Doctor C Everett Koop: Surgeon General who angered US conservatives with his stance on abortion and Aids

Dr C Everett Koop, who died on 25 February at the age of 96, was a leading US health official throughout much of the 1980s who spoke frankly about Aids and railed against smoking. An evangelical Christian, Koop shocked his conservative supporters when he endorsed condoms and sex education to stop the spread of Aids. He was surgeon general for seven years during the Ronald Reagan and George HW Bush administrations. He carried out a crusade to end smoking in the US.

A former pipe smoker, he said cigarettes were as addictive as heroin and cocaine. In 1996 he criticised the Republican presidential hopeful Bob Dole for suggesting that tobacco is not invariably addictive, saying his comments “either exposed his abysmal lack of knowledge of nicotine addiction or his blind support of the tobacco industry.” Although Koop eventually won wide respect with his blend of old-fashioned values, pragmatism and empathy, his nomination in 1981 met a wall of opposition from women's groups and liberal politicians.

Critics said Reagan selected Koop, a paediatric surgeon, only because of his conservative views, especially his opposition to abortion. They noted that he had travelled the country in 1979 and 1980 giving speeches that predicted a progression “from liberalised abortion to infanticide to passive euthanasia to active euthanasia, indeed to the very beginnings of the political climate that led to Auschwitz, Dachau and Belsen.”

But Koop, a devout Presbyterian, was confirmed after he told a Senate panel he would not use the post to promote his religious ideology, and he kept his word. In 1986 he issued a frank report on Aids, urging the use of condoms. He also maneouvred around uncooperative Reagan administration officials in 1988 to send an educational Aids pamphlet to more than 100 million US households, the largest public health mailing ever carried out.

Koop opposed homosexuality and sex outside marriage, but he insisted that Americans, especially young people, must not die because they were deprived of explicit information about how the HIV virus was transmitted. He became a hero to Aids activists, who chanted “Koop, Koop” at his appearances but booed other officials. He further angered conservatives by refusing to issue a report requested by the Reagan White House, saying he could not find enough scientific evidence to determine whether abortion has harmful psychological effects on women.

Yet he maintained his personal opposition to abortion, telling medical students after he left office that it violated their Hippocratic oath. In 2009 he wrote to the Senate Majority Leader Harry Reid urging that healthcare legislation include a provision to ensure that doctors and medical students would not be forced to perform abortions.