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

Washington Monthly, March, 1987 by Paul Glastris

Then, in 1982, there was the troubling BabyDoe case, which hinted that Koop's right-to-life dogmatism would guide his thinking as surgeon general. Though doctors could do nothing about the newborn infant's Downs Syndrom and its inevitable mental retardation, they could correct life-threatening problems such as an underdeveloped esophagus. On the advice of one physician, and over the objections of two others, the parents decided to forgo treatment. The nursing staff rebelled. Pro-life groups protested. Several families offered to adopt the child. An Indiana judge ruled in favor of the parents' right to take their physician's advice. Seven days after its birth, the child died.

The Baby Doe case made the front page ofnewspapers across the country. Influential members of pro-life groups leaned on their White House contacts. Soon, HHS issued regulations that set up toll-free hotlines for reporting Baby Doe-type cases to HHS, created federal "Baby Does squads" to investigte tips, and threatened to hold hospitals receiving federal funds in violation of civil rights laws if they withheld treatment from handicapped newborns.

Although Koop was consulted in the draftingof those regulations, and defended them publicly, his major invilvement didn't begin until after the birth in 1983 of an infant that had spina bifida and other complications and was dubbed "Baby Jane Doe." "We're not just fighting for this baby," Koop proclaimed on "Face the Nation." "We're fighting for the principle of this country that every life is individually and uniquely sacred." The Justice Department wanted to make the Baby Jane Doe case a test of the principles underlying its regulations. It was Koop who formally requested copies of the child's medical records, the denial of which led to a major legal battle.

But it was also Koop, uncomfortable with theadministration's interventionist approach, who forges a compromise. In a conversation with Margaret Heckler, then secretary of HHS, about Baby Doe, Koop says he told her, "Now, I have been taking all the flack for two years, and I have had no role that could help me deflect some of that stuff. I said if I'm going to take the flack why can't I write the regulations? She was very reasonable. She said go ahead and do it."

Over the past several months, Koop had beenmeeting with some of the fiercest rivals involved in the issue: the American Academy of Pediatrics (AAP), along with pediatric hospital, pro-life, and disability rights groups. The AAP, which adamantly opposed the existing "Baby Doe" regulations, suggested a compromise that appealed to Koop's Republican sensibilities: hospitals would set up their own "infant care committees" to review Baby Doe-like cases. At these meetings, the rival group produced a "Statement of Principles for the Treatment of Disabled Infants," which in essence required physicians to treat infants with handicaps unless such treatment only prolonged the dying process. Though Koop clearly represented the administration, he played the role of moderator, and was willing to listen. "He and I were flat out adversaries on this thing," recalls Dr. M. Harry Jennison, then executive director of AAP, "but overtime I've came to respect him for his intellectual honesty."