In the isolation of a Washington, D.C., office building, with a small team of acolytes, Elon Musk is dismantling the civil service and fulfilling an old dream. Deep within the folds of the Western brain resides a yearning for a savior: a master engineer who imposes reason and efficiency on the messiness of modern life, who can deploy his acumen to usher in a golden age of abundance and harmony. This is a fantasy of submission, where the genius takes charge.

Given American conservatives’ recent rhetoric, their surrender to Musk’s vision of utopia is discordant, to say the least. Ever since the pandemic, the MAGA movement has decried the tyranny of a cabal of self-certain experts, who wield their technical knowledge unaccountably. But even as the right purports to loathe technocracy, it has empowered an engineer to radically remake the American state in the name of efficiency.

Trumpists might be surprised to know that they are fulfilling a dream first conceived by a 19th-century French crank, Henri de Saint-Simon. A utopian polymath who fought in the American Revolution and claimed to be a descendant of Charlemagne, he imagined a society in which engineers and industrial managers usurped the aristocracy at the top of the pecking order. The ruling cadre of engineers, he theorized, wouldn’t just solve social and economic problems, but serve as high priests, guiding society to efficiency, progress, and harmony. Technocracy and spirituality were intertwined in his doctrine, which he called the “New Christianity.”

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In the last years of his life, Saint-Simon struggled to find a publisher for his books. His despair led him to shoot himself seven times in the head, a failed suicide attempt. Only after his death, in 1825, did he win cultlike devotion; his wider influence became unmistakable. Scholars dubbed him the “father of socialism,” and his veneration of the engineer ricocheted through the history of the left, especially in its faith in centralized planning. “Master technology,” Stalin famously implored his followers. “It is time that the Bolsheviks become experts.” (Eventually, Stalin murdered and imprisoned those who followed this command.)

The worship of the engineer is not confined to any single strain of ideology. It’s a modern impulse, and even ardent critics of the state have fallen victim to it. In Atlas Shrugged, every high-school libertarian’s favorite novel, Ayn Rand’s heroic protagonist, John Galt, is an engineer whose solitary capacity for invention and heterodox thinking make him a sort of über-mensch. And there are hints of this same heroic self-conception in the right-wing swatches of present-day Silicon Valley. Engineers are prophets of a new order because they promise inventions that will usher in the purest expressions of freedom: realms (cryptocurrency, space colonies) that are beyond the reach of the state.

One pivotal figure in American political history briefly embodied the noblest aspirations for technocracy—President Herbert Hoover, nicknamed the Great Engineer. After training at Stanford, he made a fortune in the mining business. Hoover believed ardently in scientific management: Any procedure could be simplified through studying the data. By monitoring workers, the engineer could cull waste from the productive process. Born a Quaker, Hoover delivered lyrical descriptions of his life’s work, which aren’t so far from Saint-Simon’s faith. Where other occupations were “parasitic,” in Hoover’s view, the engineer was the handmaiden of a humane social order because he “elevates the standards of living and adds to the comforts of life.”

[Tom Nichols: Trump and Musk are destroying the basics of a healthy] democracy

At his best, Hoover’s technocratic skills were something to behold. He was a genius at orchestrating responses to catastrophes; his coordination of food and supply shipments in Europe during World War I became the basis for his political mystique. Progressives were so enamored of his work that they desperately hoped he would run for president as a Democrat, so that they could preside over a new era of rational, well-organized government. Franklin D. Roosevelt, a fan before he became a foe, tried and failed to draft Hoover to run as his party’s standard-bearer in 1920.

Elected as a Republican in 1928, Hoover was in the White House when the nation’s economy collapsed. History regards him with disdain, less for his policies than for his distinct lack of warmth and his disregard for human suffering. He treated food distribution as an engineering problem, yet he never managed to describe victims with compassion. According to his biographer Joan Hoff Wilson, “They all became statistics—by the same impersonal scientific engineering approach and temperament that was to shock and dismay his fellow Americans during the Great Depression and erode his political credibility with them.”

The problem with applying scientific management to the government is its hollow heart, as the former auto executive Robert McNamara later showed to horrifying effect. As the secretary of defense, he presided over the escalation of the Vietnam War in the 1960s, deploying a data-driven approach that rendered casualties in the vernacular of statistics. (McNamara didn’t train as an engineer, but he self-consciously employed the mindset.) In his enthusiasm for optimization and efficiency, he paid no heed to the terrible human toll of his immaculate systems.

[Read: Trump advisers stopped Musk from hiring a noncitizen at DOGE]

In a far more benign way, Jimmy Carter, the only other engineer to become president, struggled to form human connections with the public. As the New York Times columnist Tom Wicker put it, he used an “engineer’s approach of devising ‘comprehensive’ programs on this subject or that, but repeatedly failed to mobilize public opinion in their support.” Carter’s brain was ill-equipped to process the irrationality of politics.

Despite this history of failure, Americans haven’t shaken the hope that some benevolent, hyperrational leader, immune to the temptations of political power, will step in to redesign the nation, to solve the problems that politicians can’t. That hope is unbreakable, because American culture invests engineers with the aura of wizardry. This is true for Elon Musk. For years, the media glorified him as a magician who harnessed the power of the sun, who revived the American space program, who rescued the electric car. Given that hagiographic press, some of it deserved, he could easily believe in his own ability to fix the American government—and think that a large chunk of the nation would believe that, too.

But in his short stay in Washington, Musk has already evinced the same moral shortcoming that afflicted Hoover and McNamara, the same inability to calculate the costs of cruelty. He has casually paused global aid programs that alleviate suffering; he has moved to destroy bureaucrats’ careers without concern for the rippling personal consequences. He has done this with an arrogance suffused with the spiritual self-certainity of Saint-Simon’s priestly caste of engineers. To a brain as rational as Musk’s, democracy is waste and inefficiency. The best system is the one bursting forth from his mind.

Hundreds of protesters demonstrating against Israeli Prime Minister Benjamin Netanyahu’s visit to the White House.

Demonstrators gather outside White House to reject Israeli PM's visit and Trump's call for forced displacement in Gaza.

As Elon Musk set out to upend the federal bureaucracy on behalf of Donald Trump, he reached out to Trump’s team with an unusual request: U.S. law generally prohibits noncitizens from working for the federal government, but Musk was hoping to make an exception for Baris Akis, a Turkish-born venture capitalist with a green card who had become a close ally.

The answer, delivered privately by Trump’s advisers, was an unequivocal no, two people familiar with the decision told us.

Trump’s White House is in the business of deporting people, and bringing in a foreign national to help shrink the government’s American workforce would send a confusing message, one of these people said. (Neither Akis nor the White House responded to a request for comment.)

Musk and his team accepted the rejection and moved on, but the previously unreported exchange offers a glimpse into the complex dynamics of the Musk-Trump relationship, arguably the most consequential partnership in Washington. This story is based on interviews with six people who have worked closely with Trump or Musk or are directly familiar with their relationship, all of whom requested anonymity to describe private interactions.

The world’s richest man has established himself as a singular force in the administration’s effort to slash government programs, agencies, and federal employees. Yet as an unelected “special government employee,” Musk still relies on the president for his authority. Since sweeping into Washington alongside Trump, Musk has wielded enormous power. He has pressured federal employees into deferred resignations; dug into government data and financial systems; used his massive social-media platform, X, to pick fights and bully opponents; and fed the U.S. Agency for International Development “into the woodchipper,” as he boasted yesterday on X, or at least helped get the agency folded into the State Department. He believes that understanding and mastering the government’s computer systems is the key to overhauling and fixing the government. But he does so at Trump’s behest, at least for as long as he has the president’s blessing.

Trump has made a point in recent days of making clear his supremacy over Musk, and Musk, for all his influence, has found himself bending to the strictures of the White House. Musk’s private security team, for instance, must wait in the parking lot at the 1600 Pennsylvania Avenue campus when he goes to work in a conference room at the Eisenhower Executive Office Building because of the building’s own security protocols, one of the people familiar with the arrangement told us.  

“Elon can’t do and won’t do anything without our approval. And we will give him the approval where appropriate, and where not appropriate we won’t,” Trump said yesterday during a signing event in the Oval Office. “Where we think there is a conflict or there’s a problem, we won’t let him go near it.”

On Sunday, Trump exited Air Force One after arriving in Washington from Palm Beach, and praised Musk as a “cost-cutter” who was “doing a good job,” before establishing the hierarchy: “Sometimes we won’t agree with it, and we’ll not go where he wants to go.”

Trump’s somewhat pointed comments on Musk “are important,” a longtime Trump confidant told us, explaining that “there’s one president.” This person said that Trump had learned about how to work within the government during his first term, but “that’s not true of Elon.”

But Musk nonetheless has threatened to steal the spotlight from Trump in recent days, becoming the public face of the administration’s most disruptive moves, including an effort to force thousands of voluntary resignations from the federal workforce. Inside the West Wing, he has found many allies, having ingratiated himself with mid-tier Trump aides early in the transition, when he moved down to Trump’s private Mar-a-Lago club and established himself as an accessible, if quirky, presence. He regularly shared his cellphone number, including with younger staff, and spent his days sending around memes and ideas about overhauling the government, according to a person who saw the texts but who was not authorized to speak publicly.

Musk has a group of loyalists he often brings with him to each of his various government projects—a cadre Trump today praised as “smart people.” But, unlike many people with his net worth and renown, Musk “travels pretty light,” one person told us. Two people told us that, during the time he spent at Mar-a-Lago, they most regularly saw him with his young son X—“just that kid on his shoulders,” one of the people said—and sometimes X’s nanny.

Musk preempted Trump shortly after midnight Monday in a live broadcast on X with the announcement that the Trump administration would seek to shutter USAID based on his own team’s investigation of the agency. “As we dug into USAID, it became apparent that what we have here is not an apple with a worm in it,” Musk said. “What we have here is just a ball of worms.”

And he has continued to pick public fights with Democratic leaders despite his new day job as a government employee. He accused House Democratic leader Hakeem Jeffries of wanting to continue “waste fraud and abuse” after Jeffries attacked Musk’s leadership of Trump’s Department of Government Efficiency, which operates as a part of the Executive Office of the President. Musk also wrote on X that Senate Democratic leader Chuck Schumer was mad about his work “dismantling the radical-left shadow government.”

Musk’s decision to seek a special dispensation for a noncitizen adviser came after the Tesla CEO’s views on immigration policy became a flash point inside the president’s circle late last year. When Musk defended the practice of giving H-1B visas to highly skilled foreign workers, Trump allies including Steve Bannon attacked Musk as part of a group of “techno-feudalists” undermining American workers. Trump had previously been critical of the H-1B visa system, but eventually sided with Musk in the dispute. Musk also moderated his stance, calling for “major reform” to how the visas are granted.

Democrats, who have struggled to respond effectively to Trump in the first weeks of his second term, have become more focused on Musk as a potential weak point for the president, as polling has shown significant public concern about Musk. A late-January poll by Quinnipiac University found that 53 percent of voters disapproved of him playing a prominent role in the Trump administration, compared with 39 percent who approved. About one in five Republican voters disapproved of Musk’s role.

Because of his special-government-employee status, Musk’s time in government is expected to be limited. Employees under this status, who do not have to divest from outside conflicts of interest, are permitted to work no more than 130 days in a single year. Other members of Musk’s team, including Katie Miller, a Department of Government Efficiency adviser, are also working for the government under the temporary designation. (Musk is also close to Miller’s husband, White House deputy chief of staff Stephen Miller.)

Musk’s preferred work habits before entering the federal bureaucracy could provide a window into how he might continue to feed “into the woodchipper” programs and spending that he views as Washington bloat. During his time in the private sector, Musk tended to burrow into each of his companies on different days, a person familiar with his routine told us. Monday was for SpaceX, Tuesday was for Tesla, and Wednesday was for X.

This week, Sunday and Monday were clearly for USAID. By tomorrow and Thursday, however, he might be ready to turn his buzz saw elsewhere.

President Donald Trump, who campaigned on a promise to put America First, just proposed the wildest and most improbable intervention by the United States in overseas affairs since the invasion of and occupation of Iraq, more than 20 years ago.

At a joint press conference with the Israeli prime minister, Benjamin Netanyahu, Trump promised that the U.S. would become the occupier of Gaza.

“The U.S. will take over the Gaza Strip and we’ll do a job with it too. We’ll own it,” Trump said. “I do see a long-term ownership position, and I see it bringing great stability to that part of the Middle East, and maybe the entire Middle East.” Trump suggested that U.S. troops would be used, if needed, to implement his vision for Gaza.

He presented this idea, one never before suggested by a U.S. president or Middle East peace negotiator, as a way to end generations of conflict between Israel and the Palestinians and, also, as a bonus, an opportunity to create sweet real-estate development opportunities. The idea was breathtaking in its audacity, and it would be fair to say that its implementation would run into myriad obstacles at home and abroad, except that the overwhelming likelihood is that the U.S. would never come near implementing this notion.

Trump’s proposal to displace 2.2 million Palestinian residents from their homes, which he expanded on today, has already angered  the Arab world. A direct American intervention in Gaza would radically expand the U.S.  footprint in the Middle East, giving it possession of a territory devastated by 15 months of fighting between Hamas and the Israel Defense Forces, ignited by the Hamas attack on Israel on October 7, 2023. And it could further destabilize a region never known for its stability.

Trump, as is his practice,offered few details as he outlined the expansive idea at a White House press conference, standing next to a smiling Netanyahu.

The president—who has long been vociferously opposed to U.S. military intervention abroad—did not rule out sending the American military to secure Gaza while it was being rebuilt. Asked if U.S. troops would be deployed, Trump said that “we’ll do what’s necessary. … We’ll take it over and develop it.”

The plan would permanently remove Gaza’s residents from Palestinian territory and settle them outside of their land. Trump did not specify where homes for the new refugees might be found, though he again repeated his desire for Egypt and Jordan to take in Gaza’s residents. Both of those nations have firmly declined, their leaders quietly panicking, according to regional diplomats, at the thought of Trump forcing them to take radicalized Palestinians as refugees.

The displacement would presumably be met with outrage across the region. Palestinians, like Israelis, want to stay on their land. Neighboring Arab nations—even those with close U.S. ties—would not want to abet an Israeli expulsion of Palestinians from the strip. The Saudi foreign ministry released a statement offering its “unequivocal rejection” of any attempt “to displace the Palestinian people from their land.”

A ceasefire took hold in Gaza just before Trump took office, bringing a tentative halt to a conflict that has reportedly killed more than 20,000 Palestinian civilians and as many as 20,000 Hamas militants, leveled much of the strip, and created a devastating humanitarian crisis. Trump’s plan would pull the United States even more deeply into the conflict by taking over the territory, which has been fought over since Egypt occupied it in 1948.

The region has already been reshaped by Israel’s response to the October 7 attacks that killed nearly 1,200 people and saw another 250 taken hostage. Israel has pummeled Hamas, destroying its leadership, and also delivered devastating blows to Hezbollah in Lebanon. Combined with the collapse of the Assad regime in Syria, the events of the past year have left Iran more isolated than it has been in decades, and Trump today ordered the return of the “maximum pressure” campaign to sanction Tehran.

Trump’s Gaza plan, were it to be carried out, would appear to be a remarkable win for the far-right members in Netanyahu’s governing coalition, who have longed for permanent Israeli expansion into both Gaza and the West Bank. Netanyahu—a longtime Trump ally, and the first foreign leader to visit the White House in the president’s second term—suggested he was open to the idea, noting that Trump “sees a different future for that piece of land.” He added: “It’s worth paying attention to this. We’re talking about it. It’s something that could change history.”

One White House official told me that Trump’s comments were not a spur-of-the-moment suggestion but reflective of a newfound, post-election confidence that he could put together the ultimate deal and change decades of history.

“Look, the Gaza thing has not worked. It’s never worked,” Trump told reporters. “I think they should get a good, fresh, beautiful piece of land, and we get some people to put up the money to build it and make it nice and make it habitable and enjoyable.” Trump has been buoyed by two first-term Middle East initiatives that Washington experts said would have devastating consequences for U.S. national security, but did not: The decision to move the U.S. embassy in Israel from Tel Aviv to the capital, Jerusalem, and the order to assassinate the Iranian Quds Force leader Qassem Soleimani.

Trump—who also has been publicly and privately musing about winning a Nobel Peace Prize—has been known to first take an outlandish position and then move to a more moderate stance. Sometimes there is a method to his madness, and sometimes there is simply madness in his madness. World leaders, from Denmark to Panama to the Middle East, have spent the past two weeks trying to discern the difference.  

“It occurs to me that Trump may have floated this idea to raise the stakes after Arab countries refused his request to take in Palestinians,” Mark Dubowitz, CEO of the Foundation for Defense of Democracies, wrote on X. “Now, he’s cranking up the pressure: If you won’t take them, we’ll remove them ourselves and take control of Gaza. Classic Trump: Go to the extreme, making what once seemed outrageous suddenly look like the reasonable middle ground.”

Whatever motivated Trump’s comments, his proposal remains a repudiation of the principle of national self-determination, which has been a cornerstone of U.S. foreign policy for more than a century, albeit one that has been imperfectly honored.

Any direct U.S. intervention in Gaza would fly in the face of Trump’s long-standing desire to disengage from foreign entanglements; he began negotiations to withdraw U.S. forces from Afghanistan, wants to slash aid to Ukraine and has threatened to abandon military positions in Korea, Europe, and Syria. And it may face pushback from at home from some usually reliable allies.

“I think that would be an interesting proposal,” Senator Lindsey Graham told reporters on Capitol Hill after Trump spoke. “We’ll see what our Arab friends say about that. I think most South Carolinians would probably not be excited about sending Americans to take over Gaza. It might be problematic.”

The plan also, ultimately, was at least a little bit about real estate. Trump remains a developer at heart, and his son-in-law Jared Kushner said last year that Gaza’s “waterfront property could be very valuable” and that Israel should remove civilians while it “cleans up” the strip. The president today suggested that the appeal of Gaza’s beachfront property would be a draw for the strip’s future inhabitants, whether or not they be Palestinian, when asked whom he imagined living in the rebuilt region.

“I envision world people living there,” Trump declared. “The Riviera of the Middle East.”

It took the Trump administration—and, really, Elon Musk—all of 10 days to dismantle USAID, the world’s single largest humanitarian donor. On January 24, a memo from the State Department ordered virtually every foreign-assistance program funded by the United States government to halt work for 90 days. Four days later, the State Department said that lifesaving humanitarian assistance should continue, and that special waivers could be granted to select programs. Nevertheless, soup kitchens stopped handing out food, clinics suspended care, and truckers paid through aid programs stopped delivering medicine.

Then came the purge. Early yesterday morning, the Department of Government Efficiency, a Musk-led group that has been announcing what stays and goes in Washington, told employees not to come to work. Musk posted on X an hour later, “We spent the weekend feeding USAID into the wood chipper.” More than 1,000 employees—including some in war zones—were locked out of their work accounts. Earlier today, Politico reported that nearly all of USAID’s Washington-based staff will soon be placed on leave, and ABC News reported that staff on foreign assignments are being evacuated.

USAID, which has distributed aid to hundreds of millions of people around the world for 60 years, estimates that it has extended children’s life expectancies by six years in many of the countries it works in. But its $40 billion in annual spending—about 0.7 percent of the U.S. budget—has been criticized for inefficiencies, and many Americans accuse the government of spending too much on foreign aid. Some of those critiques are arguably fair. In 2022, for example, USAID spent more than $100,000 on theatrical productions in Ireland and Colombia. (That said, Americans also tend to drastically overestimate the amount we spend on foreign aid.) USAID was established by Congress as an independent agency, and by law, only Congress can dissolve it. The White House, though, seems determined to do away with it as an independent agency; yesterday, Secretary of State Marco Rubio announced that he is now the acting head of USAID. If the agency is successfully subsumed by the State Department, it could, in theory, continue in a slightly diminished form—or be totally gutted. When reached for comment, a State Department spokesperson referred me to Rubio’s recent statements to the media. One of them read: “USAID may move, reorganize, and integrate certain missions, bureaus, and offices into the Department of State, and the remainder of the Agency may be abolished consistent with applicable law.”

So far, the administration has framed the foreign-aid pause as temporary. But even if much of USAID’s work is allowed to resume in a few months, the intricate global-health ecosystem being torn apart will not be easily repaired. Famine and disease—two of the issues against which USAID has made the most progress—don’t stop when funding does, and can spread disastrously in even a short window. Prior to the stop-work order, at least 220,000 people worldwide got their HIV medication every day at clinics supported by the U.S. government. Juli Duvall-Jones, who oversees an HIV clinic in eastern Ivory Coast, told me that the pregnant women her clinic serves are no longer receiving their daily treatment, meaning that some children will almost certainly contract HIV during birth or through breastfeeding. People who are exposed to HIV have only 72 hours—less than the amount of time many clinics have now been closed—to begin a medication regimen called post-exposure prophylaxis that can help prevent infection. A pause of any length in USAID-funded anti-HIV efforts will cause more people to contract the disease. Missing doses of treatment can make it less effective. Without treatment, the disease kills young people in about 12 years, and older adults even faster.

[Read: Melinda Gates on why foreign aid still matters]

The head of one aid group, who, like several aid workers I spoke with, asked that neither she nor the group be named for fear of permanently losing their USAID funding, told me that her organization—which, among other projects, treats severely malnourished children and babies in Sudan—is now scraping by on money diverted from other projects. Most aid efforts operate on extremely thin margins, so any pause in funding is felt almost immediately. “We can sort of keep it going for a few days,” she said. But once the money runs out, these children will lose the supplemental oxygen, fortified foods, and 24/7 medical supervision they need. Many, she said, will die in two to six hours.

As the 90-day pause drags on, longer-term consequences will start to become clear. In Uganda, the national government has stopped spraying insecticide and distributing bed nets to pregnant women and young kids; during the country’s next rainy season, which spans from March to May, malaria cases and deaths may spike. The Center for Victims of Torture, a global nonprofit, has furloughed most of its staff and stopped rehabilitation programs in Jordan, Uganda, and Ethiopia, including one for women among the estimated 100,000 raped in a recent war in Tigray, Ethiopia. Scott Roehm, CVT’s director of global policy and advocacy, told me that many of the center’s clients attempted suicide prior to getting help. He fears what will happen to people who have to stop their treatment—and those who never get help at all.

Right now, it seems unlikely that all or even most of USAID’s programs will resume at the end of April. Yesterday, Donald Trump said Ukraine should give America its lithium in exchange for aid, suggesting that programs that don’t give the U.S. an immediate win may be cut for good. The longer the pause lasts, the more devastating the effects will be, not just for aid recipients but also for Americans. The Famine Early Warning Systems Network, a monitoring tool funded by USAID, has been offline since Friday. Without it, aid workers may struggle to intervene early enough to prevent mass starvation, and farmers have lost a major tool for anticipating agricultural shocks. Michael VanRooyen, an emergency physician who has led humanitarian work in Darfur, Rwanda, and Ukraine, estimates that an extended pause in food aid could kill hundreds of thousands of people, many of them children. USAID workers leading the agency’s response to an active Ebola outbreak in Uganda were among those locked out of work systems. Without their involvement, the U.S. could miss signs that the outbreak is growing or changing—or even that a new pandemic is brewing.

Democratic lawmakers have started pushing back on the demolition of USAID. Yesterday, Brian Schatz, a Democratic senator from Hawaii, said in a statement that “dismantling USAID is illegal and makes us less safe,” and placed a blanket hold on nominees for State Department positions until USAID is back up and running.

[Read: The constitutional crisis is here]

But if the agency is restored—next week, next month, or years from now—restarting its work won’t be as simple as turning the flow of cash back on. After the week USAID has had, staff might be hard to come by. According to one group of development workers tracking the fallout, the aid freeze has caused nearly 9,000 Americans and far more people around the world to lose their jobs. Many may decide to pursue work outside the humanitarian sector, which typically offers low pay and benefits. Even if the pause ends quickly, the federal government has given workers little incentive to return. Musk has called USAID “a criminal organization,” “a ball of worms,” and a “viper’s nest of radical-left Marxists who hate America.”

Whoever does come back to work will need to get back in touch with the people who lead local organizations (many of which have or will have gone defunct), the world leaders with whom they once partnered, and the people who shuttle supplies around the world. Susan Reichle, a foreign-assistance expert who served in every presidential administration from George H. W. Bush’s to Trump’s first term, told me that the pause has already broken trust that could take years to repair. “USAID staff are having to meet with ministers of health, ministers of power, ministers of education” to tell them that work has stopped, Reichle said. “And they can’t tell them if or when those partnerships will ever continue.”

Having a measured, humane debate about the way the U.S. distributes humanitarian aid is possible. It is in the country’s interest to spend aid money effectively. And the way the United States distributes global aid could certainly be improved. But the instant retraction of much of the world’s food and health-care infrastructure will create damage that cannot be undone. After three months, “many of those people will be dead, or so severely harmed and malnourished that it causes them irreversible and deep suffering,” Lawrence Gostin, the faculty director of Georgetown’s O’Neill Institute for National and Global Health Law, told me. A pause on saving lives means exactly that.