ORIGINAL ©
Sule

Appress.

By
C, Everett Koop, MD. ScD
SURGEON GENERAL
OF THE
U. S. Pupiic HEALTH SERVICE
U, S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

Presentep TO 50TH ANNIVERSARY ANNUAL CONFERENCE OF THE
NATIONAL COUNCIL OF JUVENILE AND FAMILY CourT JUDGES

CINCINNATI, QHIO
Juty 13, 1987
I

GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

I AM VERY PLEASED TO JOIN YOU THIS MORNING, AT THIS, YOUR 50TH
ANNIVERSARY CONFERENCE.

DEAN McHARDY EXTENDED A VERY CORDIAL INVITATION FOR ME TO SPEAK
AND MENTIONED A NUMBER OF REASONS WHY I OUGHT TO ACCEPT. ONE REASON
HE DIDN’T MENTION. BUT IT MIGHT HAVE BEEN THE KEY REASON, IS THAT I
HAPPEN TO HAVE BEEN AROUND IN 1937 -- I HAD EVEN ALREADY GRADUATED
FROM COLLEGE -- THAT WAS ONLY 50 YEARS AGO -- AND THEREFORE I COULD
STAND HERE AT THE PODIUM AND REPRESENT “CONTINUITY” OR “HISTORICAL
PERSPECTIVE” OR -- AT THE VERY LEAST -- “PRODUCTIVE OLD AGE.” WHICH IS
THE NEW “IN” PHRASE,
2

OF COURSE, TEN YEARS AGO, YOUR INVITATION WOULD HAVE BEEN
RECEIVED AT MY OFFICE WITH QUIZZICAL LOOKS AND THE STAFF WOULD HAVE
RECOMMENDED THAT THE SURGEON GENERAL POLITELY DECLINE. YOUR CONFER-
ENCE WOULD NOT HAVE BEEN CONSIDERED A PRIORITY EVENT FOR THE S.G. T0
ADDRESS,

BUT MUCH HAS HAPPENED OVER THE PAST FEW YEARS. AND LAW AND
PUBLIC HEALTH HAVE BECOME MUCH MORE RELEVANT TO EACH OTHER. WE’ VE
DISCOVERED THAT WE NEED EACH OTHER BECAUSE, FRANKLY, THE COUNTRY NEEDS
US WORKING TOGETHER IN ORDER THAT WE MIGHT RESPOND TO EVENTS THAT
DEEPLY DISTURB THE AMERICAN PEOPLE.

THIS IS THE FEELING I HAD TWO YEARS AGO, IN OCTOBER 1985, WHEN |
CONVENED A “SURGEON GENERAL’S WORKSHOP ON VIOLENCE AND PUBLIC HEALTH”
IN LEESBURG, VIRGINIA. IT WAS THE FIRST ONE OF ITS KIND.
3

THE GENESIS FOR THAT WORKSHOP WAS MY SENSE THAT IT WAS TIME MY
COLLEAGUES IN THE HEALTH AND MEDICAL PROFESSIONS -- DOCTORS, NURSES,
PSYCHOLOGISTS, AND OTHERS -- BEGAN TO RECOGNIZE THAT INTERPERSONAL
VIOLENCE -- AND DOMESTIC VIOLENCE IN PARTICULAR -- WERE ISSUES THAT
BELONGED TO THEM AS MUCH AS THEY BELONGED TO THE POLICE AND THE
COURTS,

THERE WERE ABOUT 170 PARTICIPANTS, ALL INVITED BY NAME. AFTER
TWO DAYS OF INTENSIVE DISCUSSION AND MEDIATION THEY PRODUCED A LARGE
NUMBER OF RECOMMENDATIONS,..156 OF THEM. IT WAS, ALL TOLD, A VERY
EXCITING AND VERY FRUITFUL MEETING,

ONE SENTIMENT APPEARED OVER AND OVER AGAIN, PHRASED DIFFERENTLY
BUT SAYING ESSENTIALLY THE SAME THING:
4

IT WAS THAT MORE PUBLIC HEALTH PEOPLE NEEDED TO WORK CLOSELY WITH
THE POLICE AND THE COURTS, IN ORDER TO PROVIDE MAXIMUM SERVICE TO
VICTIMS OF CRIME...AND ALSO IN ORDER TO BRING THE PERPETRATORS OF
CRIME BEFORE THE BAR OF JUSTICE.

THAT RECOMMENDATION MADE A LOT OF SENSE, AND I FOLLOWED THROUGH ON IT
AFTER THE LEESBURG WORKSHOP WAS OVER,

FORTUNATELY, I HAD A SYMPATHETIC EAR AT THE JUSTICE DEPARTMENT.
MRS. LOIS HERRINGTON WAS ASSISTANT ATTORNEY GENERAL AT THAT TIME. SHE
AND I SIGNED AN AGREEMENT A FEW MONTHS LATER. IN MAY OF 1986, TO
JOINTLY CARRY OUT A “LAW/HEALTH INITIATIVE ON DOMESTIC VIOLENCE,”

UNDER THE TERMS OF THAT INITIATIVE, EACH OF US PLEDGED TO
SENSITIZE OUR RESPECTIVE DEPARTMENTS AND CONSTITUENCIES ABOUT THE
NEEDS AND INTERESTS OF THE OTHER.
5

SINCE THAT TIME, WE’VE HAD A NUMBER OF EXAMPLES OF INTERDEPART-
MENTAL AND INTER-DISCPLINARY COOPERATION,

ONE OF THE EARLIEST PROJECTS IS A STUDY OF FAMILY VIOLENCE IN THE
CITY OF ATLANTA. GEORGIA. OUR PUBLIC HEALTH PERSONNEL IN THE CETNERS
FOR DISEASE CONTROL HAVE BEEN WORKING CLOSELY WITH MR. GEORGE NAPPER,
ATLANTA’S VERY ABLE COMMISSIONER OF PUBLIC SECURITY.

THE ATLANTA PROJECT IS INTERESTING BECAUSE IT IS DOCUMENTING THE
RANGE OF PUBLIC AND PRIVATE AGENCIES CONTACTED BY BOTH VICTIMS AND
PERPETRATORS OF FAMILY VIOLENCE, THEY’RE LOOKING AT THE ROLE PLAYED
NOT ONLY BY THE POLICE AND THE COURTS, BUT ALSO BY HOSPITAL EMERGENCY
ROOMS, CHILD PROTECTIVE SERVICES, WOMEN’S SHELTERS, FOSTER CARE, AND
SO ON,
6

YOU AND I TEND TO SEE THE SERVICE DELIVERY SYSTEM FROM OUR OWN
RELATIVELY NARROW PERSPECTIVE. BUT THAT’S QUITE DIFFERENT FROM THE
VIEW OF THE PEOPLE CAUGHT UP IN THE FLOW OF SERVICES AND OF EVENTS.

I THINK THE ATLANTA PROJECT WILL HELP GIVE US ALL SOME DIRECTION
TOWARD BETTER INTER-SERVICE COLLABORATION AND COOPERATION,

ANOTHER PROJECT IS BEING CARRIED OUT IN DETROIT, MICHIGAN. WHICH
WAS THE COUNTRY’S LEADING CITY IN HOMICIDES, UNTIL MIAMI PUSHED IT
INTO SECOND PLACE.

MOST OF YOU KNOW, I’M SURE, OF THE RECENT ACTION BY THE DETROIT
CITY COUNCIL TO BAN THE CARRYING OF FIREARMS IN PUBLIC. FOLLOWING UP
ON THE ENACTMENT OF THAT ORDINANCE, WE’RE LOOKING AT THE EFFECT ON THE
CITY’S DEPARTMENTS OF HEALTH AND LAW ENFORCEMENT,
7

WE’RE WORKING WITH TWO TOP-NOTCH CIVIL SERVANTS UP THERE: POLICE
CHIEF WILLIAM L. HART AND DR, JOHN B, WALLER, THE DIRECTOR OF THE
DETROIT HEALTH DEPARTMENT,

YOU MAY REMEMBER THAT CHIEF HART HAD BEEN THE CHAIR OF THE
ATTORNEY GENERAL'S TASK FORCE ON FAMILY VIOLENCE A COUPLE OF YEARS
AGO, AND JAY WALLER HAD CHAIRED THE WORK-GROUP ON HOMICIDE PREVENTION
AT OUR LEESBURG WORKSHOP,

WE HOPE THAT THIS DETROIT PROJECT WILL GENERATE SOME HARD DATA ON
THE HAND-GUN ISSUE, WHICH CONTINUES TO BE A VERY EMOTIONAL ONE IN THIS
COUNTRY,
8

A THIRD INTERDISCIPLINARY PROJECT IS GOING ON IN MY OWN IMMEDI-
ATE OFFICE. WE‘RE IN THE PROCESS RIGHT NOW OF DEVELOPING A SURGEON
GENERAL’S STATEMENT CONCERNING THE HANDLING OF VICTIMS OF CHILD SEXUAL
ABUSE. THE PROJECT IS ACTUALLY SUPPORTED BY THE OFFICE FOR VICTIMS OF
CRIME OF THE DEPARTMENT OF JUSTICE, WHICH ASKED ME TO LEND A HAND IN
THIS ISSUE,

WHEN THE DOCUMENT 1S COMPLETE, I WILL SEND IT AS A KIND OF
"EXTENDED LETTER” TO MY COLLEAGUES IN MEDICINE, NURSING, AND PUBLIC
HEALTH. IT'S NOT MEANT AS AN OFFICIAL FEDERAL GUIDELINE, BUT RATHER
AS AN “ADVISORY OPINION” FROM THE SURGEON GENERAL.

BOTH THE JUSTICE DEPARTMENT AND PUBLIC HEALTH SERVICE HOPE THAT
THE NET EFFECT OF THIS “LETTER” WILL BE TO INCREASE THE LEVEL OF
COOPERATION AND COLLABORATION BETWEEN PUBLIC HEALTH AND MEDICAL
PEOPLE, ON ONE HAND, AND LAW ENFORCEMENT AND SOCIAL SERVICES PEOPLE ON
THE OTHER,
9

WE ALSO HOPE IT WILL CONTRIBUTE TO BETTER SERVICE FOR CHILD
VICTIMS AND THEIR FAMILIES AND TO MORE CONVICTIONS THAT STICK AMONG
THE PERPETRATORS OF THIS HEINOUS TYPE OF CRIME...AND THAT IT WILL ALSO
HELP PROTECT INNOCENT PEOPLE WHO ARE FALSELY ACCUSED,

IN THE COURSE OF DEVELOPING THIS DOCUMENT, IT'S BEEN MY GOOD
FORTUNE TO HAVE HAD SUPERIOR COURT JUDGE JEAN MATUSINKA OF LOS ANGELES
AND JUVENILE COURT JUDGE DAVID GROSSMAN, FROM RIGHT HERE IN
CINCINNATI, AS TWO KEY ADVISORS,

I BELIEVE I'M THE FIRST SURGEON GENERAL WHO HAS ACTUALLY SOUGHT
THE ADVICE OF OFFICERS OF THE COURT IN A MAJOR PUBLIC HEALTH MATTER.
AND I FEEL GOOD ABOUT THAT,

AND 1 COULD ALSO BE THE FIRST SURGEON WHO EVER VOLUNTARILY SOUGHT
THE ADVICE OF ANYONE IN THE LEGAL PROFESSION AND HAS ACTUALLY FOLLOWED
IT, SO YOU SEE HOW TIMES HAVE CHANGED.
10

THESE KINDS OF EFFORTS PRODUCE A GENERALLY HEIGHTENED SENSITIVITY
AMONG ALL PROFESSIONALS AND THAT, TOO, IS BENEFICIAL.

FOR EXAMPLE, IN PREPARING FOR THIS PRESENTATION. I TALKED WITH
OUR PEOPLE IN C.D.C,. AND THEY MENTIONED THAT THE JUSTICE DEPARTMENT IS
REVISING AND UPDATING ITS NATIONAL CRIME SURVEY AND THE F.B.1.’S
UNIFORM CRIME REPORTING SYSTEM, APPARENTLY, SOME OF THE CHANGES WILL
GENERATE NEW INFORMATION THAT WILL BE ESPECIALLY RELEVANT FOR
RESEARCHERS IN PUBLIC HEALTH.

I’M ABSOLUTELY CONVINCED THAT BRINGING MEDICAL AND HEALTH
PERSONNEL INTO CLOSER COLLABORATION WITH LAW ENFORCEMENT AND COURT
PERSONNEL IS A GOOD THING TO DO. WE’VE DONE IT...AND WE KNOW IT
WORKS,
I]

AS I INDICATED, OUR APPROACH TO THE JOINT “LAW/HEALTH INITIATIVE"
IS MORE THAN THEORY. IT’S A PRO-ACTIVE INITIATIVE WITH PROJECTS
ALREADY GOING ON,..AND OTHERS ALREADY BEING PLANNED,

FOR EXAMPLE, I’M APPALLED AT THE DATA WE HAVE CONCERNING THE
CRIME OF WOMAN BATTERING, OVER A MILLION WOMEN A YEAR ARE ABUSED AND
BEATEN EACH YEAR IN THEIR OWN HOMES BY HUSBANDS, EX-HUSBANDS, OR
BOYFRIENDS. MANY OF THOSE WOMEN NEVER TURN TO THE POLICE OR THE
COURTS, BUT INSTEAD RELY ON HOSPITAL EMERGENCY ROOMS, PUBLIC CLINICS,
OR THEIR OWN FAMILY DOCTORS TO PATCH THEM UP AND KEEP THEM GOING,

YOU NEVER SEE A BATTERED WOMAN ONCE...YOU ALWAYS SEE HER AGAIN
AND AGAIN. EVEN THOUGH THERE IS SOME EVIDENCE THAT THE PROBLEM MAY BE
DIMINSHING SLIGHTLY, IT STILL REPRESENTS A MAJOR BURDEN TO THE HEALTH
SYSTEM OF THIS COUNTRY,
12

BATTERED WOMEN NOT ONLY NEED MEDICAL HELP AT THE TIME OF THE
ASSAULT, THEY ALSO NEED US LATER, WHEN THEY RETURN BECAUSE OF ABUSE-
RELATED ALCOHOLISM AND DRUG ADDICTION. ..MISCARRIAGES AND ABORTIONS
1s HYPERTENSION AND COLITIS, AND A WHOLE RANGE OF IMMOBILIZING
NEUROSES.,

T BELIEVE IT’S TIME FOR MY COLLEAGUES IN EMERGENCY MEDICINE, IN
GYNECOLOGY, AND IN FAMILY MEDICINE TO TAKE OFF THEIR BLINDERS AND DEAL
CANDIDLY WITH THE ISSUE OF SPOUSE ABUSE, OR WOMAN BATTERING,

FOR TOO LONG IT HAS BEEN THE PRACTICE FOR HEALTH WORKERS TO
IGNORE THE CLEAR VISUAL AND EMOTIONAL SIGNALS SENT OUT BY A WOMAN
PATIENT WHO HAS BEEN ABUSED. WE'VE SAID, “IT'S NOT MY PROBLEM. LET
HER GO TO THE POLICE. THEY'LL HANDLE IT.” AND WE'VE PATCHED HER UP
AND SENT HER BACK HOME WITH A PRESCRIPTION AND A WARNING TO “BE MORE

CAREFUL NEXT TIME.”
13

BUT WE CAN NO LONGER IGNORE THE FACT THAT THE RECURRING CYCLE OF
WOMAN BATTERING TENDS TO ESCALATE AND VERY OFTEN ENDS IN A HOMICIDE...
USUALLY THE WOMAN’S,

SO WE NEED TO DO A BETTER JOB AS PROVIDERS OF HEALTH CARE TO THIS
GROUP OF VULNERABLE AND ENDANGERED PATIENTS: ABUSED AND BATTERED
WOMEN,

AND WE NEED THE HELP OF THE COURTS AND OF LAW ENFORCEMENT,

IT WOULD CERTAINLY HELP IF THE CRIMINAL JUSTICE SYSTEM -- IN
EVERY JURISDICTION -- ACKNOWLEDGED THAT RAPE AND SEXUAL ASSAULT ARE
INDEED CRIMES OF VIOLENCE AND THAT THE PERPETRATOR OF SUCH A CRIME
MUST BE BROUGHT TO JUSTICE, AND THAT SHOULD HAPPEN, REGARDLESS OF THE
RELATIONSHIP -- PAST OR PRESENT -- BETWEEN THE PERPETRATOR AND THE
VICTIM,
14

OBSTETRICIANS WHO IGNORE THE PHYSICAL SIGNS OF BATTERING AMONG
ANY OF THEIR PREGNANT PATIENTS ARE PRACTICING BAD MEDICINE.

AND JUDGES WHO TRIVIALIZE FAMILY VIOLENCE -- ESPECIALLY THE
CRIMES OF WOMAN BATTERING AND SEXUAL ASSAULT -- ARE PRACTICING BAD
LAW.

YOU AND I HAVE GOT TO CHANGE THAT. AND WE OUGHT TO START NOW,

I‘VE TALKED A BIT ABOUT OUR PUBLIC HEALTH INTEREST IN THE ISSUE
OF FAMILY VIOLENCE AND I COULD CONTINUE IN THIS VEIN FOR A GOOD DEAL
LONGER. BUT INSTEAD OF THAT, IN THE FEW MINUTES 1 HAVE REMAINING, 1’D
LIKE TO TOUCH UPON THREE ISSUES IN WHICH BOTH THE LAW AND PUBLIC
HEALTH HAVE AN INTEREST,

THE ISSUES CONCERN EAMILY, CHARITY, AND EQUITY.
15

TO BEGIN WITH, I BELIEVE THE AMERICAN PEOPLE ARE NOT REALLY HAPPY
WITH THE PRESENT AMBIVALENCE WE HAVE FOR THE WORD “FAMILY.”

WE'VE WANTED TO LIBERATE OURSELVES FROM THE FAMILY CLICHES AND
STEREOTYPES OF THE PAST. AND, ON THE FACE OF IT, THAT’S PROBABLY NOT
A BAD IDEA,

BUT 1 THINK WE’VE LOST OUR WAY IN THE EVOLUTIONARY PROCESS. WE
KNOW WHAT WE’RE EVOLVING FROM...BUT WE DON’T YET KNOW WHAT KIND OF
STRUCTURE OR SET OF HUMAN RELATIONSHIPS WE’RE EVOLVING TO.

T‘VE ALWAYS CONSIDERED MYSELF TO BE “PRO-FAMILY.” 1 BELIEVE VERY
STRONGLY IN THE FAMILY VALUES OF RESPONSIBILITY AND LOYALTY AND MUTUAL
LOVE AND RESPECT,
16

BUT THOSE VALUES ARE ALL UNDER GREAT STRESS THESE DAYS, AS IS THE
CONTEMPORARY FAMILY ITSELF...HOWEVER YOU DEFINE IT. AND THAT WORRIES
ME, SINCE SO MUCH OF THE HARMONY OF COMMUNITY LIFE IN THIS COUNTRY HAS
SPRUNG FROM AN ESSENTIAL HARMONY IN FAMILY LIFE.

THOSE HARMONIES SEEM TO BE FADING...AND I DON’T SEE OR HEAR
ANYTHING TO REPLACE THEM,

THAT’S AN ISSUE FOR ALL AMERICANS, I WOULD SAY. BUT IT’S ALSO AN
ISSUE THAT TRANSLATES INTO ANTI-SOCIAL AND ANTI-PERSONAL BEHAVIOR...
AND THAT MEANS MORE PRESSURE ON OUR SYSTEMS OF JUSTICE AND PUBLIC
HEALTH,
17

ANOTHER ISSUE IS RELATED TO THE FAMILY ISSUE, BUT WITH A
DIFFERENT SLANT, IT’S THE ISSUE OF SOCIAL RESPONSIBILITY OR SOCIAL
CARING. IN THE OLD DAYS IT WAS KNOWN AS “CHARITY.” BUT THE WORD
“CHARITY” HAS FALLEN OUT OF FAVOR, SO I'LL USE “SOCIAL RESPONSIBILITY”
INSTEAD.

I WRESTLED WITH THIS PROBLEM IN REFERENCE TO “BABY DOE.” I
FIRMLY BELIEVE THAT WE WERE CORRECT IN ASSERTING THE STATE'S RIGHT 10
INTERVENE AND PROTECT THE LIFE OF A HANDICAPPED INFANT.

BUT THERE’S STILL SOME DISCOMFORT AMONG OUR FELLOW CITIZENS ABOUT
THE RIGHT OF THE STATE TO DO THAT. AND I THINK MANY PEOPLE ARE ALSO
UNCOMFORTABLE ABOUT THE STATE EXERCISING ITS RIGHT IN THE NAME OF THE

PEOPLE.
18

I’M CONCERNED ABOUT THIS BECAUSE THE ISSUE GOES FAR BEYOND “BABY
DOE.” IT TOUCHES ON “GRANNY DOE,” SOMEONE WE HAVEN’T DEALT WITH YET
BUT WHO, I’M SURE, IS WAITING OUT THERE SOME PLACE FOR OUR ASSISTANCE,

AND I’M CONCERNED BECAUSE BOTH MEDICINE AND THE LAW HAVE GIVEN
NEW LIFE -- LITERALLY AND FIGURATIVELY -- TO PEOPLE WHO, IN FORMER
YEARS, WOULD NOT HAVE BEEN SO VISIBLE...0OR WHO MIGHT NOT HAVE BEEN
PRESENT AT ALL,

THE LIST WOULD INCLUDE HANDICAPPED OR DISABLED CHILDREN AND
ADULTS, ..THE CHRONICALLY MENTALLY ILL,,, THE FRAIL ELDERLY... THE HOME-
LESS PERSON,..AND NOW A NEW CATEGORY, THE “HIGH-RISK” PERSON,

THIS IS THE CATEGORY OF PEOPLE WHO ARE MOST LIKELY TO HAVE OR TO
GET AIDS. THEY TEND TO DO THINGS THAT THE MAJORITY OF AMERICANS DON’T
USUALLY DO, WHETHER IT’S A SEXUAL ACTIVITY OR A DRUG-RELATED ACTIVITY,
19

I'VE REPEATEDLY ASKED THE COUNTRY TO JOIN ME IN FIGHTING A
DISEASE...NOT THE PEOPLE WITH THE DISEASE. AND PRESIDENT REAGAN, IN
HIS SPEECH BEFORE THE AMERICAN FOUNDATION FOR AIDS RESEARCH LAST MAY,
SAID THE SAME THING,

BUT THIS NOTION IS ACCEPTED GRUDGINGLY, FOR THE MOST PART, AND I
FIND IT OUT OF CHARACTER WITH THE REST OF OUR HISTORY AS A SOCIETY,
WE’VE ALWAYS BEEN MORE GENEROUS AND MORE CHARITABLE THAN THAT.

IF WE BEGIN TO CATEGORIZE PEOPLE WITH PROBLEMS AS PRESENTING ONE
OR ANOTHER KIND OF “BURDEN” ON THE REST OF THE SOCIETY, THAN I BELIEVE
QUR SYSTEM OF JUSTICE 1S THREATENED AND THE FUNDAMENTAL ETHIC OF
HEALTH CARE IS SIMILARLY THREATENED,

T DON’T MEAN TO BE ALARMIST ABOUT IT. BUT I’LL TELL YOU THAT THIS
TS A MATTER OF SOME CONCERN TO ME,
20

AND FINALLY, A THIRD AND RELATED ISSUE IS THE ISSUE OF EQUITY IN
OUR SOCIETY, I’M NOT TALKING ABOUT THE FINANCIAL TYPE. I’M TALKING
ABOUT THE EQUITY -- OR LACK OF IT -- IN HUMAN RELATIONSHIPS, BETWEEN
MEN AND WOMEN, BETWEEN ADULTS AND CHILDREN, AND BETWEEN THE ELDERLY
AND EVERYONE ELSE.

MY AWARENESS OF THIS ISSUE GOES BACK TO THAT LEESBURG WORKSHOP I
SPOKE OF A FEW MOMENTS AGO. MANY PARTICIPANTS THERE -- ESPECIALLY THE
WOMEN’S ADVOCATES -- SPOKE FEELINGLY ABOUT THE NEED FOR WOMEN 10 BE
“EMPOWERED” TO DO THINGS OR TO BE THINGS IN OUR SOCIETY. IT WAS A
PLEA FOR BRINGING THE LEVEL OF POWER AMONG WOMEN UP TO THE LEVEL OF
POWER HELD BY MEN IN OUR SOCIETY.

I UNDERSTOOD THEIR ARGUMENT, BUT 1°M STILL UNCOMFORTABLE WITH THE
POWER EQUATION, I'D JUST AS SOON MEN AND WOMEN NOT KEEP ESCALATING
LEVELS OF POWER AS IF THEY WERE ARMED COUNTRIES.
21

BUT THAT’S BESIDE THE POINT, THE REAL ISSUE, IT SEEMED TO ME,
WAS THAT MEN AND WOMEN DO NOT GENERALLY INTERACT AS EQUALS, AND MEN IN
PARTICULAR TEND NOT TO TREAT WOMEN EQUITABLY.

IN THE MILDER FORMS OF THIS PROBLEM WOMEN ARE STRESSED, FRUS-
TRATED, AND ANGERED. IN MORE SEVERE FORMS, THEY ARE PHYSICALLY,
EMOTIONALLY, AND PSYCHOLOGICALLY VICTIMIZED.

I] WAS SHOCKED TO LEARN, FOR EXAMPLE, THAT IN A RECENT NATIONAL
SAMPLE OF YOUNG MEN IN COLLEGE, 25 PERCENT OF THEM HAD COMMITTED -- OR
HAD ATTEMPTED TO COMMIT -- A SEXUALLY VIOLENT ACT AGAINST A FEMALE
COMPANION,

THAT’S A CRIMINAL ACT, BUT THOSE YOUNG MEN DIDN’T SEE IT AS
SUCH, TO THEM, THEIR BEHAVIOR WAS MERELY PART OF THE “GAME” OF MALE-
FEMALE RELATIONS,
22

CLEARLY SOMETHING IS WRONG IN OUR SOCIETY WHEN SUCH A SIZABLE
PERCENTAGE OF AN ENTIRE GENERATION OF YOUNG MEN RESPOND TO YOUNG WOMEN
THIS WAY,

WE HAVE A SIMILAR SITUATION IN REFERENCE TO CHILDREN. THE
STATISTICS FOR CHILD ABUSE AND CHILD SEXUAL ABUSE ARE -- TO ME. AT
LEAST -- CLEAR INDICATIONS OF THE EXTENT TO WHICH SOME ADULTS STILL
LOOK UPON CHILDREN AS PROPERTY, EVEN AS PLAYTHINGS.

AND THE REST OF SOCIETY SEEMS TO HAVE TROUBLE FOCUSING ON THIS.

I’M SURPRISED, FOR EXAMPLE, AT THE DIFFICULTY MANY PEOPLE IN BOTH
LAW AND PUBLIC HEALTH ARE HAVING GETTING THEIR COMMUNITIES TO LOOK
MORE CLOSELY AT INFANT AND CHILD DEATHS, THEY SUSPECT THAT FEWER OF
THESE DEATHS ARE REALLY “ACCIDENTS.” AND THEY BELIEVE THAT MANY OF
THE SO-CALLED ACCIDENTAL INFANT DEATHS WOULD BE RECOGNIZED AS HOMI-
CIDES, IF ONLY THEY COULD HOLD THE INTEREST OF THE COMMUNITY.
23

T WAS A VERY HAPPY MAN IN THOSE DAYS WHEN I WAS A PRACTICING
PEDIATRIC SURGEON, I FELT THAT I WAS DOING SOMETHING TO HELP CHILDREN
GET A FAIR SHAKE FROM THE HEALTH CARE SYSTEM,

BUT I CAN TELL YOU THAT I ALSO HAD MANY MOMENTS WHEN I SIMPLY DID
NOT BELIEVE THAT THE CHILD WHOM I WAS EXAMINING HAD REALLY MET WITH AN
“ACCIDENT.” AND I AM HAUNTED BY THE CHILDREN WHO OUGHT TO HAVE WON MY
ATTENTION AND MY PROTECTION AT THE TIME,.,BUT PERHAPS I LET THEM DOWN,

AND I‘VE OFTEN ASKED MYSELF WHY, AND THE ANSWER THAT MAKES THE
MOST SENSE IS THAT, WHEN I LOOKED AT THE PARENT AND TRIED TO SEE HIM
OR HER AS THE GUILTY PARTY, I SAW ANOTHER ADULT..,SOMEONE LIKE ME...
SOMEONE WHO OBVIOUSLY "KNOWS BETTER,” AND I DISMISSED THE EVIDENCE OF
MY OWN HANDS AND EYES,

I THINK THERE 1S A KIND OF CONSPIRACY OF ADULTS AGAINST CHILDREN
.1 AND WE OUGHT TO BE ASHAMED OF OURSELVES,
24

BUT I WANT MORE THAN ADULT CONTRITION AND CONFESSIONS OF GUILT.
I WANT ADULTS TO CHANGE THE WAY THEY ACT TOWARD CHILDREN. I WANT THEM
TO SEE CHILDREN AS HUMAN BEINGS DESERVING OF LOVE AND RESPECT...
DESERVING OF EQUITY IN ALL THEIR HUMAN RELATIONSHIPS.

I DON’T THINK IT'S TOO MUCH TOO ASK. IN FACT, IT STRIKES ME AS
BEING AN IRREDUCIBLE MINIMUM,

AND THE SAME IS THE CASE FOR OUR ELDERLY. I THINK WE STILL SEE
OLD PEOPLE AS SOMEHOW “LESS THAN” TOTAL PERSONS, AND MAYBE CLINICALLY
YOU CAN SAY THAT FOR SOME OLDER PEOPLE. THEY MAY NOT HAVE THE VISION
OR THE HEARING OR THE STRENGTH OR THE MEMORY THEY ONCE HAD,

BUT THEIR ESSENTIAL HUMANITY REMAINS WITH THEM ALWAYS, AND IT
OUGHT TO BE RECOGNIZED AND TREATED EQUITABLY IN THE COURSE OF ALL
HUMAN INTERACTIONS,
25

EQUITY IS A PECULIAR THING TO BRING UP BEFORE AN AUDIENCE OF
JUDGES AND SOCIAL SERVICE PROFESSIONALS IN THIS, THE MOST EQUITABLE
AND EQUALITY-CONSCIOUS SOCIETY ON EARTH,..AND POSSIBLY IN HISTORY,

BUT BECAUSE WE ARE FARTHER ALONG THAN OTHERS DOES NOT MEAN WE’VE
MOVED AS FAR ALONG AS WE OUGHT TO. AND THAT’S MY CONCERN IN THIS
THIRD ISSUE, THE EQUITY ISSUE,

I THINK WE AMERICANS, BY LAW AND BY TRADITION. ARE ABLE TO DO
BETTER THAN WE’RE NOW DOING -~ AND I’M IMPATIENT FOR THE IMPROVEMENTS
TO BEGIN,

AS I SAID EARLIER, I WILL ONLY TOUCH UPON THE ISSUES OF FAMILY,
CHARITY, AND EQUITY THIS MORNING. I COMMEND THEM TO YOU FOR
EXPLORATION IN MUCH MORE DEPTH,
26

AND NOW, A CLOSING WORD,

ACTUALLY, IT’S NOT MINE BUT IT BELONGS T0 A FINE PHYSICIAN,
PSYCHOLOGIST, AND PHILOSOPHER, DR. WILLIAM JAMES.

THIS COMES FROM A COLLECTION OF HIS WORK TITLED, ESSAYS ON FAITH
AND MORALS. IN ONE OF THE PIECES, CALLED “THE WILL TO BELIEVE.” HE
SPEAKS OF HOW YOU DEAL WITH “MORAL QUESTIONS.”

"SCIENCE CAN TELL US WHAT EXISTS,” SAYS JAMES, BUT AS TO THE
WORTH OF WHAT EXISTS, “WE MUST NOT CONSULT SCIENCE, BUT...OUR HEART.”

AND HE GOES EVEN FURTHER:
27

“IF YOUR HEART DOES NOT WANT A WORLD OF MORAL REALITY. YOUR HEAD
WILL ASSUREDLY NEVER MAKE YOU BELIEVE IN ONE.”

IN OTHER WORDS, AS YOU AND I AND OUR COLLEAGUES IN HEALTH AND LAW MOVE
FORWARD ON THE MANY ISSUES AFFECTING THE QUALITY OF AMERICAN LIFE. WE
MUST BE SURE THAT OUR HEARTS ARE IN IT...0R, MORE THAN THAT, OUR
HEARTS MUST TELL US THAT THIS IS REALLY WHAT WE HAVE TO DO.

THERE ARE LIMITS TO WHAT MEDICINE AND THE LAW CAN TELL US, AND
WHEN ALL IS SAID AND DONE, WE’LL GO OUT AND DO THE RIGHT THINGS FOR NO
OTHER REASON THAN OUR FEELING THAT THEY’RE SIMPLY THE RIGHT THINGS TO
DO,
28

[ STILL HAVE TWO YEARS TO GO IN MY SECOND TERM AS YOUR SURGEON
GENERAL. 1 STILL HAVE SOME GOOD THINGS I WANT TO DO. THE FACTS AND
THE SCIENCE AREN’T ALL IN YET, BUT MY HEART TELLS ME IT’S TIME TO MOVE
AHEAD ON THEM:

TO HELP REDUCE THE LEVEL OF VIOLENCE, ESPECIALLY FAMILY VIOLENCE
e+ 1Q STRENGTHEN FAMILY LIFE...TO REVIVE THE SPIRIT OF CHARITY
». AND TO RECOGNIZE THE PRINCIPLE OF EQUITY AS CENTRAL TO ALL
HUMAN RELATIONSHIPS,

THESE ARE THINGS NO ONE PERSON CAN ACCOMLPISH, AND I DON’T EVEN
PRETEND TO IT,..BUT I WANT TO BE PART OF THE PROCESS,
29

T HOPE YOU FEEL THE SAME WAY,..AND I HOPE THAT LAW AND HEALTH

WILL JOIN TO DO MANY OF THOSE GOOD THINGS FOR THE AMERICAN PEOPLE...
TOGETHER,

THANK YOU,

Ht # # #