Of the Christian conservatives whom Ronald Reagan appointed to high office after winning the presidency in 1980, none excited evangelicals like his pick for surgeon general, C. Everett Koop.
Koop, they were sure, was a true believer in the Lord and the pro-life cause. He was a ruling elder at a renowned evangelical church. He had spoken at Wheaton College. He had opposed abortion even in the early 1970s, before most evangelicals had joined the pro-life movement. He was a close friend of Francis Schaeffer and his family. He had even coproduced a pro-life documentary and book with Schaeffer titled Whatever Happened to the Human Race?
Given Koop’s evangelical and pro-life bona fides, his nomination to be surgeon general polarized members of Congress along predictable ideological lines. Pro-choice liberals strongly opposed him, while pro-life Christian conservatives relished the chance to see one of their own in a position of national influence. Amid congressional hearings on the nomination, Senator Ted Kennedy signaled his disdain by blowing cigar smoke in Koop’s face. Liberals like Kennedy stalled Koop’s progress for nine months.
But when Koop left office in 1989, it was liberals like Kennedy—not Christian conservatives—who praised him most effusively. To the dismay of some pro-life Christians, Koop did almost nothing to address abortion as surgeon general; in fact, it took prodding by the Reagan administration before he issued even a single report on it. Instead, Koop spent most of his political capital fighting smoking and AIDS. Koop’s approach to AIDS especially rankled some conservative culture warriors because his proposed solution was to encourage condom use rather than abstinence alone.
Koop spent the rest of his long life (he remained active until his death in 2013) cultivating alliances with liberals. Though he did not renounce his opposition to abortion, he grew estranged from the pro-life movement. He developed a friendship with Bill and Hillary Clinton since he supported their universal health care plan. And he never fully patched up his strained relationship with conservative evangelicals who thought he had abandoned his principles.
Nigel M. de S. Cameron’s Dr. Koop: The Many Lives of the Surgeon General attempts to make sense of Koop’s many complications and attempts at reinventing himself. Cameron is fascinated with Koop’s charisma and outsize ego, and he treats him as a man of genuinely deep faith—as well as a man with significant flaws and blind spots.
To the consternation of many evangelicals, Koop was never a culture warrior, even though they initially mistook him for one. In fact, he had a strong aversion to culture wars. And despite spending most of life traveling in evangelical circles, his brand of evangelicalism was really a conservative (and thoroughly irenic and pluralist) version of mainline Protestantism. He had a lifelong aversion to both fundamentalists and conservative political ideologues.
Koop did not grow up in a religiously devout household. During his childhood in Brooklyn, New York, his parents took him to Protestant church services, but faith was not a significant factor in their lives. Still less did it influence Koop’s own life when he became an adult. During his time in medical school and as a young surgeon in Philadelphia, he worked seven days a week—which meant spending every Sunday morning at the hospital. There was no time for God.
But Koop was curious about faith, so he decided to read through the entire New Testament one summer. He was so intrigued that he read through it again. At that point, one of the nurses at his hospital invited him to visit her church, Philadelphia’s Tenth Presbyterian, where evangelical pulpit luminaries Donald Grey Barnhouse and James Montgomery Boice served as pastors. Koop and his wife were drawn to Barnhouse’s intellectually rich exposition of the New Testament, and one day in 1947, he realized that he did believe the gospel.
Even though it belonged at that time to a mainline denomination, Tenth Presbyterian was thoroughly evangelical. It made demands on Koop’s life that he sometimes found uncomfortable.
Koop never entirely acquiesced to these demands, and he certainly never became a fundamentalist. He was happy to adjust his schedule to accommodate church on Sunday mornings. But he could not resist the call of work for the rest of the Sabbath—Koop would regretfully describe himself as a workaholic father, and comments from his children suggest a feeling of distance, even in adulthood. He never seemed to learn the importance of Christian humility; colleagues would routinely mention his “large ego.”
And he refused to give up cocktails. Though most evangelical Presbyterians would eventually become comfortable with consuming alcohol in moderation, that was not the case in the late 1940s and early 1950s. But regardless of the church’s expectations, Koop loved martinis and saw no reason to forego them. For five years, he resisted invitations to join the church, preferring to remain a regular visitor if formal belonging entailed becoming a teetotaler or a Sabbatarian. Eventually, Barnhouse prevailed on Koop to take the membership leap, but Koop ultimately didn’t let it stop him from ordering what he wanted at cocktail parties.
Koop developed close relationships with leading evangelicals, but throughout his life he remained defiantly unwilling to toe the evangelical party line. When Tenth Presbyterian voted to leave the mainline United Presbyterian Church and join the more conservative Presbyterian Church in America, Koop opposed the move. And when evangelicals began linking their faith to the Christian right, Koop refused to follow.
His faith did, however, lead him to develop a deep concern for the poor, and after joining Tenth Presbyterian he began volunteering hours of his time each week to minister to Philadelphia’s homeless. He also developed a deep reverence for human life that guided his medical practice.
He fully embraced Presbyterian views of God’s sovereignty. The death of his young adult son, David, in a climbing accident shook him severely, but he found solace in the belief that all of this was part of God’s sovereign plan. “From the beginning of time,” wrote Koop and his wife, Betty, “God’s plan called for David to climb, to become expert at it; and to die in that particular, awful way.”
Koop’s strong anti-abortion convictions led some people to mistake him for a Christian culture warrior, but this judgment misread the makeup of the early pro-life movement. When Koop embraced the pro-life cause in 1970, its ranks were still overwhelmingly Catholic, with some proponents identifying as liberal Democrats. It had yet to become synonymous with political conservatism or culture-war politics. In fact, few evangelicals were interested in talking about abortion, and no evangelical denomination had yet passed a pro-life resolution.
Koop refused to be pegged as either a conservative or a liberal since he believed that science, not ideology, should guide his work in public health. And he said that he opposed abortion not because of the Bible or Christian theology but because of his duty as a doctor to save human life. At the time, he was surgeon in chief at Children’s Hospital of Philadelphia, and he reasoned that saving children’s lives after they were born committed him to saving their lives before they were born as well.
As long as the pro-life movement kept its distance from conservative politics or the culture wars, Koop was comfortable giving public speeches against abortion and supporting pro-life organizations. But this distance was diminishing around the time of Reagan’s election and Koop’s appointment as surgeon general. At the very moment Koop ascended to a position of political power, he found himself out of step with the movement that had championed his ascent.
Koop was critical of advocacy for anti-abortion laws because he believed that pro-life campaigns should focus on public persuasion rather than legal coercion. And he also believed in following the scientific evidence wherever it led. When the Reagan administration commissioned him to produce a report on the physical and mental health of women who had abortions, Koop stuck to what he thought the data showed, denying any conclusive evidence of substantive effects on women’s well-being. Pro-lifers were dismayed, but Koop thought he was simply following the evidence.
Koop’s greatest contribution as surgeon general may have been his public-relations campaign against tobacco. Perhaps largely because of Koop’s efforts, the 1980s saw the greatest drop in smoking rates of any decade in American history. This was not because of any new awareness that cigarettes could cause lung cancer or other diseases; people in Koop’s position had been saying this since 1964. Instead, the shift occurred because Koop publicized new studies showing the dangers of secondhand smoke. Smokers, it turned out, were potentially harming other people’s health, not only their own. Armed with this new information, airlines, workplaces, and public venues began implementing smoking bans, and smoking rates plummeted.
The achievement made Koop a national celebrity. He earned greater name recognition and greater public trust than any previous surgeon general had earned.
But according to Cameron, Koop did not handle his fame well. He was blind to conflicts of interest. He was sometimes petulant and egotistical. After his moment in the national spotlight, he failed to adjust to life outside it. But his brash self-confidence occasionally opened doors. When he volunteered to campaign for the Clinton health care plan because of his belief that access to affordable health care would save lives, Bill and Hillary Clinton took him up on the offer. Thereafter, he developed a closer relationship with them than with any other president after Reagan.
Koop wanted to be remembered for saving lives, because it was the passion of his entire career. He saved the lives of children through his pioneering work in pediatric surgery, and he attempted to save unborn lives by speaking out against abortion. As surgeon general, he tried to save lives on a national scale by encouraging condom use and launching a public-relations campaign against smoking.
In some of those efforts, Koop had the support of his fellow evangelicals. In other cases, they diverged, especially when certain allies seemed more interested in saving the nation’s Christian identity through politics than in saving the lives of individual image bearers. Yet he persisted in following his own conscience, even when it differed with prevailing trends in evangelicalism. As he said near the end of his life, if history remembered him as the “man who saved more lives than anybody else in the United States,” that legacy that would make him “very happy.”
Daniel K. Williams teaches American history at Ashland University. His forthcoming book is Abortion and America’s Churches: A Religious History of Roe v. Wade.
Editor’s note: Parts of this review have been amended to clarify certain details about Koop’s views, his actions during and after his time as surgeon general, and his relationships with family members.
