Revisiting the “Koop Report”

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– David C. Reardon, Ph.D.

What do Dr. C. Everett Koop and Dr. Henry Foster have in common? As nominees for the post of the U.S. Surgeon General, both have been through grueling confirmation hearings which were deeply concerned with two key questions: 1) Is abortion a legitimate form of medicine? and 2) Would approval of this nominee give an advantage to either pro- or anti-abortion forces? While Senate committee members may have been reluctant to directly ask these questions, they nonetheless colored every aspect of the two nominee’s hearings.

The practices and philosophies of Dr. Koop and Dr. Foster could hardly be more dissimilar. In his widely read book What Ever Happened to the Human Race?, Dr. Koop had emphatically denounced abortion as a prostitution of medicine. In addition, as a noted pediatric surgeon he had provided important leadership in the effort to safeguard the rights of handicapped infants who were being threatened with neglect, starvation, and organ harvesting. His nomination by President Reagan was savagely opposed by liberals who feared he would use the post as a pulpit for the religious right.

Dr. Foster, on the other hand, is an obstetrician, an abortionist, and a researcher of abortion techniques who has difficulty counting the number of abortions he has performed or supervised. Less widely known is the fact that in the 1970’s he was performing involuntary sterilization’s (via hysterectomy) on mentally handicapped women, a small contribution to the eugenic goals of population controllers.[1] In an apparent contradiction to this earlier practice, Dr. Foster has used his role as a “Public Policy Advocate” of Planned Parenthood to champion “reproductive choice”–at least for those who are choosing abortion. His nomination has been hotly opposed by the religious right and just as hotly defended by liberals who insist that neither abortion nor memory lapses are against the law.

As perhaps the most contested issue in medical ethics it is not surprising that the abortion question perennially haunts those who hold, or aspire to hold, the nation’s top public health office. In Koop’s confirmation hearings he was forced to pledge that he would not use the Surgeon General’s office as a bully-pulpit against abortion. This pledge, however, was sorely put to the test in July of 1987 when President Reagan directed the Surgeon General to prepare a report for the nation on the health risks of abortion for women. The jumbled results continue to plague both Dr. Koop and the post-abortion movement.

In brief, in a letter to the President seventeen months later, Dr. Koop ducked the assignment claiming that due to an inadequate base of research no definitive statements could be made. The pro-abortion media immediately twisted Koop’s non-report into a claim that no dangers to abortion could be found, ergo, abortion is safe. Similar distortions of Koop’s statements continue to this day particularly in medical journals where pro-abortion researchers frequently cite the Surgeon General’s letter as an “authoritative” review which confirmed the safety of abortion. For his part, Dr. Koop continues to be haunted by the whole matter, facing the sporadic denouncements of conservatives who believe that he “betrayed” the cause.

What really happened? What did Koop really say and what could he have said? These are questions which we have frequently been asked, and now is as good a time as any for committing our answers to print.

The Unwanted Assignment

It all began when the President was preparing for a summit meeting with pro-life leaders who were outraged over the firing of JoAnn Gasper from the Department of Health and Human Services. (Mrs. Gasper had been fired for enforcing a hard line interpretation of federal regulations banning abortion funding, a position her immediate supervisors in the Administration did not share.) At the urging of at least one pro-life aide, President Reagan was convinced that pro-lifer’s would be mollified by allowing Koop, one of their own, to produce a report which would prove the negative health effects of abortion on women and thus contribute to the reversal of Roe v. Wade. Having personally reviewed a number of post-abortion testimonies himself, Reagan was perhaps so convinced of abortion’s traumatic effects that he assumed that the assignment would be an easy one which Koop would relish. (It is even reported that President Reagan frequently gave copies of post-abortion testimonies to others in defense of his anti-abortion position.)

Koop, for his part, did not relish the assignment. On at least two occasions Koop attempted to convince the president to withdraw his request for a report. When his petitions were rejected, Koop assigned the task to an assistant explaining that he wanted to “distance” himself from the report. Koop simply did not like being dragged back into the abortion controversy, especially in an official role as an “expert” on the health effects of abortion. He knew, far better than the president, that every piece of evidence, every conclusion, every nuanced statement that Koop might make was going to be dissected and attacked by one side or the other. The forensics experts at the O.J. Simpson trial faced less of a grilling than that which confronted Koop.

So, rather than report on what can be deduced from the data, Koop chose to concentrate on what is not known. He did this by insisting that any official report from his office could only include “unassailable” data.[2] Because there are no perfect studies, especially in the field of behavioral science, there is always room for criticism and dispute. So, in hiding behind the demand for “unassailable” data, Koop had found his way out. By raising the level of scientific proof required to an impossibly high level, Koop was able to report to the president that all existing studies are flawed and therefore “scientific studies do not provide conclusive data about the health effects of abortion on women.”

In fact, the final “report” was not a report at all. Instead it was merely a letter to the President explaining why there was insufficient data on which to base a report. Koop concluded the letter by stating that a prospective five year study, costing between $10 and $100 million would best address the lack of unassailable data. Even in this, however, he was noncommittal. His statements regarding the possibility of a prospective study had the tone of “if you really want to know, this is what should be done.” Nowhere did he actually champion the pressing need for such a study on the grounds that abortion is one of the most common surgeries in America and lack of adequate research about abortion sequelae is simply unconscionable.

Most curiously, in the furor of confusion following his letter, it became clear that Dr. Koop in fact had two positions. His public position was that of the uneasy Sergeant Schultz who claims: “I know nothing!” This non-opinion was all that he could confidently defend as the Surgeon General for the United States. But as he also held the private opinion (which because it was private was somehow above criticism) that there was sufficient and compelling evidence which left “no doubt in my mind” that there are serious physical complications and “tremendous psychological problems” resulting from abortion.[3]

Why the Dodge?

Some critics of Koop believe he sidestepped his assignment because he did not want to face another vicious attack from the pro-choice media and Congress. His confirmation hearings for the Surgeon General post had been a grueling experience. In addition, it is probable that the promise he made at that time not to use his post as “a pulpit for ideology” also colored his views about the desirability of writing the report and the boundaries within which he could write it. It is also likely that he did not relish losing the good favor bestowed upon him by liberals after he had begun promoting “safe-sex” in response to the AID’s crisis. After basking in the praise of the major media outlets, he was once again being exposed to attack for every word he might write in criticism of that sacred cow, abortion.

Given these factors, it is no wonder, then, that Koop repeatedly bemoaned the fact that the President’s demand for a report was forcing him to walk “a political tightrope.” There was no way he could cross it without enraging one side or the other.

Still, Koop has a history of taking unpopular stands. Courage is not his short-suit. He is a highly principled man. His pledge to disdain ideology as the Surgeon General was almost certainly more binding on him than any fear of enraging pro-abortionists. But most important, I believe, was his view that the issue of post-abortion sequelae was leading the pro-life movement onto the wrong track. In an interview with leaders of The Rutherford Institute shortly after release of his letter to the president, Koop sharply criticized the efforts of pro-lifers who were working to increase public awareness of abortion complications for women. According to Koop, “I think it is wrong for the pro-life forces to get all upset about the health effects of abortion on women and get away from the health effects of abortion on the fetus. This is the marker issue there… [A]s soon as you contaminate the morality of your stand by getting worried about the health effects of abortion on women, you have weakened the whole thing…”[4]

This suggests that, in addition to all of the pressures which made the writing of such a report personally undesirable, Koop was confronted with a very serious moral conflict. In short, if he had written a report which validated concerns of abortion’s health risks for women, he would have been contributing to the abandonment of the moral high ground. From this it would appear that Koop believes abortion is primarily a moral issue, not a medical one. It should be opposed not for what it does to women, but for what it does to the unborn.

Finding The Moral High Ground

I would suggest that this moral and strategic view is fundamentally why Dr. Koop chose to drop the ball. President Reagan had handed him the opportunity to focus national attention on abortion’s health risks. He could have made very specific, and scientifically defensible, conclusions which would have dramatically affected the ground rules of the debate on abortion. (See sidebar.) But Koop did not want to change the issues of the debate. Instead, he believed it was fundamentally wrong to address abortion as if it is a public health issue.

Other avid pro-lifers share this view. Indeed, there are not a few who have very little sympathy for women who suffer post-abortion problems. Some have even expressed their disdain for women injured by abortion with comments such as: “They deserve what they get.” Less punitive pro-lifers are simply idealists. They want to believe that somehow, with just a better education program, or a more articulate argument, we will be able to awaken America to the moral superiority of our position. To advance this moral argument, evidence of fetal development is relevant but scarred uteruses are not.

Dr. Koop’s concern about preserving the moral center of our cause is a serious one which needs to be addressed. In the accompanying article “Is the Post-Abortion Strategy a Moral Strategy?” it is my goal to show that the pro-woman approach is not only consistent with the pro-life moral imperative, it is, in fact, a fuller and more complete expression of it.

Originally published in The Post-Abortion Review 3(3),Summer 1995. Copyright 1995 Elliot Institute