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Medical Ethics and the Stewardship of Life
Medical Ethics and the Stewardship of Life

This article originally appeared in the December 15, 1978, issue of Christianity Today, three years before Koop, who died yesterday, was nominated to serve as U.S. Surgeon General.

C Everett Koop, chief surgeon of Children's Hospital in Philadelphia, received much publicity in 1974 as head of the surgical team to successfully separate Siamese twins. Recently, in another operation on Siamese twins, he had to decide which twin should live and which should die; both would have died if they had remained attached. Such pressures are not unusual.

Koop gets up at six A.M. to have his daily devotions. He drives to the hospital, arriving at about 7:20. He checks the files of the patients that he will be operating on that day and begins surgery at 8; three days a Week he finishes by 10:30 or 11. By then he has performed or six operations. He sees ten to fifteen patients after that, usually with a medical student, teaching him as he examines patients. Koop carries a load of administrative as well as teaching duties—committee meetings with staff, rounds, and conferences with students. After he leaves the hospital at 6:30, he still has about three hours of paper work to do. Koop's schedule has changed somewhat in the last few years. He now avoids long, tension-producing operations, leaving them to his younger colleagues, though he reserves Wednesday for his big cases.

When he first came to Chi1dren's Hospital in 1946, Koop had to convince people that the surgery he wanted to do on children would work. He almost lived at the hospital, leaving "my remarkable wife" to carry much of the weight of raising their children. The divorce rate among surgeons, explains Koop, is astronomical.

Assistant editor Cheryl Forbes interviewed Dr. Koop in his office at Children's Hospital. The following is an edited version of the transcript.

What do you think of the use of amniocentesis as a prenatal testing device? Do you agree with the March of Dimes decision to withhold funds for the test?

Amniocentesis is a technique whereby a needle is placed directly into the amnion, the fluid in which the developing fetus is living, and then by studying the chromosomes certain problems can be elucidated and diagnosed. That is the current mode. I think we're just in the very beginning of it. It might one day be possible to inject a dye into that same amniotic fluid and have the youngster swallow it, as he does constantly, and do a GI series on that baby to learn about things in the gastro-intestinal tract. The chromosomal studies of amniocentesis are also in their infancy. Now, what is the tool to be used for? Obviously, the whole system is to find out if there is something wrong with the fetus. And if the fetus is defective some parents will decide to abort it. Since I take a high view of life, I see amniocentesis as a search and destroy mission.

If you hold that the sanctity of life is more important than the problem, how do you choose between two lives? Which life then becomes more important to save?

Everybody has his own reasons for coming to a decision like that and remember that bona fide choices like that are exceedingly rare. If I were an obstetrician, which I am not, and you were my patient and you were pregnant, I would think that my major obligation was to you. It would be a tough moral decision if it ever had to be made. But even the director of Planned Parenthood—world population, the late Dr. Allen Gutttmacher, very proabortion, said that there is almost nothing mentally or physically that obstetricians cannot handle in reference to the pregnant mother. Therefore there is seldom need to sacrifice the fetus to save the mother's life.

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Medical Ethics and the Stewardship of Life