By Andrew Manley
BBC Focus On Africa magazine
Gen Lansana Conte has ruled in name only in recent years, preferring to spend time in his home village of Wawa.
Conte is seriously ill through diabetes complications
And the vacuum that has opened during the most recent phase of the president's illness risks being filled by the powerful, self-interested players that have come to dominate government during the president's long decline.
The current situation can be viewed in terms of personal ambitions, ethnic tensions, or both.
The seemingly all-powerful secretary-general at the presidency, Fode Bangoura, took day-to-day control of the country while Conte was in Switzerland. It was Bangoura who took charge of the daily security meetings with army chief Kerfalla Camara and other officials.
Bangoura then strengthened his position in early April by sacking prime minister Cellou Dalein Diallo after an abortive government reshuffle in Diallo's favour.
This resulted in army elements storming the national radio station and Conte rescinding a decree that he may not have known much about in the first place.
The International Crisis Group (ICG) said the episode highlights the "fundamental decrepitude, verging on anarchy, at the centre of a government incapable of taking decisions".
Another key player in this widening vacuum is the country's richest man and figurehead of Conte's dominant Soussou ethnic group, Al Hajj Mamadou Sylla.
Guinea imploding at this point is in virtually nobody's interests
Accused by his enemies of using his close relationship with Bangoura to acquire a virtual stranglehold on what remains of economic and financial policy, Sylla is said to have more interest in economic stagnation than thoroughgoing reform of the kind the International Monetary Fund (IMF) desperately wants to see in place.
His will be a key voice in any upcoming reshuffle of an increasingly meaningless cabinet.
However, both Sylla and Diallo are opposed to the man who under the constitution steps in if Conté dies: Al Hajj Aboubacar Somparé, president of the National Assembly and founder member of Conte's ruling but badly fractured Parti de l'Unité et du Progrès (PUP).
Somparé is well regarded among Guinea's few patient outside partners. But, according to local pundits, he will be blocked by PUP hardliners and the Sylla faction, to whom he is a threat. If it came to this, Guinea's crisis of power would take a still more dangerous and personalised turn.
Meanwhile the three way ethno-political split between the dominant Soussou minority, the Malinke and the Peul of the north and centre, remains real enough.
The succession to Conte is the main question dominating the minds of those close to him - and ethnic tensions will be used in whatever way they feel most effective.
But for ordinary Guineans, daily existence has become a hard enough struggle as the decade has crawled on.
Even mid-ranking civil servants are finding it difficult to make salaries - when paid - stretch. And the continual slide of the Guinean franc against the US dollar has been aggravated in recent months, with rich individuals mopping up available dollars and driving the franc's street value down further.
The IMF has been trying to stabilise the economy for several years, stressing that implementing the most recent set of agreed economic measures is Conakry's only hope of moving towards completion point under the Heavily Indebted Poor Countries initiative, allowing the country's unsustainable external debt to be treated.
Senegal's President Wade has links to Guinea's opposition party
But the current government paralysis makes this as unlikely as ever in the short term.
Measures such as privatisation of public utilities will not occur until there is a solid succession to Conte.
However, so far, only career pessimists are talking of the country falling apart entirely.
But the potential for violent social disorder is real, especially given the increasingly ruthless struggle for power in a post-Conte era. The risk then would be of junior army officers stepping in, acting "in the interests of the nation" - and such a development would be viewed with alarm throughout West Africa.
Liberia, Sierra Leone, Senegal and Mali would all view their neighbour's descent into conflict with alarm, fearing destabilisation of their own governments.
There is already pressure behind the scenes on the key domestic players from France, UN officials and other diplomats to find a lasting settlement for the post-Conte era.
And late March saw a major roundtable which proposed an 18-month transition period after Conte, the hammering out of a new constitution, census and electoral register, and supervision of the whole stabilisation process by a panel drawn from the Economic Community of West African States, the African Union and the UN.
According to the coordinators of this "Forces Vives" initiative, the diplomatic reaction to their proposals has been enthusiastic. Guinea imploding at this point is in virtually nobody's interests.