Even if Boris Yeltsin recovers from his latest bout of heart trouble, he will now be under intense pressure to step aside. His inner circle seems likely to conclude that he is so enfeebled, both physically and politically, that the time has come to anoint a successor, albeit one who doesn't immediately assume the mantle. Russians still remember with embarrassment the long physical decline of Leonid Brezhnev; no one wants a repetition of that painful fiasco.
For the Kremlin ruling elite, this is a disaster. While a healthy and boisterous Yeltsin was in charge, they knew they could hang on to power, even if this meant pressuring him into flouting Russia's constitution and postponing next year's presidential elections - which he is currently far too unpopular to win. There would have been a nasty legal fight with his enemies, and some bleating from abroad, but he would have probably survived.
Without Yeltsin, the elections are more likely to go ahead, marking the first democratic transfer of executive power in Russia's 1,000-year history. Although the West will no doubt wax lyrical about the triumph of democracy, its leaders may be deeply disappointed with the results. None of the likely contenders are as pro-western as Mr Yeltsin, and several are hostile to Western interests.
Powerful forces are at work. Some of the Kremlin's inner circle have made enormous personal profits from Russia's stumbling progress towards privatisation, ill-gotten fortunes that they will be reluctant to forego. So they will be looking for a dealmaker, an heir who will discreetly agree to grant them immunity from prosecution, as well as their jobs.
But he will have to satisfy some tough, perhaps impossible, job requirements. He must try to win over an embittered and uninterested electorate, which shows very little enthusiasm for anyone supported by the current regime. Most Russians - including 40 million below the poverty line - have abandoned much hope that they will have any share in the spoils of market reform. Worn down by growing unemployment, drastic power shortages, falling living standards and rising crime, many hanker after the social protection that they used to enjoy under the Soviet system.
So it is no surprise that - to the alarm of the West - the rising powers in the land are Communists and nationalists. Polls show that an alliance of these two groups is likely to emerge with the most seats in December's parliamentary elections, which will be a crucial forerunner to the presidential poll. When he speaks publicly, the Communists' leader, Gennady Zyuganev, sounds like a moderate, intent on quashing corruption rather than interfering with the free market. But his followers include some unreconstructed Marxist- Leninists; no one can be certain that he would not turn out to be an old- style Soviet leader, were he ever to rise to power.
Yet at present he is more popular than anyone the Kremlin is likely to come up with. Their list includes Viktor Chernomydrin, the prime minister and former chairman of the state gas monopoly Gazprom, and the West's favoured choice, largely because he is deemed to be moderate. But there are few indications that he would win, and he is hated by powerful figures within Mr Yeltsin's inner circle - notably, his head of security, Alexander Korzhakov.
A candidate with more chance of success would be Yuri Skokov, a tough- spoken wheeler-dealer from the military-industrial complex. He has the nationalist credentials to appeal to current public taste. He is also working alongside Alexander Lebed, the highly popular former army general whom some Russian analysts say could command up to 10 million votes.
The two are seeking to cash in on the country's sense of national humiliation, and to steal some of the thunder from the ultra-nationalist Vladimir Zhirinovsky. With his exploits (including brawling with a woman in parliament) and wild demands to annex Alaska, Mr Zhirinovsky seems to be fading in popularity. But no one has yet written him off.
As the runners and riders line up to fill the presidential shoes, the West looks on nervously from the sidelines. "What we want is stability," said one Western diplomatic source. "We can deal with any of these people, if we have to, so long as the country remains stable." That may prove to be no easy goal; the country is littered with potential flashpoints.
Not the least of these is the vast Russian army which is still grieving the loss of its imperial status. Its rank and file are ill-equipped, under- fed, demoralised, and frequently unpaid. They watch in horror as the West blithely discusses expanding Nato to Russia's borders while the top brass in Moscow do little more than bluster and dither. The disastrous and inconclusive war in Chechnya, in which young Russians found themselves bombing their own nationals, has made matters even worse.
But the level of resentment among ordinary Russians is also running high. Earlier this week, the Moscow newspaper Kuranti conducted a poll to try to find out if people are now so angry and frustrated with life that they would be willing to take to the streets. The results reflected a deep level of general gloom.
The sample of 2,392 Russians was asked whether they thought "mass protest actions" against price rises and the low standard of living were a possibility. More than half, 57 per cent, thought it was unlikely, but 27 per cent - a far larger larger slice of society than ever actively participates in any riot or violent revolution - saw it as "quite possible". The crown is unlikely to sit comfortably on the head of Mr Yeltsin's successor, no matter who that may be.