long-term approach we need.” And he warned corporate executives that in the absence of well-considered long-term plans for investment and growth, they would expose their firms “to the pressures on investors focused on maximizing near-term profit at the expense of long-term value.”

Many influential investors agree with Fink, and they are joining forces. On February 1, the Financial Times reported that since last summer, the world’s largest asset managers—Warren Buffett, Jamie Dimon, the chief executive of JPMorgan Chase, and the heads of BlackRock, Fidelity, Vanguard, and Capital Group, among others—have been holding secret meetings to frame proposals that would encourage longer-term investments while reducing friction with shareholders. These proposals, which are reportedly some months away from final agreement and publication, may well involve changes in boards of directors, executive compensation, and shareholder rights.

The summit participants plan to support these changes for the companies in which they invest. Given the pools of funds they control, which amount to many trillions of dollars, their coordinated action may well represent a turning-point in the struggle to reorient corporate strategy toward the long term.

Indian Prime Minister Narendra Modi’s recent visit to the United Arab Emirates revealed New Delhi’s intention to bolster bilateral relations with the Gulf states. It was the first visit by an Indian prime minister in over 30 years, demonstrating the country’s renewed focus on expanding ties with the region it has always called “West Asia.” Although India and the Middle East share a long history of trade, immigration and cultural exchange, relations have yet to reach their full potential.

Read "Dealing with Delhi: How culture shapes India’s Middle East policy"

In this policy briefing, Kadira Pethiyagoda highlights the importance of an under-reported aspect of the relationship – culture. The author explains the role it plays in India’s policies toward the region, particularly under the current government, and argues that Gulf states need to understand the impact of Indian values and identity. Pethiyagoda provides recommendations on how the Gulf states can, through better understanding the cultural drivers of Indian foreign policy, build stronger ties with India, thereby advancing both economic and strategic interests.

Downloads

• English PDF
• Arabic PDF

How has the Joint Comprehensive Plan of Action (JCPOA)—signed between the P5+1 and Iran one year ago—played out in practice? Several Brookings scholars, many of whom participated prominently in debates last year surrounding official congressional review, offered their views.

I had been mulling a rebuttal to my colleague and friend Jon Rauch’s interesting—but wrong—new Brookings paper praising the role of “hacks, machines, big money, and back room deals” in democracy. I thought the indictments of Chris Christie’s associates last week provided a perfect example of the dangers of all of that, and so of why Jon was incorrect. But in yesterday’s L.A. Times, he beat me to it, himself defending the political morality (if not the efficacy) of their actions, and in the process delivering a knockout blow to his own position.

Bridgegate is a perfect example of why we need fewer "hacks, machines, big money, and back room deals" in our politics, not more. There is no justification whatsoever for government officials abusing their powers, stopping emergency vehicles and risking lives, making kids late for school and parents late for their jobs to retaliate against a mayor who withholds an election endorsement. We vote in our democracy to make government work, not break. We expect that officials will serve the public, not their personal interests. This conduct weakens our democracy, not strengthens it.

It is also incorrect that, as Jon suggests, reformers and transparency advocates are, in part, to blame for the gridlock that sometimes afflicts our American government at every level. As my co-authors and I demonstrated at some length in our recent Brookings paper, “Why Critics of Transparency Are Wrong,” and in our follow-up Op-Ed in the Washington Post, reform and transparency efforts are no more responsible for the current dysfunction in our democracy than they were for the gridlock in Fort Lee. Indeed, in both cases, “hacks, machines, big money, and back room deals” are a major cause of the dysfunction. The vicious cycle of special interests, campaign contributions and secrecy too often freeze our system into stasis, both on a grand scale, when special interests block needed legislation, and on a petty scale, as in Fort Lee. The power of megadonors has, for example, made dysfunction within the House Republican Caucus worse, not better.

Others will undoubtedly address Jon’s new paper at length. But one other point is worth noting now. As in foreign policy discussions, I don’t think Jon’s position merits the mantle of political “realism,” as if those who want democracy to be more democratic and less corrupt are fluffy-headed dreamers. It is the reformers who are the true realists. My co-authors and I in our paper stressed the importance of striking realistic, hard-headed balances, e.g. in discussing our non-absolutist approach to transparency; alas, Jon gives that the back of his hand, acknowledging our approach but discarding the substance to criticize our rhetoric as “radiat[ing] uncompromising moralism.” As Bridgegate shows, the reform movement’s “moralism" correctly recognizes the corrupting nature of power, and accordingly advocates reasonable checks and balances. That is what I call realism. So I will race Jon to the trademark office for who really deserves the title of realist!

Editor's Note: : We’re hosting a conversation on Markaz on the Iranian nuclear talks, debating the merits of a deal, as well as the broader issues at stake for the United States and the region. This piece originally appeared in The Huffington Post.

As we near what may be the endgame of the current negotiations with Iran, I am reminded of the place where President Obama announced the overarching strategy that helped produce this moment: Prague. After stating his readiness to speak to Iran in a Democratic primary debate in 2007, and following that up postelection in 2009 with a series of initial statements directed to the Iranians, the president chose the Czech capital to lay out his vision of dealing with the dangers of nuclear weapons in April 2009. That included emphasizing that Iran would not be permitted to obtain a nuclear weapon on his watch: "Rules must be binding. Violations must be punished. Words must mean something. The world must stand together to prevent the spread of these weapons."

As a result of that 2009 speech, the president's nuclear strategy became known as the Prague Agenda. I had the privilege to travel with President Obama back to Prague in April 2010 to witness the signing of a major accomplishment in another area under the Prague Agenda, namely the New START treaty. By the following year, April 2011, I was in Prague as U.S. ambassador. That year, and in the each year that followed, we held an annual Prague Agenda conference to assess the steps that had been taken and the challenges that lay ahead.

In the years since, there has been steady progress in each of the four main areas the president laid out on that spring day in Prague in 2009. New START was a step forward on his first objective, to reduce the risks posed by existing nuclear weapons. Another goal, preventing nuclear terror by safeguarding materials and improving safety, has since been the subject of a series of successful Nuclear Security Summits in Washington, Seoul, and The Hague.

I saw first-hand the president's personal commitment to a third objective articulated in Prague: to promote the peaceful use of nuclear energy. I was, for example, present in the Oval Office in October 2011 when the president and the Czech prime minister met. President Obama advocated for the use of civil nuclear power as a part of the Czech energy mix (and also to achieve energy independence from Russia). That approach has been replicated in administration policy supporting civil nuclear energy in the United States and around the world.

Now, with the possible Iran deal, progress under the Prague Agenda's final prong is in reach: holding to account a state which had violated its nuclear obligations under international treaties. I am not of the school that believes the president needs to secure an Iran deal to build his legacy. That was never the case; having known him for almost a quarter of a century, since we were law students together, and having worked for him for six years, first in the White House and then as ambassador, I can attest that those kinds of considerations do not enter into critical decisions like this one. Even the president's strongest critics have to admit that legacy is, as a matter of logic, much less of a consideration after the recent breakthroughs on the Affordable Care Act and on Trade Promotion Authority.

Instead, as the comprehensive nature of the Prague Agenda itself suggests, President Obama is pursuing a deal out of principle. He is acting from his conviction that a good agreement with Iran represents another step toward making the U.S., our allies, and the world safe from nuclear terror. It is that ambition that has driven the president's formulation and consistent pursuit of each of the four elements of the Prague Agenda, the obscure aspects just as much as the headline-making ones.

Of course, as the president himself has repeatedly emphasized, the deal must be a good one. That is why I recently joined a bipartisan group of experts convened by the Washington Institute for Near East Policy in signing a statement laying out criteria for what any deal with Iran must at a minimum contain in five core areas: monitoring and verification; possible military dimensions; advanced centrifuges; sanctions relief; and consequences of violations. We also agreed on the importance of complementing any agreement with a strong deterrence policy and a comprehensive regional strategy. I have been encouraged by the warm reception for our statement from all corners, and by the strong tone struck by the American negotiators in Vienna this week. They recognize that willingness to walk away is the surest path to securing a good deal. If such a deal can be struck that meets the criteria in our bipartisan statement, that will be another stride forward under the Prague Agenda — perhaps the biggest yet.

How has the Joint Comprehensive Plan of Action (JCPOA)—signed between the P5+1 and Iran one year ago—played out in practice? Several Brookings scholars, many of whom participated prominently in debates last year surrounding official congressional review, offered their views.

We can be sure that the 2016 presidential candidates, whoever they are, will be in favor of promoting opportunity and cutting poverty. The question is: how? In our contribution to a new volume published today, “Campaign 2016: Eight big issues the presidential candidates should address,” we show that people who clear three hurdles—graduating high school, working full-time, and delaying parenthood until they in a stable, two-parent family—are very much more likely to climb to middle class than fall into poverty:

But what specific policies would help people achieve these three benchmarks of success?  Our paper contains a number of ideas that candidates might want to adopt. Here are a few examples: 

1. To improve high school graduation rates, expand “Small Schools of Choice,” a program in New York City, which replaced large, existing schools with more numerous, smaller schools that had a theme or focus (like STEM or the arts). The program increased graduation rates by about 10 percentage points and also led to higher college enrollment with no increase in costs.

2. To support work, make the Child and Dependent Care Tax Credit (CDCTC) refundable and cap it at $100,000 in household income. Because the credit is currently non-refundable, low-income families receive little or no benefit, while those with incomes above $100,000 receive generous tax deductions. This proposal would make the program more equitable and facilitate low-income parents’ labor force participation, at no additional cost.

3. To strengthen families, make the most effective forms of birth control (IUDs and implants) more widely available at no cost to women, along with good counselling and a choice of all FDA-approved methods. Programs that have done this in selected cities and states have reduced unplanned pregnancies, saved money, and given women better ability to delay parenthood until they and their partners are ready to be parents. Delayed childbearing reduces poverty rates and leads to better prospects for the children in these families.

These are just a few examples of good ideas, based on the evidence, of what a candidate might want to propose and implement if elected. Additional ideas and analysis will be found in our longer paper on this topic.

Far too many people reach their advanced years without planning for how they want their lives to end. The result too often is needless suffering, reduced dignity and autonomy, and agonizing decisions for family members.

Addressing these end-of-life issues is difficult. Most of us don’t want to confront them for ourselves or our family members. And until recently, many people resisted the idea of reimbursing doctors for end-of-life counselling sessions. In 2009, Sarah Palin labelled such sessions as the first step in establishing “death panels.” Although no such thing was contemplated when Representative Earl Blumenauer (D- Oregon) proposed such reimbursement, the majority of the public believed that death panels and euthanasia were just around the corner. Even the Obama Administration subsequently backed away from efforts to allow such reimbursement.

Fortunately, this is now history. In the past year or two the tenor of the debate has shifted toward greater acceptance of the need to deal openly with these issues. At least three developments illustrate the shift.

First, talk of “death panels” has receded, and new regulations, approved in late 2015 to take effect in January of this year, now allow Medicare reimbursement for end of life counselling. The comment period leading up to this decision was, according to most accounts, relatively free of the divisive rhetoric characterizing earlier debates. Both the American Medical Association and the American Hospital Association have signaled their support.

Second, physicians are increasingly recognizing that the objective of extending life must be balanced against the expressed priorities of their patients which often include the quality and not just the length of remaining life. Atal Gwande’s best-selling book, Being Mortal, beautifully illustrates the challenges for both doctors and patients. With well-grounded and persuasive logic, Gwande speaks of the need to de-medicalize death and dying.

The third development is perhaps the most surprising. It is a bold proposal advanced by Governor Jeb Bush before he bowed out of the Presidential race, suggesting that eligibility for Medicare be conditioned on having an advanced directive. His interest in these issues goes back to the time when as governor of Florida he became embroiled in a dispute about the removal of a feeding tube from a comatose Terry Schiavo. Ms. Schiavo’s husband and parents were at odds about what to do, her husband favoring removal and her parents wishing to sustain life. In the end, although the Governor sided with the parents, the courts decided in favor of the husband and allowed her to die. If an advanced directive had existed, the family disagreement along with a long and contentious court battle could have been avoided.

The point of such directives is not to pressure people into choosing one option over another but simply to insure that they consider their own preferences while they are still able. Making this a requirement for receipt of Medicare would almost surely encourage more people to think seriously about the type of care they would like toward the end of life and to talk with both their doctors and their family about these views. However, for many others, it would be a step too far and might reverse the new openness to advanced planning. A softer version nudging Medicare applicants to address these issues might be more acceptable. They would be asked to review several advance directive protocols, to choose one (or substitute their own). If they felt strongly that such planning was inappropriate, they could opt out of the process entirely and still receive their benefits.

Advanced care planning should not be linked only to Medicare. We should encourage people to make these decisions earlier in their lives and provide opportunities for them to revisit their initial decisions. This could be accomplished by implementing a similar nudge-like process for Medicaid recipients and those covered by private insurance.

Right now too few people are well informed about their end-of-life options, have talked to their doctors or their family members, or have created the necessary documents. Only about half of all of those who have reached the age of 60 have an advanced directive such as a living will or a power of attorney specifying their wishes. Individual preferences will naturally vary. Some will want every possible treatment to forestall death even if it comes with some suffering and only a small hope of recovery; others will want to avoid this by being allowed to die sooner or in greater comfort. Research suggests that when given a choice, most people will choose comfort care over extended life.

In the absence of advance planning, the choice of how one dies is often left to doctors, hospitals, and relatives whose wishes may or may not represent the preferences of the individual in their care. For example, most people would prefer to die at home but the majority do not. Physicians are committed to saving lives and relatives often feel guilty about letting a loved one “go.”

The costs of prolonging life when there is little point in doing so can be high. The average Medicare patient in their last year of life costs the government $33,000 with spending in that final year accounting for 25 percent of all Medicare spending. Granted no one knows in advance which year is “their last” so these data exaggerate the savings that better advance planning might yield, but even if it is 10% that represents over $50 billion a year. Dr. Ezekiel Emanuel, an expert in this area, notes that hospice care can reduce costs by 10 to 20 percent for cancer patients but warns that little or no savings have accompanied palliative care for heart failure or emphysema patients, for example. This could reflect the late use of palliative care in such cases or the fact that palliative care is more expensive than assumed.

In the end, Dr. Emanuel concludes, and I heartily agree, that a call for better advance planning should not be based primarily on its potential cost savings but rather on the respect it affords the individual to die in dignity and in accordance with their own preferences.

Editor's note: This piece originally appeared in Inside Sources.

Dear South Sudan's Leaders:

Today, the country that all of you and your fellow citizens fought to establish is at a crossroads. And you, the country’s leaders, are now standing at the proverbial “fork in the road.” The question now is: Which road will each of you take? Your choice will determine not only your place in history but will significantly impact the future of your shared country, its diverse peoples and your neighbors. Each of you can choose to chase after personal power, primitive accumulation, and self-enrichment—using the ethnic group that you belong to as a foundation for that quest. This disastrous decision would plunge your country further into violent and destructive mobilization, effectively shutting the door to the type of state formation that is undergirded by a desire to achieve national integration, peaceful coexistence and sustainable development. Alternatively, each of you can opt to maximize a different value, one that places you among the world’s greatest leaders—that is, those who, when they came to the fork in the road, chose to lead their people down the road of opportunities for peaceful coexistence, prosperity and liberty.

As the citizens of South Sudan watch and wait in utter fear and disgust, it is time for you, the country’s leaders, to decide whether you want to lead them into a future filled with unending violence, hunger, and desolation, or into one where all of the country’s various peoples, regardless of their ethnic or religious affiliation, gender, and economic status, can live together peacefully and pursue their values and interests without molestation from others.

In the early 1990s, Nelson Mandela and his compatriots found themselves at a similar crossroads. They chose not to act opportunistically and retreat to their various ethnic enclaves.  Like the great leaders that history has proven them to be, they knew that, as apparently beneficial as such an option would have been to them, they would have plunged their country into an abyss from which it was unlikely to recover anytime soon. Instead, they chose the road that led them and their country to the type of state formation that is undergirded by institutional arrangements that provide an enabling environment for wealth creation and economic growth. That is why, today, the country that they founded has one of the world’s most progressive and human-rights friendly constitutions.

South Sudan is a new and relatively underdeveloped country, but it has the potential to emerge as a highly developed and peaceful one. However, in order for that potential to be fully exploited and used effectively to enhance development, the latter must be provided with institutional arrangements that guarantee the rule of law.

To you, the leaders of this new country: All of you can gracefully exit the scene, serve as elder statesmen, and provide the country’s new crop of leaders with the type of advice and support that can help the country successfully emerge from its violent and destructive past, as well as chart a path towards peace, sustainable economic growth and development, and equitable and fair allocation of national resources.

How will history judge you? As tyrants, opportunists, despots, exploiters, and oppressors, who used their public positions to grab power and riches for themselves or as public servants who spearheaded and led the transformative processes that brought peace, security, and development to their country? The choice is yours.

Posterity will judge you well, but only if you choose wisely!