The MacNeil/Lehrer NewsHour

MR. MacNeil: Good evening. I'm Robert MacNeil in New York.

MR. LEHRER: And I'm Jim Lehrer in Washington. After our summary of the news this Wednesday, we have a full report on AIDS Day in Washington, a debate about sanctioning suicide for the terminally ill, a look at why one thousand people a day are dying in the African nation of Angola, and a Clarence Page essay about strange alliances. NEWS SUMMARY

MR. LEHRER: Today was AIDS Day in Washington and elsewhere, a day designed to call attention to the dreaded disease. President Clinton spoke about AIDS in a speech at Georgetown University Hospital in Washington this morning.

PRESIDENT CLINTON: For nearly every American with eyes and ears open, the face of AIDS is no longer the face of a stranger. Millions and millions of us have now stood at the bedside of a dying friend and grieved. Millions and millions of us now know people who have had AIDS and who have died of it who are both gay and heterosexual, both. Millions and millions of us are now forced to admit that this is a problem which has diminished the life of every American.

MR. LEHRER: The President's remarks were interrupted by a heckler who charged Mr. Clinton was not doing enough about the disease. Mr. Clinton said presidents should be a lightning rod for frustration. He said he was glad the man was screaming at him and hadn't given up. We'll have more about AIDS Day in Washington right after the News Summary. Elsewhere, the U.S. Postal Service issued a new 29 cent stamp today. It features a red ribbon, the symbol of AIDS awareness. In Philadelphia, marchers carried black umbrellas to remember AIDS victims and people gathered outside a Minneapolis museum to write down memories about people who died of AIDS and then tossed the papers into a fire. Robin.

MR. MacNeil: The government reported today that the nation's economy continued to grow at a moderate rate in the third quarter. Gross Domestic Product rose 2.7 percent for the period, slightly less than estimated earlier but substantially better than the growth rate in the previous two quarters. The nation's merchandise trade deficit shot up to $36 billion in the third quarter. It was the worst imbalance in six years. Imports hit a new record high, while exports declined. The pre-dawn launch of the space shuttle Endeavor was scrubbed today because of high winds at Cape Canaveral. The shuttle is scheduled for an 11-day mission to repair the $1.6 billion Hubbell Telescope. It was launched in 1990 and has been sending back blurry images ever since. NASA will try again early tomorrow morning.

MR. LEHRER: There was more unrest in the Israeli-occupied territories today. One Israeli teacher was shot dead and three Jewish settlers were wounded in the West Bank. Yesterday, dozens of Palestinians were shot and wounded in Gaza Strip clashes. We have a report narrated by Louise Bates of Worldwide Television News.

MS. BATES: Young Palestinians are keeping the violence alive in the occupied West Bank, hurling stones at Israeli troops. This past week has shattered Israel's hopes of restoring calm in the occupied territories. On Wednesday, a young kindergarten teacher was killed and three other Jewish settlers wounded when Palestinian gunmen sprayed a car with automatic weapons fire. Later, an anonymous caller speaking Arabic said the Islamic resistance movement, Hamas, carried out the shooting. The group is committed to wrecking the Israeli-PLO peace accord. The first phase of the self-rule plan is due to come into effect in two weeks. There are fears that the latest killing will ignite more vengeance attacks on Arabs by the other opponents of the accord, Jewish settlers. The settlers called an emergency meeting to discuss security and resolved to block West Bank roads while carrying out acts of civil disobedience. Placards held a grim prediction of what's to come as Israelis protested at the murderer of the 24-year-old teacher. To further rattle the peace process, Hamas has promised more killings but says Wednesday's ambush was just the first of five attacks planned on Israelis.

MR. LEHRER: Sec. of State Christopher goes to the Middle East Friday. He will spend a week there trying to revive stalled peace talks between Israel and Syria, Lebanon, and Jordan.

MR. MacNeil: There were signs of progress at the Bosnian peace talks in Geneva. The Muslim-led government said for the first time that it would agree to divide Sarajevo with rival Serbs. The Serbs, Muslims, and Croats are negotiating over a proposal to divide the country into three ethnic states. Meanwhile, in Sarajevo, two nurses were killed when the city's main hospital came under attack. Shells hit an emergency room just after midnight. A doctor and two technicians were wounded by shrapnel. U.N. officials said they were trying to determine who fired the shells but Serb forces were suspected.

MR. LEHRER: Separatists in the former Soviet republic of Georgia agreed to a cease-fire today. The accord was reached after two days of talks in Geneva. Fighting began in August, 1992, when the government moved to put down a nationalist rebellion in the region known as Abkhazia. Since then, about 3,000 people have been killed and more than 200,000 driven from their homes.

MR. MacNeil: PBS, the Public Broadcasting Service, named a new president today. He is Irvin Duggan, former Federal Communications Commissioner. Duggan replaces Bruce Christianson who resigned last summer after nine years to become dean at Brigham Young University. That's it for the News Summary tonight. Now it's on to AIDS Day, legalizing suicide, death in Angola, and a Clarence Page essay. FOCUS - WORLD AIDS DAY

MR. LEHRER: AIDS Day in Washington is our lead story tonight. Margaret Warner has our report on what President Clinton and others did and said.

MS. WARNER: President Clinton began the day with a morning jog in a sweatshirt that promoted the theme of World AIDS Day, "Time to Act." Across town, Health & Human Services Sec. Donna Shalala and Surgeon General Joycelyn Elders dished up breakfast at a shelter for homeless men suffering from AIDS. Elders said federal researchers were working hard to develop an effective AIDS vaccine.

DR. JOYCELYN ELDERS, Surgeon General: Right now, the best we've got is try and prevent this disease from happening, and our best vaccine is education today, but we're working ever hard to try and develop another vaccine.

REPORTER: Is the copy of Bill Clinton's promises on AIDS, 30 Recommendations?

MS. WARNER: A critic from the activist group, Act-Up, tried to disrupt the event. Back at the breakfast table, Shalala touted the President's health care reform proposal.

DONNA SHALALA, Secretary of Health & Human Services: Fundamentally, what you need is health insurance, and that's what the President is trying to do, to give everyone health insurance, but I don't have a short-term answer, I mean, I don't have a short- term answer. What we have is an intermediate answer in the President's legislation.

MS. WARNER: Other cabinet officials also got into the act. At the Justice Department, Attorney General Janet Reno warned that the administration would take legal action to end discrimination against AIDS sufferers.

JANET RENO, Attorney General: For far too long, for far too many people with AIDS, the workplace has not been a place of help and comfort and caring. Instead, vicious stereotypes and blinding ignorance have combined to make work a place of fear for many people with AIDS. And for many years, it seemed that almost no one with power and authority seemed to care. Those days are behind us. We are determined to strip away the ignorance and prejudice by education if we can, by litigation if we must.

MS. WARNER: At the Energy Department, Sec. Hazel O'Leary talked about adjusting workloads.

HAZEL O'LEARY, Secretary of Energy: It may mean a more flexible work schedule to allow someone who's having a down time and feeling very sick to simply be treated like an individual, which is what we'd like to do with each and every one of us, to accord some flexibility to that individual's work day, to understand that when that individual is up and feeling healthy and ready to go, fine, get right back in there and go again.

PRESIDENT CLINTON: [talking to AIDS patient] Hello.

LARRY SINGLETARY, AIDS Patient: [talking to President] Hello.

MS. WARNER: For those infected by the virus, the message was consistent, they want more money to find a cure. AIDS patient Larry Singletary delivered that message to President Clinton during his visit to Georgetown University Hospital.

LARRY SINGLETARY, AIDS Patient: I just hope for the best, just hope that you appropriate lots of money, so that, you know, research be done.

MS. WARNER: The President then spoke to health care professionals in the hospital's auditorium. He urged them not to become disillusioned in their long war with a resistant foe.

PRESIDENT CLINTON: I do believe that all of us, each in our own way, sometimes just want to go on to other things. Even some of my friends who are infected just want to go on to other things, maybe especially them. They just get sick of talking about it and thinking about it and focusing on it. The purpose of this day is to remind us that our attitudes, behavior, and passion should be revved up in the other 364 days of the year.

MAN IN AUDIENCE: [shouting at President] You're so concerned about AIDS, where is the Manhattan Project on AIDS that you promised during your campaign one year, lots of talk, no action, where is it? Thirty recommendations of George Bush's Commission on AIDS, you promised to implement it during your campaign. Where are they? One year, Slick Willie, the Republicans were right! We should have never trusted you! You are doing nothing, absolutely nothing!

PEOPLE IN ROOM SHOUTING BACK AT MAN: [Booing] Sit down!

MAN IN AUDIENCE: Talk is cheap! We need action! It's time to put up or shut up!

MS. WARNER: The President insisted his administration had done more than the previous one to combat the AIDS epidemic. He cited a 20 percent increase in research, $45 million in additional spending for prevention, and a 66 percent increase in the budget for treatment and care.

PRESIDENT CLINTON: The next thing I'd like to say is I think the best thing we can do for people who are living with HIV and living with AIDS is to pass a comprehensive health care plan so that people do not lose their benefits. That is important. [applause] Now let me say that is important for two reasons: First thing is just simply having the security of knowing that there will be a payment stream to cover quality care. But the second thing I think is also important, and that is the point I began this talk with, which is that we have to affirm the lives of people who are infected, and the living. And if you know that you have health insurance that can never be taken away and that the cost of this will not vary because you will be insured in a big community pool with people who are not infected and, therefore, whose real costs are lower, than there is never an incentive for someone to fire you or not to hire you.

MS. WARNER: The reform package aside, those involved in the AIDS fight outside government give the administration a mixed report card on its efforts so far. Dan Bross heads the AIDS Action Council in Washington.

DAN BROSS, AIDS Action Council: People with AIDS are clearly better off today because of leadership and the compassion and the personal commitment of President Clinton. But you know in the final analysis, until there's a cure, our government is not doing enough. And even though funding has been increased in the area of research and care, funding is still critically lacking in the important area of prevention. We can talk about leadership. We can talk about awareness, but until this administration puts more money in the AIDS budget in the area of prevention and education, we are still not doing everything we can to confront this epidemic. Probably my most critical comment toward this administration is still a year into office we do not have a national plan for addressing the HIV epidemic.

MS. WARNER: President Clinton insists he doesn't mind the criticism. He said today he'd far rather that AIDS activists criticize him than give up on him. FOCUS - FINAL QUESTION

MR. MacNeil: Next tonight, a debate over assisted suicide. The man whose name is now synonymous with it, Dr. Jack Kevorkian, is back in the news. He was jailed today for helping a 61-year-old doctor who had bone cancer to kill himself. Kevorkian was charged with violating Michigan's nine-month-old ban on assisted suicide. Regardless of the legal outcome in this case, the debate over assisted suicide goes on. Should doctors under certain circumstances be allowed to help terminal patients end their lives? Tonight we have three doctors with different views. Dr. Timothy Quill is an internist in Rochester, New York. He's the author of Death and Dignity, Making Choices and Taking Charge. In 1991, he wrote in the New England Journal of Medicine about his experience in assisting a young woman with terminal cancer in her suicide. Dr. Carlos Gomez is the senior resident in internal medicine at the University of Virginia Medical Center. And Dr. Eric Cassell is an internist who practices medicine in New York City. Gentlemen, starting with you, Dr. Quill, let's discuss the Kevorkian phenomenon. By assisting suicide so openly, is Dr. Kevorkian clarifying or muddling this debate?

DR. QUILL: I think there's no question that he has initially been a lightning rod for this debate but subsequently muddled the debate. The debate has in the media at least has focused almost exclusively on Dr. Kevorkian and his unusual ideas and behaviors, and actually he's frightened people, and rightly so. I think we need to hear much more about the 20 people who have been so desperate and in need of a caring medical system that they found themselves going to Michigan to die at the hands of pathologist. I think that's a very disturbing concept and really shows that we must do a much better job of caring for people who are dying.

MR. MacNeil: Why is it disturbing?

DR. QUILL: I --

MR. MacNeil: A disturbing concept.

DR. QUILL: It's disturbing partly because Dr. Kevorkian is a pathologist whose training is with people who are dead. Working with terminally ill patients is a real skill, and people develop expertise over time. You need to have skills in hospice care which is the standard of care for taking care of people who are dying, skills and the ability to relieve pain, to diagnose depression, to do all the many complex tasks that are required in taking care of dying people. There are thousands and thousands of wonderful doctors in the primary care community, in the AIDS community, in the cancer community who are struggling with their patients right now to help them die better when they don't have any other choices. And we need to hear much more about those stories and much less about Dr. Kevorkian, in my opinion.

MR. MacNeil: Dr. Gomez, what do you think of Dr. Kevorkian's work?

DR. GOMEZ: I think probably the best thing that could be said about him is that he's a sick man. It's, it's unfortunate, as Dr. Quill said, that the debate over the permissibility of assisting a suicide has focused so much on Jack Kevorkian. I think he is everybody's worst nightmare.

MR. MacNeil: Why? Why do say that?

DR. GOMEZ: I mean, this is a man who's never taken care of patients. This is a man who hasn't got any clinical skills. This is a man whose sole competence, apart from being a pathologist, is in killing people. And for the debate, which is extremely complicated, very controversial, very difficult to tease out, to focus over the actions of one man, I think does everybody a disservice.

MR. MacNeil: Dr. Cassell, what do you think about Dr. Kevorkian?

DR. CASSELL: I think that Dr. Kevorkian is a caricature of the medicine that makes the problem in the first place. People die at the hands of a person they don't know in an impersonal setting by a piece of machinery. Why the piece of machinery, why a technology for it? And instead of focusing on what the real problem is, the people require when they're sick and when they're suffering, and that when that care is really wonderful and personal and directed at them, they very rarely have to go to Michigan to be killed by somebody. The problem presented is very different one and I hope we'll talk about it, but there's something else that he points out, how easy it is to kill somebody. And that has to always be a caution for, for physicians. It's not difficult to kill somebody. It's easy. It's simple, technically simple, and so we have to build around it much more care, much more worry about it as we normally do. So I think Kevorkian brings out the fact that it's an impersonal thing, a technological thing, and also an easy thing, and we have to look at that and think if that's what the lightning rod of publicity is, we have to pay attention to why it's that way and what instead we might do.

MR. MacNeil: Dr. Quill, you are for, as I understand it, a limited legal right for doctors to assist terminally ill patients in some circumstances to commit suicide. Describe what kind of patients and under what circumstances you think there should be a legal right for doctors to do that.

DR. QUILL: Well, first of all, I would say that assisted suicide would never be an alternative to hospice care. Hospice care has answers for most of the problems that terminally ill patients face. And it is a true alternative to the kind of high technology death that none of us want. So in my mind assisted suicide is only a very narrow question trying to address those infrequent but very troubling patients who in spite of caring hospice work, good efforts to relieve symptoms, are still suffering in a way that's intolerable. These people also have to have mental competence at the time they are requesting this, that it is their idea, not the doctor's idea. They're basically people who have explored every other option and don't have any good option. The people that I have talked to have been in this state don't really want to die but they have reached a point where their living is so -- of such poor quality that they choose death in preference to a life where their personhood is really disintegrating, where they're feeling humiliated. And I must say it is disturbing to families, to patients, to everyone around, to work with somebody who has struggled often in a heroic way against their illness and who is feeling humiliated prior to death. So it's a narrow question but I think we must try to address it because many people are afraid of that kind of end, an end. Only a few people would actually find themselves there. But the fear can taint the last part of a person's life.

MR. MacNeil: Dr. Gomez, you are against making any assisted suicide legal. Why, hearing Dr. Quill describe certain kinds of patients whose last -- even with the best care -- whose last months or days may be in agony?

DR. GOMEZ: I think that Dr. Quill presents the optimistic argument that this is going to be a practice that's narrowly confined, and in fact, if the world were filled with just Timothy Quills he might be right. The problem is, is that every experience that we've had with physicians involved in actively killing their patients has been disaster. There's the experience of the Netherlands. There's the experience prior to the Nazis in Germany, and it doesn't strike me that we have any reason to be optimistic that you can introduce the practice of killing into medicine and expect it to be used for the better. I, I don't know why Timothy Quill is this optimistic. He and I have talked about this a number of times. And there is a lot that he says that resonates and is very true. But I would draw the line at a physician intentionally killing a patient. I think that what is missing in this country, as Dr. Quill and others have said, is adequate care of terminally ill people, people in pain, people who are suffering. It certainly isn't something that house officers and medical students are taught to focus on, and that is to our great disgrace. But the answer here is not to kill patients who are suffering at the end of their lives; the answer is to figure out more innovative, more intelligent, more compassionate responses, and I don't think those responses involve killing.

MR. MacNeil: Dr. Cassell, you want it left illegal, as I understand it, but for a different reason.

DR. CASSELL: Well, I, I think that one of the things that medicine teaches you is that no matter how much you know or how much you've seen, or how much suffering you've seen, and you think you now know, you'll see somebody sooner or later who is in such agony that your experience doesn't encompass it, it demands the solution that Dr. Quill talks about, it demands relief. Ethicists for a long time have argued over, well, if giving too much morphine to relieve pain, is that really killing the patient, and all those back and forths to try and solve the problem which we all know. There are some people who really require relief, the best of care, and yet, we all also know you've got to be very careful before you allow somebody to kill somebody else. So now we have two problems. One is there are people who really have to have relief, and we know how difficult it is to give that permission away. So my own sense of it is it belongs in the privacy of the relationship between the physician and the patient. We are a culture that's lost the private life. There were a lot of things done in private, and I think Dr. Gomez is wrong when he knows how many people kill how many other people, how many physicians aid people in their death, we have no idea how often that happens.

MR. MacNeil: But they do.

DR. CASSELL: But they certainly do, and my own sense of it is it has to be pushed into physicians that this patient's care is their responsibility, the relief of the suffering is their responsibility, and they've got to do it, they have to do it, and then there will be these few times that Tim talked about where everything else is not enough, and they're going to have to come to an agonizing decision to end somebody's life with that person. And then they're going to feel badly about it and worry about it and go home sick and gray about it. And it's just what they should do. Yet, their responsibility is to that sick person.

MR. MacNeil: To help him die if --

DR. CASSELL: Yes. I don't call it assisted suicide. I call it assisted death. Suicide is a different issue.

MR. MacNeil: Dr. Quill, what's wrong with leaving it that way?

DR. QUILL: Well, first of all, I want to agree with Dr. Cassell that suicide is not the right word for this process. Suicide involves in some sense destroying the essence of who you are. These are generally people whose essence is being destroyed by their illness, and suicide is an escape from that destruction, so it's not the right word, although I'm not sure our language has a right word for this process. But the danger of keeping the process private, which is where it is right now, and it works to some degree, but it really makes a desperate patient dependent on the values of the doctor more than anything else and perhaps also on the willingness of the doctor to take risk. It's also a very complicated process. These are very delicate --

MR. MacNeil: Excuse me, take risks because it's illegal in many states.

DR. QUILL: Take risks, take legal risks, that's right.

MR. MacNeil: Yeah.

DR. QUILL: If it's discovered, you can become part of a very public and a difficult process. It's also a very hard process, a delicate decision, and in my mind you want this to be a time when you can talk to your psychiatric colleague, is depression distorting a person's judgment here, you can talk to your colleagues in hospice, is there anything else that we can do in the area of symptom relief, and so that only would you actually end up with this agonizing decision when all other avenues have been at least adequately considered. So the risk of making it more public is that, is that more people may become involved in it, but the risk of keeping it secret is that it's really going to depend on the willingness to take risk and the skills of the doctor, and they are variable.

MR. MacNeil: Dr. Gomez, the others say, and reading about it today, I read more about it from nurses than others, even modern painkilling drugs and doctors willing to use them aggressively in very sympathetic comfort, care or palliative care, leave some terminal patients dying in agony. How do you treat such patients? If you won't do what Dr. Cassell some doctors do quietly and Dr. Quill thinks they should be allowed to do in public, how do you treat them?

DR. GOMEZ: I think there's probably more agreement among the three of us than, than seems at first evident. First of all, I don't withhold narcotics or any other painkiller from a patient who is suffering even if I think that it's going to cause respiratory death and kill them. I don't think that one ought to do that. If the patient needs the drug, one gives the drug, and one gives the patient as much freedom as he or she wants to take the drug. I believe in that very strongly. That's what I do in my own practice. At the same time, what Tim Quill is talking about and what the proponents of assisted suicide are talking about is the physician acting with intentive lethality, i.e. to say the physician is acting precisely not to relieve suffering but to kill the patient or to aid the patient in their suicide. There is a difference, for example, whether one gives a large dose of morphine to relieve the pain from a metastatic cancer and giving them a bolus of potassium chloride, for example, to end it all. I think there is a substantive difference there, and I think that if we codify the practice of physician assisted suicide, if we make this part and parcel of what it means to be a physician, I think it changes fundamentally the practice of medicine, and I think more importantly than that it's finally to the detriment of that very relationship, that very private relationship that Dr. Cassell was talking about between physician and patient. They have to approach one another with the understanding that the physician is not going to kill but the physician is going to do everything in his or her power toalleviate pain and suffering even if it means giving a narcotic that might kill the patient. What I object to is having the physician be seen as the proximate cause of death, where the physician is executioner in society, because as tightly as you want to control this, it is not going to remain the small band of patients that Timothy Quill talks about. The circle is going to expand, and eventually we're going to be sitting here five years down the road, if we allow this to happen, and talk about incompetent patients and unconscious patients and children whose "quality of life" isn't going to be appropriate or isn't going to be deemed worthy, and it's going to be physicians who are going to be acting as the social agents in this case.

MR. MacNeil: Dr. Quill.

DR. QUILL: I think it's not accurate to say the primary intention in these circumstances is to end the patient's life. The primary intention in these circumstances is always to give a person escape and relief from their suffering. Sometimes death can provide that -- only death can provide that relief. And patients will talk to you about that very directly and we, in fact, acknowledge that possibility in certain circumstances. About 10 percent of patients who are on hemodialysis, which is kidney machines, eventually choose to stop dialysis because their, their quality of life and the burdens of their illness outweigh the desire to keep living. And we believe that's a legitimate conversation, and people are allowed to talk about that, and patients are allowed to stop. They will die if they stop. Now, this has been a very rare occurrence. There hasn't been a rush to stop dialysis, but, but people have been able to carry this out very responsibly and conservatively. I think there is -- from a patient's point of view, there aren't a lot of differences between these acts that we're talking about. These are ethical distinctions that from the reality of a patient and a family member who's watching this kind of terrible suffering, these distinctions start to become distilled and blurred, I think.

MR. MacNeil: Gentlemen, I know we've only scratched the surface of a very deep subject, but I thank you all for joining us. Jim.

MR. LEHRER: Still to come on the NewsHour tonight death in Angola, and a Clarence Page essay. FOCUS - ANGOLA'S AGONY

MR. LEHRER: Now, the bloody civil war in the African nation of Angola. It has killed 100,000 people in the past year. Hundreds of thousands have been driven from their homes, and some 3 million Angolans are in desperate need of food. The fighting began in 1975 when rebels known by the acronym UNITA rose up against a military government backed by the Soviet government and Cuba. The rebels were led then and now by Jonas Savimbi, who was backed by the United States until earlier this year. Savimbi's forces and the government signed a peace accord in 1991, but war erupted again last year when Savimbi refused to accept defeat in the country's first multiparty elections. This time the fighting was worse than ever before. The full extent of the suffering it has caused has only recently become known. Lindsay Taylor of Independent Television News reports on a town which was recently liberated after nine months under siege.

MR. TAYLOR: Another day, another funeral. Six thousand people have died in the remote town of Menongue. Today it's another child, a humble but dignified journey to the cemetery, and one already taken by the child's father and two more of his children. Until a few weeks ago, the town was completely cut off from the outside world,trapped by the civil war. For nine months, the population has had to survive without food and medical supplies, and this is the result. Officially it's a hospital, but until recently, staff here described it as a place where people come to die. Here are the direct and indirect victims of the war, those who are caught in the waves of shelling or who have stepped on land mines, and those displaying the months of deprivation, malnutrition, disease, and infection without the drugs to combat them. Some aid has now reached here, but its distribution is haphazard, controlled by the government soldiers who guard the airport. Angolans as young as 16 often join the army because it's the only way of getting food. There are no organized structures supervising distribution and even for the planes to get here they must run a gauntlet of attacks by UNITA rebels.

DARRYL ALESSI, American Aid Pilot: There's been some talk in Luanda of cutting off the flights or else requiring that it be considered a combat zone. It's very hazardous. Our aircraft get shot as well by machine guns. Our RPGs are fired at them frequently, rocket-propelled grenade, so yes, there's talk of stopping it altogether.

MR. TAYLOR: That would spell further disaster for these children being fed at a church-run center. A year ago, people's hopes here were raised by a general election and a promise of democracy. Instead, now they have barely the means to survive and a civil war more vicious than ever before.

PHILLIPE BOREL, Director, UN World Food Program: We have a illusion and disillusion. The time of the election or the time was the time of the illusion. The month following the election was the time of disillusion, and this is growing worse and worse since the month of October last year. And that's now one year. During one year we have seen disaster after disaster.

MR. TAYLOR: It's not just outlying areas that are hit by the war. The capital, Luanda, has been swamped by refugees. This camp is on the outskirts of the city.

PHILLIPE BOREL: Those camps are overpopulated. You can find cholera, acute malnutrition, but Luanda is facing a growth in population that Luanda cannot absorb really or cannot support.

MR. TAYLOR: In the center, life has a semblance of normality. Some are profiteering from the war. But for others, the street is the only way of earning a living. The resulting thriving black economy has contributed to the continued crisis in the hospitals. Here the shortage of drugs renders staff powerless to stem the tide of sick and dying. The United Nations admits it's a desperate situation and one which the World Community must face up to.

GEN. ALIOUNE BLONDIN BEYE, UN Special Envoy: [speaking through interpreter] In the past twelve months, Angola has known more death, more destruction of its infrastructure than in all the past sixteen years. What happened during those last twelve months? Alas, it was the elections, which were more or less imposed by the International Community. Therefore, if these elections did not result in democracy, and instead there is this catastrophic situation, the International Community has a responsibility, and we must follow it.

MR. TAYLOR: International pressure, it's hoped, will help force a solution to the civil war, but until such times in Menongue and places like it, the UN predicts three million will face starvation, and Angolans will continue to die at the rate of 1,000 a day.

MR. LEHRER: Now three additional views of the situation in Angola. Herman Cohen was Assistant Secretary of State for African Affairs in the Bush administration. Sharon Pauling is a senior policy analyst at Bread for the World, a Washington policy organization. Andrew Natsios is vice president of the relief agency World Vision. He just returned from a trip to Angola. Mr. Natsios, how would you describe the situation there based on what you saw and heard on the ground?

MR. NATSIOS: Well, the, the characterization of Somalia as the worst disaster in the world a year and a half ago is now applicable to Angola. More people are dying in Angola than any other country in the world where there is a famine or civil war going on, and more people are going to die unless political settlement is reached.

MR. LEHRER: Ms. Pauling, how would you characterize the overview?

MS. PAULING: Well, this is the worst situation right now affecting the subsaharan region of Africa. Clearly, in Somalia and Sudan, we're seeing catastrophe, but the fact that civil war was renewed under the leadership of Jonas Savimbi of UNITA after he refused to accept the election outcome has really plunged this country back into a terrible, terrible crisis that's resulting in the kind of death that we just viewed and malnutrition, et cetera.

MR. LEHRER: Why did it take so long for the outside world to find out about this?

MS. PAULING: Well, you know, the media is not focused on Angola. We're focused on Somalia. The United States has forces there, so we're concerned I think about what's going on in Somalia, because there's a U.S. presence. It took us a long time to get into Somalia. Siad Bari was out in '91. We didn't go in until the end of '92. It's unfortunate that the International Community waits so long rather than helping to prevent this catastrophe -- these catastrophes by helping with a conflict resolution and the kind of development and economic assistance that would help to prevent these kinds of things from erupting.

MR. LEHRER: Mr. Natsios, is the situation that's causing a thousand people to die a day, is there any way to break that, just what is causing their death in terms of people being shot or in a military way or those who are dying of starvation or disease?

MR. NATSIOS: There are three categories, three or four categories of what, of actually killing people. The first is the war, itself. People are dying from shrapnel wounds and gunshot wounds and that sort of thing, artillery rounds.

MR. LEHRER: And are these combatants?

MR. NATSIOS: No, No.

MR. LEHRER: Are these people who are members of the government army, or members of the militia, Savimby's militia?

MR. NATSIOS: No. A small number of soldiers are dying. It's mostly non-combatant, as is the case in most of these civil wars tragically. The second thing is there's been a drought for three or four years now in the South on both the government side and the UNITA side, and that's been killing people because the crops aren't growing. The third is that Angola has more land mines probably than any country in the world, including Somalia, Afghanistan, and Cambodia, which have a huge amount themselves. I think Angola has - -

MR. LEHRER: Who put those land mines down?

MR. NATSIOS: Those land mines were set by both sides, and they're particularly being used by UNITA now around the cities that they - - they control the rural areas for the most part. The governments, with some exceptions, control the cities. UNITA has placed land mines around the cities, and people who leave the city get, get blown up. That is the cause of death now. A lot of people are foraging for food, and those land mines are killing people. And the land mines on some ofthe roads that the governments put down to prevent UNITA from moving around are also preventing the food shipments from going in by land into the cities. We have to go in through airlift, and there is not sufficient air strips or airport hangars and planes to get into some of these areas with sufficient food. And the biggest cause of death, however, more than by far than anything else is starvation. People are dying of starvation, particularly in the cities where they have no access to food, other than the relief food that's coming in by air.

MR. LEHRER: Ms. Pauling, do you agree with that, as far as what's causing people to actually die?

MS. PAULING: Starvation is causing it, but clearly it's the guns that are, as in many other situations, are preventing, you know, acting as obstacles to relief in many situations, giving in --

MR. LEHRER: In other words, the food is available, the food is actually there?

MS. PAULING: Well, the relief supplies are coming in, but in many cities like Juambo and Akito, it's been very difficult to move food in. And Mr. Natsios has talked about the fact that land mines are surrounding --

MR. LEHRER: Sounds like a horror, horrible.

MS. PAULING: -- a number of these cities. People are being absolutely literally held hostage inside of these towns, which is why it's so critical for international pressure to be placed on the parties to the conflict, and clearly, UNITA does bear a large brunt of responsibility for what's happening to especially children inside of Angola. During the Cold War, Angola had the highest amputee rate in the world because of the fighting. That amputee rate now is beginning to get even higher than it was during the Cold War years.

MR. LEHRER: And, of course, a lot of that is caused by land mines --

MS. PAULING: Exactly.

MR. LEHRER: -- because they go off and tear off limbs. Well, let's bring Mr. Cohen into this. Is there a diplomatic -- there are talks going on to try to make peace between UNITA, Savimby, on one side, and the government on the other. Where are those? Are they going to lead anywhere?

MR. COHEN: There's a real dilemma here. The talks are going on but there are no real negotiations going on, and I'll tell you why. The government has right on its side, total legitimacy. They won the election. It was a free and fair election. UNITA lost the election. UNITA had demanded this election, and then they reneged and they went back to the bush and started fighting, so UNITA is totally in the wrong, so --

MR. LEHRER: And those were the people that were supported by the United States, right?

MR. COHEN: From 1986 on.

MR. LEHRER: Yes.

MR. COHEN: The South Africans were really the main support of people throughout this period, so when you have that type of right and wrong situation which is so clear, there's a tendency on the part of the U.N. and the Angolan government, international observers, to just issue ultimatums to UNITA. You've got to comply. You've got to lay down your arms. You've got to put your troops in camps and go back to the status quo and live up to the agreements that you sign. That's fine. That's right. But it's not going to end the war. The only way to end the war is to have a real negotiation where all of UNITA's concerns can be taken into account, and those are security guarantees, meaningful power sharing, resource sharing, and a decentralized government where UNITA could have some local authority.

MR. LEHRER: That's in spite of their having lost the election.

MR. COHEN: That's right.

MR. LEHRER: In other words, they control -- I read today that they control something like -- they don't control it but the -- the government only controls 30 percent of the land in Angola, is that right?

MR. COHEN: That's right.

MR. LEHRER: That basically -- do you agree with that, Ms. Pauling?

MS. PAULING: I think that may be.

MR. LEHRER: Yeah. How much of that is -- how much of that -- 70 percent is under UNITA's control.

MR. COHEN: They're not administering much. They just --

MR. LEHRER: Nobody is.

MR. COHEN: No. The government is barred from going into these areas but no one is really taking care of them.

MR. LEHRER: Well, then -- yeah.

MS. PAULING: You know, there are two tragedies going on here. One is the fact that there's a humanitarian crisis, and this fighting is really causing thousands, tens of thousands of people to die. On the other hand, what's really tragic is that the people of Angola wanted to believe in the democratic process. They went to the polls to vote. The International Community in many ways remains on their promises of support for democratization by standing back. The United States delayed in its own recognition of the Angolan government as the victor in those elections. It wasn't until Clinton came into office that we finally recognized the Angolan government. So we've got a real crisis here where people are wondering, does it make sense to vote? And this is what the United States has been saying, you know, if you do certain things, the International Community, the U.S. is going to support you, and that, quite frankly, is not happening, so I think it's important that the U.S. and the International Community bring pressure to bear in the form of the embargo that was put in place in September to ensure that UNITA will abide by these accords that were taken.

MR. LEHRER: Let's ask Mr. Cohen. Is that -- can that be done? Is it going to be done?

MR. COHEN: It's very unrealistic.

MR. LEHRER: Should it be done?

MR. COHEN: Certainly you could put embargoes on UNITA but it won't work. Look how hard it is to have sanctions against a government which has a territory controlled. You can block their ports and what have you, but you can't have sanctions against a rebel movement, a guerrilla movement, unless you're willing to send troops, and certainly nobody's willing to do that.

MR. LEHRER: Well then, if, if -- what about Ms. Pauling's point, the Angola deal was negotiated -- I mean, one of your predecessors --

MR. COHEN: I negotiated it myself.

MR. LEHRER: Right. And Chester Crocker was involved before you.

MR. COHEN: That's right.

MR. LEHRER: And this was, this was a deal that as she said the people of Angola were said, go to the polls and, and choose your own government. They chose their won government, and the whole thing fell apart, and things are even worse now. What is your feeling about what the United States and the International Community owes the people of Angola?

MR. COHEN: Well, we have to have a very activist policy to bring this to a head, and I think we're being a little too passive right now, strictly allowing the U.N. to issues these ultimatums to UNITA. We have to have a more creative approach and get an agreement that will really give UNITA an incentive to stop the war.

MR. LEHRER: As a practical matter, based on your knowledge, Mr. Cohen, does the United States have any clout left with Savimby? Could we get Savimby to do something even if we wanted to?

MR. COHEN: I do think we have a lot of influence but it's more important right now to influence the government of Angola, despite the fact that they're in the right and they have a legitimacy to be willing to make concessions to bring about national unity and national reconciliation.

MR. LEHRER: Mr. Natsios, what's your view of that? I mean, did you come back with a solution in your hip pocket?

MR. NATSIOS: Well, I wish I did. In fact, the tragedy of all these civil wars is you come back and you wonder what to do. I agree --

MR. LEHRER: And you knew I was going to ask you about it.

MR. NATSIOS: I knew that, yes. Let me just mention two things to add to what Hank said, and that is, it's very clear, at least from my -- I was there two weeks ago. I went to Milange, which is one of the cities with the highest malnutrition rate. I was at the airport when it was being shelled. So I saw the war up close. It is very clear to me that no one is going to win on either side a military victory. And so a negotiated settlement is the only way that the war is going to end and the suffering is going to end. But most importantly from my perspective, the U.N. needs to follow the humanitarian negotiating principle of separating negotiations over humanitarian relief groups from the political negotiations, which is a rule that Hank and I always followed when I was in office. I negotiated the humanitarian roots. I spent a month in Angola in the bush and got both sides to agree to the roots. Hank did the political side of it, and we kept him separate, and by that method of negotiation we diminished the number of people who were killed while we were waiting for the political negotiations to succeed, and I think it's -- the U.N. seems to me to be a little confused about that now. We need to impress them to make sure they separate those sets of negotiations.

MR. LEHRER: Ms. Pauling, what's your view of what kind of pressure could be brought at this stage? Forget what -- the history up to this point -- but to solve it now, it's going to take some - - do you agree with Mr. Cohen, in other words?

MS. PAULING: I think the ambassador's point is certainly well taken, that the negotiations don't seem to actually be negotiations. I'm not sure to what extent Mr. Savimby or UNITA is there really in, in good faith. They've begun attacking cities, trying to improve their political advantage. Their military advantage was vastly improved during the whole elections preparation process because there was no de-mobilization. There was not sufficient disarming that went on, so that UNITA was able to, in fact, spread out more throughout the country. So we have a real problem. I do think though that serious talks must go forward. If we are not able, or if the parties are not able to resolve some of their differences in these talks, I think it's important that we find ways of enforcing an embargo. And while it might be more symbolic than it's not, it's important to talk with the parties in Zaire, in South Africa, in some of these areas that need assistance in helping to enforce.

MR. LEHRER: I hear you, and we have to go. Ms. Pauling, gentlemen, thank you. FOCUS - MEMO - STRANGE ALLIANCES

MR. MacNeil: Finally tonight, essayist Clarence Page of the Chicago Tribune has some thoughts about the growing political acceptance Minister Louis Farrakhan, leader of the Nation of Islam, received earlier this fall.

CLARENCE PAGE: To black Americans, it was historic, Jesse Jackson, NAACP Leader Ben Chavez, and Kweisi Mfume of the Congressional Black Caucus all sharing the stage with Louis Farrakhan, black America's No. 1, separatist. The event brought an old saying to my mind, "Politics makes strange alliances." Congressman Mfume said as much as he tried to explain it.

KWEISI MFUME, Congressional Black Caucus: [September] We want the word to go forward today to friend and foe alike. At the Congressional Black Caucus, after having entered into a sacred covenant with the NAACP to work for real and meaningful change, we'll enter into that same covenant with the Nation of Islam, the Rainbow Coalition.

CLARENCE PAGE: Still, it was difficult at times to tell how full this partnership was. Jesse Jackson avoided embracing Farrakhan, and he described the alliance in delicate terms, as "operational unity, not uniformity," which means, you agree when you can, he said, and you disagree when you must. And they do disagree still on quite a bit, but for today, the hatchet is buried. That is the deal. It all began last summer. Farrakhan was miffed that he was booked, then omitted, from last summer's big 30th anniversary civil rights march in Washington. Jewish leaders objected to his presence, and Farrakhan objected to their objections. In his newspaper, The Final Call, he blasted the black leaders who had caved into the Jews, in his view. One wonders why the nation's No. 1 black separatist was so eager to speak at a vast rally of integrationists. Black leaders could have ignored his attacks like Martin Luther King ignored the attacks of Malcolm X, but Mfume, Jackson, and Chavez did not, which shows how much things have changed for black leaders since the 60's. Other observers looked at this rapprochement between the spiritual heirs of Martin Luther King and the spiritual heir to Malcolm X and Elijah Mohammed and they saw it as a sign of hope. Pardon my skepticism but I viewed it as a sign of despair, a sign that mainstream black leaders have become desperate and somewhat confused over how to win back support that has eroded among young people, the young bloods, the hip hop generation that views traditional civil rights leaders as being ancient history, old hat.

SPOKESMAN: Are we ready to stop the killing?

CROWD: Yes!

CLARENCE PAGE: A national trend appears to be emerging. Some black ministers and politicians even have endorsed street gang leaders at gang summits held in Kansas City, Atlanta, Cleveland, Minnesota, and Chicago.

JESSE JACKSON: Embrace each other right now! Hug somebody! Love somebody!

CLARENCE PAGE: Gang leaders, some of them old enough to be grandfathers, said they wanted to help stop the violence among the young bloods. But again I have a problem. As eager as the gang leaders were to talk about violence, they didn't want to talk about the drugs gangs deal, which are, after all, the source of much of the violence. That point was beside the point, they said, and amazingly, the ministers and politicians didn't argue.

REV. BENJAMIN CHAVEZ, Executive Director, NAACP: I would like to call one of many brothers I've come now to respect with my life. I want Brother Nande Allejandes to come and give the initial statement, and then I will come.

CLARENCE PAGE: To stop the violence, some leaders reason, it is worth making a deal with the devil. It's hard for a black leader to compete in the age of Ice-T, Public Enemy, and MTV Rap.

RAPPER: You move on the ice and you're goin' to sleep --

CLARENCE PAGE: New militancy has ice on campus among black college students and on the streets among the ghetto poor. ["We Shall Overcome" being sung]

CLARENCE PAGE: The civil rights era is ancient history to this disaffected generation. For them, respect for Farrakhan seems to be growing and respect for integration waning, if they ever had any at all. For them, white liberals have turned conservative, no longer supporting black mayors in cities like Los Angeles, Chicago, even New York. Bill Clinton, wasn't he the guy who attacked Jesse Jackson and Sister Soulja? At a time when relations between blacks and whites should be getting better, they often seem to be getting worst, even so, I for one don't have too much faith in this new and rather odd coalition between integrationists and separatists, between ministers and street gang bangers. Whenever black Americans have made genuine progress, we have done it in coalition, in real working partnership with others. I think that coalition-building spirit still lives today. Unfortunately, it's pulse is weak. I'm Clarence Page. RECAP

MR. MacNeil: Again, the major story of this Wednesday, World AIDS Day was marked by efforts to help prevent the spread of the disease which now kills 90 Americans a day and infects 14 million people. Good night, Jim.

MR. LEHRER: Good night, Robin. We'll see you tomorrow night. I'm Jim Lehrer. Thank you, and good night.