A long-overdue biography of the 13th Surgeon General of the United States, Dr. C. Everett Koop, has finally appeared, at a time when many of the issues his story engages remain prime concerns for public policy. “Dr. Koop: The Many Lives of the Surgeon General,” by Nigel M. DeS. Cameron, sets and meets a high bar — to record in detail the lifetime achievements and candid critiques of a man who wrestled with the most challenging issues in ethics and medicine, issues that traverse vital questions of life and death in a society under stress.

The book is not a leisurely afternoon’s read; based on hundreds of interviews and thousands of documents, the biography spans 341 pages of narrative and 72 pages of references and footnotes. Even at this length, the book faces the difficult task of covering an individual who had a profound impact on the practice of medicine and the course of federal engagement in a range of once- and still-divisive subjects.

First, a brief word on the biography of the author, Nigel Cameron. Cameron has been a longtime writer and teacher regarding the interplay of religion, bioethics, technology, and public policy, both domestically and internationally. He is a graduate of Cambridge and Edinburgh Universities and has most recently served as Research Professor of Bioethics at the Illinois Institute of Technology and Fulbright Visiting Research Chair in Science and Society at the University of Ottawa. He has published widely on the range of topics addressed in the Koop biography.

As with any other subject of the scope of Dr. Koop’s life, it is well to read widely. Several reviews of “Many Lives” have already appeared, and more would be welcome. Historian Daniel K. Williams produced one last month for Christianity Today that is largely devoted to Dr. Koop’s uneven relationship with evangelicalism and the pro-life cause, at least in its political and policy manifestations. The review is titled, “How a Great Pro-Life Hope Disappointed His Allies.” Cameron’s book is particularly valuable in describing the origins of that hope, which were not so much ideological as practical, with their roots in an extraordinary medical career that began before World War II and continued well into this century.

Cameron’s recounting of that history is revelatory. Koop showed so much prowess as a physician, Cameron relates, that a surgeon allowed Koop as a college undergraduate to perform a leg amputation on a diabetic patient. As Koop advanced in his career, in fits and starts at a series of prestigious institutions, he challenged various orthodoxies, beginning with the reality that the surgeons of the day generally declined to perform procedures on children under the age of three. Koop saw no reason for such discrimination. He likewise rejected the idea that a baby’s cognitive abilities or other limitations, for example, Down syndrome, should result in their not being approved for life-saving care. As he went about virtually creating the specialty of pediatric surgery, he rattled some cages at other institutions, like Johns Hopkins, and his own Children's Hospital of Philadelphia (CHOP), where prior practice had been to set aside many disabled children and withhold treatment.

Koop, according to the trainees who honored him on his retirement from CHOP in 1981 to enter government, deployed a “Koopian method,” which they described as “an operative approach that included ‘do what you do best; simplify rather than complicate diagnosis and operative procedures. Do an even better operation for the handicapped child, as they deserve and need it.’”

The Koopian method had, to say the least, not been normative in American medicine. To achieve it required a string of steps, beyond the ethical judgments it required regarding human equality, in which Koop’s role was decisive. He amplified his impact by advocacy for the specialty of pediatric surgery and collateral specialties in anesthesiology and specific conditions among neonates that had been typically fatal.

These efforts came to a head when Koop became founding editor of the Journal of Pediatric Surgery in 1965, a position he held for 11 years. Koop essentially established the first neonatal intensive care unit (NICU) in the United States at CHOP. This step was revolutionary. Dr. Koop rose further in the public mind when he and a team he assembled accomplished the first successful surgical separation of conjoined twins in 1957. He was in every sense a medical visionary and pioneer.

These achievements alone might have been enough to draw the attention of pro-life advocates to Koop in the years immediately after the Supreme Court decision striking down all U.S. pro-life laws in 1973. But Koop proved to be no wallflower in the public arena just as he was not in the operating theater. In the spring of 1973, he delivered the graduation speech at Wheaton College, an intellectual stronghold of American evangelicalism. He chose a topic atypical for such occasions of self-celebration and gratitude to parents and teachers: In his own words, “I hereby make a plea for the right of the unborn child to life.” His words were uncommonly powerful: “Jews were considered to be non-persons in Nazi Germany. Indians were not thought to be persons in the United States. The same Supreme Court . . . in the Dred Scott decision in 1857 declared Negros to be non-citizens. They would have been more honest if they had said non-people.”

Histories of the pro-life cause tend to suggest that the movement in its earliest days was primarily Catholic and that evangelical voices came late to the cause. They also suggest that the cause was politically mixed in its infancy, but later became subsumed in the maneuvers of what was dubbed the Christian right, a term usually offered as aspersion. There is some truth in these characterizations but far from the whole truth. The pro-life activism of the 1970s included names like Dr. Mildred Jefferson, Fr. Daniel Berrigan, Jesse Jackson, Dick Gregory, and Marjorie Mecklenburg. Non-violent pro-life demonstrators of the period were as likely to be anti-war as anti-abortion, and they studiously followed the writings of Dr. Martin Luther King in their public activism. Catholics played key roles in forming several pro-life organizations, but leaders like Dr. Koop, Billy Graham, Harold O.J. Brown, the Rev. Curt Young, and others emerged swiftly in the crimson wake of Roe.

In the early Congresses in the 1970s that deliberated on and passed pro-life legislation, most prominently the Hyde Amendment limitation on federal funding of abortion, votes were almost completely bipartisan. The most significant factor that emerged in the course of this era was a polarization that reshaped the political parties around the issue of life and related topics of faith and family. In the 1980 election, that polarization accelerated when candidate Ronald Reagan committed himself to pro-life policies and the Republican Party endorsed the reversal of Roe v. Wade. The pro-life movement would have welcomed a similar stance from Jimmy Carter.

In the meantime, Dr. Koop stepped forward in various ways with dramatic appeals for the right to life. Cameron depicts these events vividly and makes clear how they sprang, as so much else in Koop’s life did, from his convictions about science and an ability, accurately assessed in this biography, to maneuver creatively on behalf of principles and practices he favored. “Whatever Happened to the Human Race?” was the foremost of these contributions. The project was conceived by Koop and birthed with Francis Schaefer, aided by his filmmaker son, Franky Schaefer, in 1977 at L’Abri Fellowship in Switzerland.

The book and five-part film series remain riveting. Released in 1979, the films were shown at evangelical churches across the United States, and they were galvanizing. Just six years after the Roe ruling, the pro-life movement was largely focused on the effort to reverse the law and Koop’s work, with its historical analogies and human rights language, comported with the aim of legal, indeed constitutional, reform.

All of this stimulated a campaign by right to life stalwarts in 1980 to secure the post of Surgeon General for the pathbreaking Dr. Koop. Cameron documents how Reagan’s pro-life allies, including HHS Secretary Richard Schweiker, Senator Jesse Helms, future leader of the Knights of Columbus Carl Anderson, and others campaigned against bitter opposition to see Koop nominated and confirmed to the office. The media and Senate firestorm against Koop was indeed vicious. Cameron recounts how the once pro-life Senator Ted Kennedy blew cigar smoke in Koop’s face when meeting him.

Koop received official word of his nomination by President Reagan on Valentine’s Day 1981, but Washington’s love was fleeting. Overlooking the overwhelming totality of Koop/s career, media voices like The New York Times rushed to lambaste him as “Dr. Unqualified” or even “Dr. Kook,” epithets not remotely apt to one of the most distinguished physicians in American history. Pro-life lobbyists persisted in a grueling campaign, which resulted in Koop’s confirmation fully nine months later (appropriately enough), on November 16, 1981.

Understandably, such a browbeating by opponents seemed manifestly unfair to Koop. His career had encompassed numerous achievements and landmarks. He reacted in what on close analysis seems like a self-contradictory manner. Cameron writes that in 1981 Koop “assured anyone who would listen that it was not his intention to use the office of Surgeon General to campaign on abortion.” But the nation in the early 1980s was at the peak of the movement’s most direct effort in Congress to reverse Roe. Koop occupied the most visible role in the country on matters of public health. He insisted, as most pro-lifers also did, that his views of the issue were based on science and not on theological grounds, as liberal media outlets liked to suggest (and scorn). Koop continued to speak on the issue alongside longtime allies and friends at Americans United for Life, the leading legal group of the day.

Whatever Koop hoped for from relative silence in terms of media respect and a respite from slander, history was uncooperative. Soon after he took office, an event in Bloomington, Indiana took place that jarred the wheelhouse of his expertise — the birth of a baby with Down syndrome whose treating physician and parents wanted to deny life-saving surgery. Sometimes the game searches out the coach and the players on the sidelines. Desiring it or not, Koop was moved back onto the field, where he would remain for the rest of his years in public life.

Read part two