DEPARTMENT OF HEALTH AND HUMAN SERVICES

August 12, 1982

Mr. Morris B. Abram
Chairnan
President'sGommission for the
Study of Ethical Problems in
Madicinc and Biomedical and
Behavioral Research
suite 55s
2000 )I Street, N.W.
Washington, D.C.  20006

Dear Mr. Abram:

Representative Henry Hyde has forwarded to me your letter
to him of June 3, 1982, and requested that I furnish you
with furthsr material on the subject of the ethical issues
regarding care of dsfective newborn infants.  I share a
concern of those who view many of the statements contained
in the staff background paper prepared for tha Commission's
hearing on January 9, 1982,  as inscnsitivc to the needs and
aspirations of handicapped children.
Mr. Hyde, you stated that:        In your letter to

"When a Commission undertakes the sort of basic
inquiry in which wc are engaged, it is necessary
for us to go back to fundamental pro ositions
and to examine each one, cvcn ones w ich seem
              K
self-evident.  As a fellow lawyer, I am sure you
are familiar with the statements which arc made
-*  Such propositions are tested out
mere y as a way of refuting them."

I was particularly troubled by the statement on page 6
of the staff paper which reads:

"Even if one believes that an individual infant is
a person and that the moral protections and duties
usually associated with personhood attach to such
an infant, thcrc remain a number of questions.
These can bu grouped under two general categories
-- decisions based on the best interest of the


Page 2 - Mr. Morris B, Abram

infant and those based on the interests of third
parties."

I did not see in the staff paper a treatment of this statc-
mcnt as you suggest, that is, as a proposition which is
tested out merely as a way of refuting it.  I look forward
to reading a strong refutation of this position in the
final Commission report.

In. general, I think that the questioning of fundamental
propositions as part of the Commission's mandate would have
its limitations, For example, I would assume that in
deliberation of the Commission regarding the ethical and
moral parameters of government provision of health services
the Commission would not question what I would consider to
be a fundamental proposition that government services should
not be made available on the basis of race nr that certain
people may be excluded from government s=te.r~~ric~s due to their
racial background.  Perhaps some fundamental propositions arc
more fundamental than others.

In 1976 I addressed the American Academy of Pediatrics as
the recipient that year of the Academy's William E. Ladd
medal.  I took that occasion to discuss the medical and
ethical dimensions of the treatment-decisions regarding the care
of newborn infants with a defect incompatible with life.  That
address has been reprinted in the latest issue of the Human
Life Rcvicw.  I believe it most clearly states my phil+y
and oonocrns regarding this issue and I have taken the liberty
of enclosing a copy of it for you.

I would be happy to discuss this matter with you and members
of the Commission at your convenience.

Sincerely yours,

C. Evbrett Koop, M.D.
Surgeon General

cc:  Mr. Henry Hyde

bee:  Mr. Carl Anderson
   Mr. David Swoap

Prepared by:CEK:vsd, 8/12/82

cc:   EXSEC and CL0

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