Warning: the Surgeon General may be good for your health - C. Everett Koop reports on AIDS

Washington Monthly, March, 1987 by Paul Glastris

Most of Koop's associates tolerated the arrogancethat came with Koop's compassion. They greatly admired him, but his bellicose style led to incidents of cruel insensitivity. He once encountered a woman at a party holding an infant. "Thanks for not having an abortion," Koop told the woman. The child was not hers, and she had had an abotion. Robert Kettrick, senior anesthesiologist at Children's, who assisted Koop hundreds of times in the operating room, says this arrogance results in part from "too many years in the university." His rhetorical combativeness is typical of academics, explains Kettrick, "but in Chick Koop's case, it came with a desire to then demonstrate his mastery of the subject and the dominance of his logic. He like to play academic bully, as if to say, 'I'm right, I've studied the issue, I know the standard retorts and where all the weak spots are in your arguements, and I'm going to eat you up.'"

As a surgeon, Koop's skills were universallyrespected. Indeed, at times during his career, Koop has been accused of saving too many lives, including those of children with birth defects, on whom other surgeons couldn't--or, for the sake of the children, wouldn't--operate. "I believe there are times nature has made a mistake and nature should be allowed to correct that mistake," says Dr. Audrey Evans, head oncologistt at Philadelphia's Children's Hospital. "There are some children born with such severe defects that they will never be useful citizens in society," she explains. To Koop, to allow such "quality of life" concerns into the medical decision process not only defies the word of God but is--like abortion--a first step onto the slippery slope of the kind of utilitarian ethics that led to Nazi death camps.

It would be hard to exaggerate the strength ofKoop's conviction on these matters. It arose in part from his work. "[N]o family has ever come up to me and said: 'Why did you work so hard to save the life of my child?'" Koop wrote. "And no grown child has ever come back to aske me why, either." But it is also a matter of religious faith. For more than 30 years Koop had been a member of Philadelphia's conservative, evangelical 10th Presbyterian Church.

But those who worked with him say his insistenceon preserving life when possible was always tempered with reason. "Chick Koop didn't try to extend a life at any cost," says Kettrick. "He knew when to give up. I never had the agonizing deaths with his patients that I did with patients of some other surgeons. I never saw him pushing life at any cost or for any cause."

For the first few years of his tenure, Koop gavelittle reason for his critics to think they'd been wrong. He raised some eyebrows by donning the uniform of the Public Health Service, the first surgeon general to do so regularly in years. True, only a few months after his confirmation, Koop came out with his first surgeon general's report on smoking, which The New York times described as "one of the strongest indictments of cigarettes since the landmark federal report on smoking 18 years ago." But a surgeon general warning that cigarette smoking is harmful to your health was not exactly breaking new ground.