Chuck Hagel is, of course, not the first presidential nominee to face stiff opposition in the Senate. In 1981, Democrats spent eight months battling the nomination of C. Everett Koop to be surgeon general. Ronald Reagan's choice of Koop, who was known as an outspoken foe of abortion, was seen as a sop to rightwing evangelicals and to the new right, which had successfully used opposition to abortion as a wedge issue to defeat Democrats in the 1980 election. But Koop, who died on Monday at age 96, turned out to be one of the great surprises of the Reagan years. By the time he left office in 1989 the same people who had vilified him as Dr. Kook were singing his praises, and in 1995, Bill Clinton awarded Koop the Medal of Freedom.
Koop did change his views in office, but he was also misjudged by both supporters and detractors. Koop was a highly respected surgeon, the founder of the department of pediatric surgery at Children's Hospital in Philadelphia. He was also a devout Christian and impassioned foe of abortion. In 1975, Koop and theologian Harold O.J. Brown met at Billy Graham's home in Minneapolis to found the Christian Action Council (CAC), the first Protestant lobby against abortion. Koop wrote two books against abortion, including a 1979 tract with evangelist Francis Schaeffer, Whatever Happened to the Human Race. Koop and Schaeffer also produced an anti-abortion movie of the same name that they took around the country. It featured photos of dolls, symbolizing aborted babies, strewn over the floor of the Dead Sea.
Koop's position on abortion was entirely uncompromising. In The Right to Live, the Right to Die, Koop explained how he had once believed that "Christian compassion" allowed for abortion in "hard cases," but that under the influence of Brown he had decided to taken an absolute stand "for the sanctity of life." Koop also saw the issue of abortion in the most extreme moral and religious terms. "The legalization of abortion on demand in the United States," Koop wrote, "will someday be looked upon by historians as the last turning point of a materialistic society in abandoning the advantages accruing to our society from a Judeo-Christian heritage."
Prior to becoming surgeon general, Koop's other social views were equally conservative. He denounced "women's lib" and "gay pride" for encouraging "anti-family trends." He declared that the establishment of "government-subsidized childcare centers" was a sign that the U.S. was following the same path as "Hitler's Germany." And his religious views were, if anything, even more extreme. Raised in the Dutch Reform Church, Koop was not only a Fundamentalist who rejected the theory of evolution, but also a Calvinist who believed, in Harold O. J. Brown's words, that "government has the obligation to uphold fundamental principles of morality." In The Right to Live, the Right to Die, Koop defended the practice of outlawing "private activity ... repugnant to the moral sensitivity of the American people. That is why we have laws against such seemingly private engagements as homosexuality, sodomy, prostitution, and adultery."
But even before taking office, Koop's views diverged from the radical conservative of the day. Koop had no interest in using abortion as a political wedge issue. His anti-abortion activity was not part of a broader political agenda; it was entirely an expression of his religious belief. Koop worked against abortion in the same spirit that he worked with MAP International—a Third World medical relief agency—or with Philadelphia's Evangelical Family and Child Service. Koop distrusted the rightwing anti-abortion lobbies. "He was really suspicious of ideology," Brown explained, "so where you have political ideology that is being presented as a sort of necessary consequence of a theological position he was very suspicious of that."
In addition, as his colleagues from Philadelphia testified at his hearings, Koop viewed his responsibility as a "health man" as being above politics. He saw "the office" of surgeon general as having a certain function that must be performed regardless of the surgeon general's own beliefs and wishes. For instance, if there were a conflict between protecting the public health and condoning what he believed were immoral actions, the surgeon general would have to protect the public health. Similarly if there were a conflict between medical evidence and religious belief, then the surgeon general would have to act on the basis of medical evidence even if doing so went against his religious beliefs. From the beginning, this distinction put him at odds with new right activists who wanted him to use his position as a bully pulpit for their political agenda.
Koop first offended Reagan conservatives, including his chief Senate sponsor, North Carolina Republican Senator Jesse Helms, by his outspoken campaign against tobacco products. At issue was not merely an important Republican constituency, Southern tobacco growers, but also the administration's unequivocal support for free enterprise. In May 1984, Koop issued a blistering condemnation of smoking and the tobacco industry. Attacking the effects of "passive smoking," when non-smokers were forced in inhale smoke from others' cigarettes, Koop called for a "smokeless society by the year 2000." Koop also endorsed smoking bans in workplaces and other public places. In response, Helms called for his resignation, and the administration sabotaged his attempt to strengthen anti-smoking regulations.
Koop clashed directly with the administration two years later when he came out in favor of a bill banning cigarette advertising. White House Chief of Staff Don Regan had tried to prevent his appearing before Henry Waxman's House Subcommittee on Health and the Environment, but Regan finally agreed to Koop's appearance on the condition that a Justice Department official accompany him and speak against the bill. An incredulous Koop put on his best Dr. Johnson imitation when Ohio Rep. Buz Lukens defended cigarette advertising on the grounds that "more discussion... is the answer rather than less." Koop replied, "I don't think advertising, sir, is discussion."
But Koop really began to alienate the Republican right when he started taking positions on the growing AIDS epidemic. New right conservatives like Paul Weyrich and Howard Phillips blamed the AIDS epidemic on homosexuals, and wanted the Reagan administration to use the epidemic to point out the immorality of homosexuality. During Koop's first term, his immediate superior, Assistant Secretary Edward Brandt, ordered him not to take a public position on AIDS, but after Brandt resigned, Koop began answering reporters' questions on the epidemic. Then, after the 1984 election, Reagan, put on the defensive about the administration's lack of action on the disease, asked Koop to prepare a report.
After personally going through 27 drafts, Koop issued his report in October 1986. Koop's report tried to calm the rising hysteria about AIDS by explaining that it could not be spread through casual social contact, but the report raised hackles on the right by calling for sexual education about AIDS in elementary school and by advocating the use of condoms by heterosexuals and homosexuals to prevent the spread of infection. Koop also addressed directly the new right's attempt to blame the epidemic on gays. "At the beginning of the AIDS epidemic many Americans had little sympathy for people with AIDS," Koop wrote. "The feeling was that somehow people from certain groups 'deserved' their illness. Let us put those feelings behind us. We are fighting a disease, not a people."
Koop's position was based on the assumption that as a "health man" he had to recommend programs that protect the public health even if they indirectly condoned behavior that he disapproved of. "With AIDS," Koop later explained, "the law has to wink at certain things. If you find all the prostitutes in a given community are infected, you have to step in and do something about it." Koop also believed that AIDS education had to be credible. "When you approach the 70 percent of sexually active teenagers and tell them to just say no, they laugh at you," Koop said.
Koop's pamphlet created a furor on the right. In its January 1987 issue, Conservative Digest charged that Koop is "proposing instructing in buggery for schoolchildren as young as the third grade on the spurious grounds that the problem is one of ignorance and not morality." National Review accused Koop of "criminal negligence" in recommending the use of condoms. In response, Koop accused National Review of "letting politics and ideology supersede science."
There is no doubt that Koop's actions reflected his view that as surgeon general he had to act as a "health man" rather than as a moralist. But when Koop talked about the issues raised by the AIDS epidemic, it became evident that his morals have also changed. Koop has lost some of his most extreme Calvinist convictions. In talking about AIDS, Koop went out of his way not to blame the gay community. He now rejected the idea that the state should pass laws against homosexuality. "I don't think such laws are enforceable," he said.
Koop's attitudes changed because of his encounter with the AIDS epidemic. "He suffers with the disease of AIDS and he suffers with prospect of millions of being affected. This is an agonizing situation for him, and it is very unsettling," Harold O.J. Brown explained. Koop let the struggle against AIDS color his views on a wide range of subjects in the same way the he once let the struggle against abortion color his view of "women's lib." He no longer condemned homosexuality, because he saw homosexuals as innocent victims of a terrible disease. He turned away from the right and from his former allies because he believed they lack compassion for AIDS victims.
Koop's last controversial act as Surgeon General was a report on the psychological effects of abortion is bound to raise new questions about whether he had abandoned his absolute opposition to abortion. Ironically, Reagan had asked Koop to do the report to mollify pro-life lobbyists angered by the administration's unwillingness to press their case defending the dismissal of a pro-life activist at Health and Human Services. White House aide Dinesh D'Souza had convinced the president that by documenting the terrible psychological effects of abortion, Koop's report would lay the basis for overturning Roe v. Wade. But in preparing the study, Koop acted as a "health man" rather than as an anti-abortion activist. He and several staff people went over the scientific evidence carefully, and became convinced that past studies demonstrating post-abortion stress were flawed.
Koop remained unalterably opposed to abortion, but he remained a professional committed to medical science and to the responsibilities of his office. "What has given me so much trouble in this job from the right," Koop told me in 1988 when I did a profile of him for The New Republic, "is that I separate ideology, religion and other things from my sworn duty as a health officer in this country." Koop remains a stirring example—to both left and right—of how a public official should conduct himself. He was one of the most impressive officials I ever had the chance to interview.