Published on Oct 6, 2012 by AdamMetropolis

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.

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.

What are some other areas of concern in pregnancy ethics?

I have a great concern about the future, with the use of prostaglandins. Prostaglandins are substances that initiate the whole physiologic process of labor. They are used now and are available to hospitals and abortion clinics, marketed only by Upjohn. In the green sheet published for pharmacologists, prostin-E is listed ask an abortion-inducer. If we now have prostaglandins available for use by physicians to initiate labor, how long will it be before another variety of prostaglandin is marketed as a menses-inducer? It would be possible, for example, to purchase vaginal tampons for a woman to use once a month on the date that she expected to have her period. She would never know whether she was having a normal period or whether she was having a prostaglandin abortion. It could eliminate the whole problem of abortion as we discuss it now, because it would never be anything but a very private affair between a woman and her vaginal tampon.

In your book you cited statistics from other countries that show that rather than reducing the number of abortions, the availability of abortion increases it.

If you don’t have a last-ditch therapy such as abortion, then people pay a little bit more attention to their techniques of contraception. In places like Czechoslovakia, Poland, and Japan people have gotten less and less careful about true contraception because they know that if they do get pregnant they always have a way out in abortion.

How dangerous is abortion? A dilatation and curettage, which is sometimes used for abortion, is not dangerous.

A D&C is one type of abortion, and the one that’s used in the first trimester of pregnancy. Theoretically, if you want to be very erudite, when you are using that technique to extract a fetus, you call it a D&E, because it’s a dilatation and evacuation. The pregnant uterus presents more of a hazard than a nonpregnant uterus, if you are going to scrape its wall. The D&C so called has also been substituted by the suction machine. It sucks out the embryo by negative pressure rather than bringing it out with a little hoe. Statistics in this country about this form of abortion are hard to come by. Free-standing abortion clinics are not under the same kind of control and regulation as is a hospital. Our best comparative statistics come from another Anglo-Saxon country, namely England, where under their national medical service they have kept careful records. After a woman has had an abortion there is an increase in the incidence of sterility, of premature deliveries, of ectopic pregnancies, and of the inability to carry a pregnancy to term because of an incompetent cervix. All of these things increase after a woman has had an abortion. Dr. Matthew Bulfin in Ft. Lauderdale, Florida, finds that very few women who have abortions have been counseled on what some of the subsequent dangers are.

What should you tell a woman who is contemplating abortion?

She should be shown photographs of exactly what she is aborting. She also needs some spiritual guidance. Many women early on in pregnancy go through a time of depression when they do not want the child. If they have only one kind of counseling available—to abort—women may live to regret it.

What about an unmarried, pregnant Christian?

That’s where we Christians are reprehensible. I’ve been involved for a long time and was instrumental in founding the Evangelical Child and Family service in Philadelphia largely because of my concern for Christian unwed mothers. One would expect that evangelical Christians, having understood the grace of God, would be most gracious under these circumstances. They are not. They are judgmental and it’s to our detriment that this can be said of us. My son and his wife took to live with them a Christian girl who was pregnant and carried her child to term. She knew she couldn’t raise the child, so I made arrangements for it to be adopted by a Christian couple who were on cloud nine at the prospect. I knew of another unwed pregnant woman who joined a very conservative, fundamentalist, independent church in the suburbs because she wanted to be in a Christian community when her child was born. I was afraid that the poor girl would get the cold shoulder. To my absolute amazement and delight, that congregation rallied around her. They provided her with babysitting and child care until she could finish her education to become a teacher. She is now raising that child herself. It could not have been possible without that church. Unfortunately, such experiences are exceptions.

Would you always recommend adoption?

In general, yes. There just aren’t many babies around to adopt these days. People are willing to adopt racially different babies, ethnically different babies, even handicapped children. I don’t think having a single parent is nearly as good for a child as the usual arrangement.

That might be a blessing sprung from the curse.

Oh, it’s a blessing, but many childless couples will not be able to have it. I wrote the introduction for a book published by Good News Press called Chosen Children. It’s the trials and tribulations of parents who adopted handicapped children and made it work. The outstanding emotional experiences in my pediatric surgical career have been to get to know parents who went out of their way to adopt handicapped children.

Explain the difference between birth control and contraception.

Birth control is a big umbrella that covers any kind of plan or procedure that prevents birth. Contraception is a form of birth control; abortion is a form of birth control. Many people use the terms contraception and birth control as if they were synonyms; they’re not. The morning-after pill is not a contraceptive, but it is a birth control medication. An IUD is not a contraceptive; it is something that’s effective in birth control.

And you would not approve of those two methods.

I would not. They affect the already fertilized egg.

Is there a problem with the use of the word fetus?

Fetus is a perfectly good Latin word for an unborn baby. It was used primarily in medical circles. I am convinced that we are using certain words to depersonalize the unborn baby. It doesn’t pose such a problem when you decide to kill it. It’s easier to kill a fetus than an unborn baby.

What other language problems are there?

You never see the term unborn baby used in proabortion circles. The most flagrant semantic fraud that has been carried out is one by obstetricians who changed the definition of pregnancy. The definition of pregnancy when I went to medical school and when you were born was that period of time between fertilization of the egg, or conception, and delivery of the baby. Now, pregnancy is called that period of time between implantation of the fertilized egg in the uterine wall and the delivery of the baby. If pregnancy doesn’t begin until implantation, and you prevent implantation as with an IUD, the patient doesn’t have to face the fact that she is destroying a fertilized egg that could have become a baby. The IUD used to be called IUCD, interuterine contraceptive device, but the word contraceptive was removed long ago, because IUDs aren’t contraceptive. An IUD acts after the egg is fertilized by a sperm. The IUD sits in the uterus and prevents the egg from nestling onto the wall and getting its blood supply.

Are medical students different today?

In talking on rounds to medical students who have never known medicine when abortion was illegal, I find that they have an entirely different concept of the worth of human life—it’ cheap.

What do you tell these medical students?

I tell them that when I was in their place the very word abortionist was a loathsome thing; now the abortionist is likely to be the professor of obstetrics in the medical school. There was a time when everybody believed that it was wrong to destroy an unborn baby. Now a great many people feel that it is right to do that. Many people believe that what is legal is right. There are thousands of women who would never have an abortion, I am sure, if the law said it’s wrong.

What would you consider extreme measures to save an infant’s life?

Let’s say that a newborn has a situation where so much of his intestine is destroyed that there is not enough left to support life. It would be possible to put that child on total intravenous nutrition and keep him alive for many months but with the ultimate understanding that eventually one would run out of veins and the child would eventually die because you could no longer provide nutrition. To use that type of nutrition would be to me in that circumstance extraordinary care that I would elect not to use. Knowing that the situation was hopeless anyway, I would provide just the usual (not extraordinary) care and the youngster would therefore not live as long. However, no active step would be taken to shorten the child’s life and he would be treated with all the love and care and compassion that we had.

Do you differentiate between certain extraordinary means and others, then?

I’m best known for a series of operations on newborn babies, children born without a rectum, with intestinal obstruction, with no connection between throat and stomach, with their abdominal organs in the umbilical cord. It would not be possible for me to have achieved the survival statistics I have if I didn’t use extraordinary care. But even in that category there are patients that I know are not going to make it and in them I would taper the extraordinary care. There are three things that I must know to make a decision. I must know the patient, his disease, and how the patient responds to the disease. I’ve never killed anyone, but I have frequently been relieved when a child under my care has died. I have told the family that this is a blessing in disguise. But that doesn’t entitle me to distribute showers of blessings to other people by destroying their children, even though they have big hardships ahead of them.

How do you know when you go to a doctor that he is trustworthy?

When I retire I plan to write a book called How to Find Good Medical Care. You’ll need to wait till then for an answer.

You’re working on a film with Francis Schaeffer. What’s it about?

Francis Schaeffer and I have been working for about a year and a half now on a project called “Whatever Happened to the Human Race?” There is a book manuscript written and we have already filmed forty-five-minute documentary movies. The first three of these cover the subject of abortion, infanticide, and euthanasia. The last two are Schaeffer’s alone and in them he presents his own Christian base and presents some authoritative answers based upon the Word of God to the problems we raise. We plan to take these films in the form of a two-day seminar in twenty cities in America, beginning in Philadelphia in the fall of 1979.

Dr. Koop.

C. Everett Koop

We take up for the prisoners that are tortured but what about unborn babies?

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