Is Duterte dying?

Visibly fatigued by the high demands of public office and openly frustrated by rising opposition to his authoritarian style, Philippine President Rodrigo Duterte has in his own words become a “lame duck” leader less than halfway through his term.

In recent weeks, the 73-year-old leader has frequently fallen from public view, including at the height of tropical storms which battered much of the capital Manila and surrounding provinces, and forced tens of thousands to flee their homes for emergency shelters.

It is the type of crisis Duterte would have previously leveraged to populist effect, by personally distributing aid and meeting with victims. His absence has raised new concerns about the president’s health, with unconfirmed reports he has secretly sought medical treatment either abroad or while at home in the southern city of Davao.

Duterte, the oldest ever sitting Filipino president, has openly acknowledged he suffers from several challenging though not necessarily fatal health conditions which some speculate may have cumulatively affected his daily work routine.

Those ailments include Buerger’s disease, a rare condition that causes swelling of the arteries and veins in the arms and the legs. Symptoms from the ailment previously caused him to stop smoking, while a cardiopulmonary doctor is now known to frequently check his heart. The president has also said he suffers from frequent migraines and relies on an oxygen concentrator to sleep at night.

Duterte has recently fueled speculation of his deteriorating health by repeatedly suggesting he may resign from the presidency. During an August 14 speech, Duterte suggested he may step aside due to his government’s failure to stem the illegal drug trade and endemic corruption at state agencies.

In the speech, Duterte said he would willingly “step down and retire” if “the military and the police find the right successor.” Emphasizing the gravity of the country’s many governance challenges, Duterte maintained that only the armed forces “can control the situation” or otherwise “everything breaks loose.”

The Philippine defense establishment, which has been significantly professionalized over the past decade after a long history of coup attempts and other strong-armed political interventions, shot down immediately the prospect of establishing a junta to replace Duterte.

Defense Secretary Delfin Lorenzana dismissed Duterte’s suggestion as a “joke” reflecting the president’s “frustration over the slow pace of the reforms he wants for the country.” He reiterated that the armed forces and police “will obey and defend the constitution” in any early succession scenario.

Under the current constitution, Duterte’s single six-year term ends in June 2022. In the event of Duterte’s early resignation, for health or other reasons, incumbent Vice President Leni Robredo would legally assume the national leadership.

Some analysts suggest tongue-in-cheek that Duterte would need to be on his literal deathbed to accept such a scenario. Duterte has repeatedly questioned the competence and legitimacy of Robredo, who functions as the opposition’s leader with pockets of support from the upper house Senate.

That likely explains why Duterte has expressed his strong preference for political ally and ex-vice presidential candidate Ferdinand Marcos Jr, who is currently contesting his 2016 election defeat to Robredo at the Philippine Supreme Court. So far, however, that legal challenge seems unlikely to succeed.

A Robredo-led administration could prioritize political revenge and judicial retribution, namely for Duterte’s widely-condemned and possibly illegal drug war, which has killed thousands in extrajudicial fashion since its launch in mid-2016.

Duterte and his allies have stood by as many as 4,000 police killings, claiming in all cases drug suspects shot first at law enforcement officers who fired back in self-defense. Thousands of other killings have been perpetrated by presumed state-linked vigilantes.

The Hague-based International Criminal Court is expected to begin full “investigations” in the coming weeks after an “examination” into allegations of crimes against humanity perpetrated in the drug war. Duterte has said any ICC investigators who attempt to enter the Philippines will be “fed to the crocodiles.”

While such bravado plays well with many nationalistic Filipinos, Duterte’s consistent deadly threats and frequent use of vulgar language have hit the country’s international standing and credibility, while raising widespread questions, including in diplomatic circles, about the leader’s mental health.

Duterte has acknowledged a previous addiction to prescription pain killers, namely fentanyl, a powerful opioid which he first started using after a motorcycle accident that injured his back, the New York Times reported. The drug is often abused for recreational purposes. It’s not clear if the national leader is currently using any pain or other prescription medication that could explain his often erratic behavior.

Yet many observers recently noted Duterte’s frail and darkened features before he most recently fell from public view. Jose Maria Sison, Duterte’s former college mentor and the leader of the country’s outlawed communist movement, even claimed in press remarks published on August 20 that Duterte had recently been in a coma.

The presidential palace released a denial to the exiled rebel’s claim. In damage control mode, Bong Go, the president’s consigliere, released a supposedly live video showing the president in good health and spirits. In the short Facebook live video, Duterte defensively and obscurely states, “How can you be comatose when you’re with a beautiful lady?”

Such humorous clips are unlikely to dispel the growing concerns over Duterte’s viability to remain in office.

Indeed, Malacanang officials are now exploring the possibility of an official presidential vacation, a hitherto unheard of proposal for a sitting president. More seriously, they are also considering to suspend issuing regular medical bulletins on the president’s physical condition, as is mandated by the constitution.

Those moves are causing political ripples, presumably in anticipation of Duterte’s possible early departure. His anxious allies are now scrambling for alternative power centers, including most notably Duterte’s own daughter, Sara Duterte, the charismatic 40-year-old mayor of Davao City.

Sara recently launched a new political party, Hugpong ng Pagbabago (HNP), which has attracted the support of most major political parties, including the oligarch-backed Nacionalista Party, the Nationalist People’s Coalition and National Unity Party.

Several leading political figures — including members of the Marcos clan, former presidents Gloria Macapagal-Arroyo and Joseph Estrada, and several prominent senators — have signed on to or aligned with the newly-created Duterte family party with an eye towards a possible sooner-than-expected dynastic succession.